SUMMARYThe GHQ-30 was used to assess psychological disturbance among staff working in four long-stay wards, four homes for the elderly mentally infirm, four elderly persons' homes and four private nursing homes. Rates of disturbance were consistent across all 16 units. Rates of CGHQ caseness were low, compared with published findings from a representative UK community sample. A strong relationship was demonstrated between staff psychological disturbance and aggression from residents over the last week. Disturbed staff were more likely to perceive a lack of support at work, and to report 'shouting back' at aggressive residents. No relationship was found between rates of disturbance and a range of demographic and work-related factors. Implications for service provision and future research are discussed.KEY woms-Care staff, residential homes, stress, psychological distress, aggression.There is increasing concern about the quality of residential care afforded to elderly people in Britain (International Journal of Geriatric Psychiatry, 1986). Staff working in these settings are often poorly trained or untrained, and there are particular concerns at this time, as the number of long-stay psychogeriatric beds is diminishing. Thus psychiatric support for the most demanding cases is under threat.In recent years stress among informal carers for dementia sufferers has been extensively studied, Morris e t al. (1988) providing a comprehensive review. Studies show high stress levels in carers, and a complex relationship between stress and other factors such as severity of dementia, level of problem behaviour, coping mechanisms used, impact of support services and satisfaction derived from the caring role.It follows that professionals caring for the elderly in institutions where a high proportion have dementia (Mann e t al., 1984) may also suffer from stress, and that staff in long-stay wards, who cope with the most demanding and behaviourally disturbed residents, may have the highest stress levels. There is evidence (Hilton et al., 1989; Lam el al., 1989) of greater dependence, disability and disturbance among long-stay patients than residents in local authority homes. However, there is a paucity of research in this area, particularly regarding large-scale, generalizable surveys (Sutherland and Cooper, 1990). Studies by Norfolk and Stirton (1985) and Benjamin and Spector (1990) demonstrated high levels of stress symptoms in psychogeriatric nursing staff, but were flawed by preselection bias and lacked a clear definition of stress 'caseness'. Livingstone and Livingstone (1984) used the GHQ-60 in their study of nurses in three selected hospital settings, finding consistent results across the three institutions. No attempt was made in these studies to relate findings to general population samples.Various authors have attempted to analyse the CCC 0885-6230/94/05038
SUMMARYThe stress upon the principal relative caregivers of a series of dementia sufferers attending an assessment day hospital was studied. The main variables influencing stress levels were the caregiver's own health self-rating and a measure of behaviour and mood disturbance in the patient. Predictors of the breakdown of community care over a 1-year follow-up period were studied. At 12 months caregiver's 'caseness' on the GHQ was a highly significant predictor. Clinical work with dementia sufferers in the community should include an assessment of the health and psychological status of the caregiver. Future research should focus upon evaluating specifically targeted interventions aimed at reducing stress in caregivers.KEY WORDS-Dementia, stress, elderly mental illness teams, relatives, caregivers.The psychological and health impact upon relatives caring for dementia sufferers in the community has been extensively studied over the past 10 years. Research in the area can be divided into a number of conceptual themes. The first theme has been to define the nature of the burden and stress felt by relatives and to examine factors influencing levels of stress. Such work has been influenced by the separation made by Grad and Sainsbury (1965) of objective and subjective burden. Vitaliano et al. (1991) criticize burden measures that do not separate objective from subjective factors, and argue for the use of instruments which relate the two concepts, so that the sources of subjective burden are explained. Early work found that caring for a relative suffering from dementia is felt to be more stressful upon relatives than caring for a physically ill relative (Eagles et al., 1987;Poulshock and Deimling, 1984). Morris et al. (1988a) review nine studies which have investigated the mental health of relatives; seven have reported raised levels of depression or stress symptoms.Research has focused upon a number of themes relevant to the stress felt by relatives:-The severity of dementia and level of problem behaviour shown by the sufferer -The type of relationship between caregiver and sufferer (eg blood relative, spouse, etc) and the past quality of the relationship -The cognitive styles and coping mechanisms used by the relative -The impact of services and of social supports -The satisfactions derived from the caring roleThe severity of dementia has not been found to be simply related to levels of stress in family members. There is agreement about which behaviours relatives most often report as problems: incontinence, overdemanding behaviour and the need for continual supervision (Morris et al., 1988a). However, such problems are not reliably related to raised stress levels. Other factors clearly mediate
SUMMARYThe case notes of 137 patients admitted to a psychogeriatric assessment ward over 12 months were reviewed. The characteristics of patients who were assaultive prior to, or during admission were compared with those who were not. The reported prevalence of assaultive behaviour from the case notes was compared with that from the formal 'violent incident' forms. Twenty-three per cent of the patients had assaulted others prior to their admission, and 23% were assaultive during their admission. Those patients who were assaultive prior to admission were likely to be assaultive during their admission. Assaultive behaviour prior to and during admission was associated with male gender, dementia, and increased age in female patients. Assaults were underreported on the formal 'violent incident' forms by nursing staff. Assaultive behaviour prior to admission predicted discharge to a higher dependency setting, but assaultive behaviour during admission did not. The implications of these findings are discussed.
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