Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia

Desai, Anand; Wharton, Tracy; Struble, Laura; Blazek, Mary

doi:10.3928/00989134-20170111-07

Cited by 10 publications

(10 citation statements)

References 43 publications

(54 reference statements)

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“…Most LTC homes work within the biomedical model and primarily focus on staff completing ‘tasks’ rather than prioritizing actions that are aligned with person‐centred care and outcome achievement 67 . Newer innovative models of care (e.g., Eden Alternative, GreenHouse Model, Butterfly Model) that are based on developing strong resident–caregiver relationships and mutual respect contribute to an environment that is receptive to residents' needs 68 . A supportive organizational culture and work environment allows staff to feel more satisfied with care 68 and decreases resident aggression, which in turn can lead to improved residents and staff outcomes.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of substitute decision‐makers and staff about person‐centred physical activity in long‐term care

Chu

Quan

Gandhi

et al. 2021

Health Expectations

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Introduction: This paper aims to explore the care processes that best exemplify personcentred care during physical activity (PA) for long-term care (LTC) residents with dementia from the perspectives of substitute decision-makers (SDMs) and LTC home staff. Little is known about how person-centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person-centred care during PA. Methods: Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person-centred care during PA from two LTC homes in Canada. The McCormack and McCance person-centredness framework was used to guide thematic content analysis of responses. Results: SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person-centredness framework as most reflecting person-centred care. Benefits of person-centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person-centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression. Significance: Understanding the care processes that are most recognized as personcentred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person-centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia.

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Section: Discussionmentioning

confidence: 99%

Perspectives of substitute decision‐makers and staff about person‐centred physical activity in long‐term care

Chu

Quan

Gandhi

et al. 2021

Health Expectations

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“…Providing care for aging individuals with dementia who display violent aggressive behaviors emphasizes the interplay between caregiver burden and aggressiveness. An increase in aggressive behavior could propagate caregiver burden, which could then lead to more aggressive behavior (Desai, Wharton, Struble, & Blazek, 2017). Most of the research implementing this framework explored violence toward formal caregivers working in nursing homes and hospital settings, rather than family caregivers (Wharton & Ford, 2014).…”

Section: Caregiving For a Partner With Dementia And Coping With Aggrementioning

confidence: 99%

Women Coping With a Partner's Dementia‐Related Violence: A Qualitative Study

Band‐Winterstein

Avieli

2019

J of Nursing Scholarship

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Purpose The aim of the present study was to differentiate between the lived experience of two groups of women caregiving for a partner with dementia. One group was coping with lifelong intimate partner violence (IPV) and dementia‐related violence (Group 1); the other group was coping with dementia‐related violence only (Group 2). Design An interpretive phenomenological analysis perspective was used. Data collection was performed through in‐depth, semistructured interviews with eight female spouses of men with dementia from each of the two above‐mentioned groups, followed by a content analysis. Findings Comparing the narratives of the aging women revealed their different experiences over several dimensions: (a) the identification of violence as a symptom of dementia; (b) the use of past couplehood memories; (c) feelings over time; (d) willingness to care for the partner with dementia; and (e) a prospective view of life. Conclusions The complexities of being old and having to cope with caregiving responsibilities for a spouse with dementia, accompanied by violent behaviors, emphasize the significance of the couple's past relationship. This notion should be taken into account in practical interventions. Clinical Relevance As part of the aging process, there is an increase in people who are engaged in dementia‐related violence. Nurses' education and practice should focus on the dynamics of dyads coping with violence and identify the particular needs of the caregiver spouse in this context.

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“…10 While there is evidence that guidelines for the management of agitation and aggression may help to reduce disruptive behaviour in aged care residents with dementia, 11 there are currently no valid guidelines designed to guide staff on a day-to-day basis. 12 There is, therefore, potential value in developing a protocol that considers how to respond to imminent aggression.…”

Section: Introductionmentioning

confidence: 99%

A protocol for responding to aggression risk in residential aged care facilities

Roberton¹,

Daffern²

2022

AJAN

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Objective: To propose a provisional protocol which organises the existing knowledge base into a set of simple procedural guidelines to support residential aged care staff to respond in a consistent and effective manner when faced with situations where aggression is perceived to be imminent, ideally preventing aggressive behaviours from eventuating.Background: Aggressive behaviours by older adults in aged care facilities have the potential to cause significant physical and psychological harm, particularly for other residents. Staff are increasingly discouraged from managing such behaviours with restrictive practices such as physical and/or pharmacological restraint. Instead, staff are encouraged to intervene before an incident takes place, using interventions that reduce the everyday risk of aggression, as well as those that are implemented when aggression is perceived to be imminent. However, for this to be implemented in a meaningful way, staff must be equipped with the knowledge, skills, and resources to intervene in ways that are respectful and effective. Developing a protocol for responding to imminent risk of aggression by organising the existing knowledge base into a set of straightforward guidelines would support staff to implement preventative strategies in a consistent and effective manner. Study design and methods:A traditional/narrative literature review was undertaken to critique and synthesise previously published research to identify research that might be relevant to the construction of guidelines for responding to the risk of imminent aggression.Discussion: This paper proposes a provisional protocol, consisting of a series of interventions for preventing aggression in residential aged care facilities: daily monitoring; de-escalating the situation; identifying and addressing situational triggers, providing an immediate therapeutic intervention, and considering medication. This protocol is necessarily provisional in nature and is intended to be further developed through theoretical critique, expert opinion, consumer feedback, and empirical evaluation. Implications for research, policy, and practice:Research in four areas would improve the ability of staff to intervene in a preventative manner: (1) developing and validating a daily monitoring tool that would allow staff to identify when aggression is imminent; (2) continuing to build a methodologically sound body of evidence to support the use of specific primary and secondary preventative interventions; (3) understanding whether the causes and processes underlying aggressive behaviour by AUTHORS TERRI ROBERTON 1 DPsych(Clinical, Forensic), BA(Hons) Psych, MAPS

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Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia

Cited by 10 publications

References 43 publications

Perspectives of substitute decision‐makers and staff about person‐centred physical activity in long‐term care

Perspectives of substitute decision‐makers and staff about person‐centred physical activity in long‐term care

Women Coping With a Partner's Dementia‐Related Violence: A Qualitative Study

A protocol for responding to aggression risk in residential aged care facilities

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