Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review

Reuther, Sven; Dichter, Martin N.; Buscher, Ines; Vollmar, Horst Christian; Holle, Daniela; Bartholomeyczik, Sabine; Halek, Margareta

doi:10.1017/s1041610212001342

Cited by 47 publications

(46 citation statements)

References 29 publications

(109 reference statements)

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“…In addition, as so much research is already available, we would argue that there is a pressing need to research effective ways of more widely implementing known good practice of the sort summarised above, for example testing whether ensuring the presence of dementia specialists (Brooker et al, 2012;Perry et al, 2011), case conferences (Reuther et al, 2012) or staff training (Spector et al 2012) provide effective ways of sustaining evidence-based care that avoids the development of behavioural distress.…”

Section: Dominance Of Research On Reducing Behavioural Difficulties Imentioning

confidence: 99%

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Oyebode

Parveen

2016

Dementia

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YesAn influential review in 2010 concluded that non-pharmacological multi-component interventions\ud have positive effects on cognitive functioning, activities of daily living, behaviour and mood of\ud people with dementia. Our aim here is to provide an up-to-date overview of research into\ud psychosocial interventions and their impact on psychosocial outcomes. We focused on\ud randomised controlled trials, controlled studies and reviews published between October 2008\ud and August 2015, since the earlier review. The search of PsychInfo, Medline and the Cochrane\ud database of systematic reviews yielded 61 relevant articles, organised into four themes echoing\ud key phases of the care pathway: Living at home with dementia (five reviews, eight studies), carer\ud interventions (three reviews, four studies), interventions in residential care (16 reviews, 12\ud studies) and end-of-life care (three reviews, two studies), along with an additional group\ud spanning community and institutional settings (six reviews, two studies). Community findings\ud suggested that appointment of dementia specialists and attention to case management can\ud produce positive outcomes; physical therapies, cognitive training and modified cognitive\ud behaviour therapy also had a range of benefits. There was more limited evidence of positive\ud benefits for people with dementia through interventions with family carers. Thirty-two articles\ud focused on the management of ‘behavioural symptoms’ through a range of interventions all of\ud which had some evidence of benefit. Also a range of multi-component and specific interventions\ud had benefits for cognitive, emotional and behavioural well-being of people with dementia in\ud residential settings, as well as for quality of life. Overall, interventions tended to be short term\ud with impact only measured in the short term. We recommend further research on interventions\ud to promote living well in the community post-diagnosis and to address end-of-life care.\ud Development of psychosocial interventions would benefit from moving beyond the focus on\ud control of behaviours to focus on wider aspects of life for people with dementia

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Section: Dominance Of Research On Reducing Behavioural Difficulties Imentioning

confidence: 99%

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Oyebode

Parveen

2016

Dementia

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“…1,[65][66][67][68][69] In Germany they are delivered through 'case conferences', [305][306][307][308][309] in England this approach is best known as the Newcastle model for the management of CB, 97,186 and others simply use practitioners supported by specialists working in multidisciplinary teams to deliver formulated biopsychosocial case-specific support to staff in care homes. 26 The Newcastle clinical protocols grew out of the FITS RCT.…”

Section: Background To the Interventionmentioning

confidence: 99%

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

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BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.

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“…Met de beschikking over verschillende in te zetten interventies voelen zij zich nu beter in staat om patiënte te begeleiden. De multidisciplinaire samenwerking is geïnten-siveerd door casuïstiekbespreking en evaluatie van het zorgbeleid [16].…”

Section: Diagnose En Behandelingunclassified

A multidisciplinary approach for the optimal treatment of problem behaviour in dementia

Ettema¹

2016

Tijdschr Gerontol Geriatr

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Problem behaviours in one form or another are very common in nursing home residents with dementia. In order to manage these challenging behaviours pharmacological and psychosocial interventions are necessary. Psychosocial interventions have gained a more central role due to negative affects of pharmacological treatment. This case study describes the multidisciplinary approach of problem behaviour in an 85 year old nursing home patient with dementia. Those involved in caring for this patient initiated changes that led to a more adequate treatment and ultimately a decrease in the problematic behaviour.

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Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review

Abstract: In summary, little evidence exists for the positive effects of case conferences in the care of people with dementia. This review highlights the need for methodologically well-designed intervention studies to provide conclusive evidence of the effects of case conferences.

Cited by 47 publications

References 29 publications

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

A multidisciplinary approach for the optimal treatment of problem behaviour in dementia

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