Behaviour-directed interventions for problematic person transfer situations in two dementia care dyads: a single-case design study

Abstract

Background Persons with dementia living in nursing homes need assistance with moving and transfers; however, caregivers assisting persons with dementia in their daily person transfers report strain-related and complicated transfer-related behavioural problems. The reciprocity of complex dyadic transfer-related behaviours is affected by environmental factors, the health status of the person with dementia and the caregiver’s skills and knowledge. The aim of this study was to explore tailored interventions guided by a functional behaviour analysis for problematic person transfer situations in two dementia care dyads. Methods This study was a quasi-experimental single-case study with an A-B design. Tailored interventions were developed in a five-step model for functional behavioural analysis. The study was conducted in a dementia special care unit at a nursing home, and the inclusion criteria were caregivers’ experiences of physical strain and/or resistiveness to care, which led to complex transfer-related behaviour. Two care dyads were included. Transfer situations were video-recorded and evaluated with the Dyadic Interaction in Dementia Transfer Assessment Scale, Pain Assessment in Advanced Dementia Scale, and Resistiveness to Care Scale for Dementia of the Alzheimer’s Type. The caregiver experience was evaluated with study-specific items addressing caregiver self-efficacy, catastrophizing thoughts, perceived control, and perceived physical strain. Scorings were graphically displayed. The graphs were inspected visually to identify changes in trend, level, latency, and variability. Nonoverlap of all pairs (NAP), including 90% confidence intervals (CIs), was calculated to complement the visual inspection. Results Verbal and nonverbal discomfort decreased in care dyad 1, which mirrored the caregiver changes in adapting their actions to the needs of the person with dementia. High variability was seen in both the intervention and the baseline phases in care dyad 2. In both care dyads, caregiver transfer-related behaviour improved. Conclusions The results indicate that the transfer-related behaviours of the care dyad might be improved through a behaviour-directed intervention tailored to meet the care dyad´s needs. The small number of cases and observations limits the generalizability, and the results should be interpreted in consideration of the piloting approach of the study.

A systematic review of specialty dementia care units in long‐term care settings

“…Interventions related to staff transfer behaviors were tailored to each care dyad; some interventions included eye contact, preparing the resident for movement, removing toilet handles, division of turning movements, and additional support for the resident. Overall, interventions were associated with improved verbal and nonverbal discomfort and staff transfer‐related behaviors 44 . Marte Meo counseling is a technique where staff‐resident care interactions are video‐recorded, analyzed, and discussed with nursing home staff.…”

“…regarding environmental design and small-scale homelike settings housing 7-8 residents were inconclusive but trended towards positive associations. [31][32][33] Studies from eight other international countries examined resident quality of life, [35][36][37][38][39] behavior, 40,41 social connectedness, 42 neuropsychiatric symptoms, 43 and staff transfer behaviors 44 and learning outcomes 45,46 Acupressure and Montessori-based methods, 41 and companion clowns were used to examine associations with resident behaviors. 40 Physically nonaggressive behaviors, agitated behaviors, and aggressive behaviors were improved among residents with dementia receiving acupressure and Montessori-based methods, as were easeof-care ratings and affect.…”

“…Three international studies examined interventions among staff: one explored staff transfer behaviors 44 and two examined staff learning outcomes. 45,46 45 but this is dependent on the learning climate in the DSCU.…”

“…Interventions related to staff transfer behaviors were tailored to each care dyad; some interventions included eye contact, preparing the resident for movement, removing toilet handles, division of turning movements, and additional support for the resident. Overall, interventions were associated with improved ORTH ET AL.T A B L E 244 Marte Meo counseling is a technique where staff-resident care interactions are video-recorded, analyzed, and discussed with nursing home staff. Findings from these studies indicate that nurses gain additional knowledge about themselves and the resident by reviewing the care-transfer recordings,…”

Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders

“…These activities may explain why the rates of chronic back pain mirror those of bedside and intensive care unit nurses and caregivers to dependent individuals with spinal cord injuries, rather than noncaregiving adults. 17,31 These physical demands-not typically seen in ADAD caregivers until late in the disease 32 -combined with diminished time for self-care, exercise, and medical care 33 may lead to muscular strain, failed transfers, falls, and injuries. The time course of symptom onset in relation to caregiving duration, intensity, and symptoms of the care recipient bear prospective study.…”