A life history intervention for individuals with dementia: a randomised controlled trial examining nursing staff empathy, perceived patient personhood and aggressive behaviours

Abstract

Behaviours of concern (e.g. aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.

Life‐story work in long‐term care facilities for older people: An integrative review

“…Of the thirteen papers (twelve studies), ten examined the experience of life‐story of people living with dementia (Buron, ; Egan et al., ; Eritz et al., ; Ervin, Cross, & Koschel, ; Heggestad & Slettebo, ; Kellett et al., ; McKeown et al., McKeown et al., ; Russell & Timmons, ; Subramaniam, Woods, & Whitaker, ), while the other three did not specify if the residents had a cognitive impairment (Bakken et al., ; Phenice & Griffore, ; Wills & Day, ). International representation was evident with the following: four from the UK, two each from Australia, Canada and Norway, and one each from New Zealand, Republic of Ireland and the USA.…”

“…International representation was evident with the following: four from the UK, two each from Australia, Canada and Norway, and one each from New Zealand, Republic of Ireland and the USA. Participants within studies were residents ( N = 150, range 4–73, mean 16) (Buron, ; Egan et al., ; Eritz et al., ; Heggestad & Slettebo, ; McKeown et al., , ; Phenice & Griffore, ; Russell & Timmons, ; Subramaniam et al., ; Wills & Day, ), staff ( N = 184, range 7–99, mean 26) (Bakken et al., ; Buron, ; Egan et al., ; Eritz et al., ; Ervin et al., ; Kellett et al., ; McKeown et al., , ) and families ( N = 25, range 3–12, mean 6) (Ervin et al., ; Kellett et al., ; McKeown et al., , ; Wills & Day, ). Within reporting the participants, McKeown et al.…”

“…Some of the studies included staff who had attended education sessions on life‐story work (Bakken et al., ; Ervin et al., ); other studies did not specify if staff had received any training or education on life‐story work. It is also unclear from the studies what level of qualifications staff participants had, with some studies including nursing staff (Buron, ; Wills & Day, ) and others a mixture of nursing and care assistants (Bakken et al., ; Egan et al., ; Eritz et al., ) or not specified (Ervin et al., ). Life‐story products within the review ranged from; life‐story/life‐history narratives (Bakken et al., ; Egan et al., ; Eritz et al.…”

“…Life‐story products within the review ranged from; life‐story/life‐history narratives (Bakken et al., ; Egan et al., ; Eritz et al. ; Russell & Timmons, ) included photography, life‐story collage (Buron, ), life‐story telling/life‐story telling recording (Ervin et al., ; Heggestad & Slettebo, ), family bibliography (Kellett et al., ), objects from life (Phenice & Griffore, ), life review sessions with life‐story book (Subramaniam et al., ) and life‐story book (McKeown et al., , ; Wills & Day, ).…”

“…This “knowing” went much deeper than knowing the persons’ name, age and diagnosis to considering the attributes that define the person. “Knowing” was conceptualised in terms of knowing the persons medical history, their past, their personal preferences and their beliefs and values (Bakken et al., ; Buron, ; Egan et al., ; Eritz et al., ; Ervin et al., ; Heggestad & Slettebo, ; Kellett et al., ; Phenice & Griffore, ; Russell & Timmons, ; Subramaniam et al., ; Wills & Day, ). Carrying out life‐story work enabled staff and family participants to see the individuality and uniqueness of each person (Bakken et al., ; Kellett et al., ; Russell & Timmons, ).…”