Predictors and Consequences of Aggressive Behavior by Community-Based Dementia Patients

Hamel, Marc; Gold, Dolores; Andrés, David; Reis, Myrna; Dastoor, Dolly; Grauer, H.; Bergman, Howard

doi:10.1093/geront/30.2.206

Cited by 202 publications

(133 citation statements)

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“…Caregiver depression, family dynamics, availability of emotional and financial support, and opportunities for respite may contribute to differences in caregiver tolerance of behavioral disturbances. Although several studies have reported that caregiver stress is related to patient behavioral disturbances in dementia (Hamel et al, 1990;Poulshock & Deimling, 1984), further research is needed to determine how caregiver stress may influence caregiver perceptions of patient behaviors.…”

Section: Discussionmentioning

confidence: 99%

Caregiver and Clinician Assessment of Behavioral Disturbances: The California Dementia Behavior Questionnaire

Victoroff

Nielson

Mungas

1997

Int. Psychogeriatr.

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As part of a multicenter project to study noncognitive behavioral disturbances in dementia, the authors developed a comprehensive caregiver-rated questionnaire for these behaviors. The authors determined the reliability of caregiver ratings and compared caregiver ratings with clinician ratings using standard instruments. Caregivers showed good test/retest reliability for ratings of all types of patient behavioral disturbance. Caregiver interrater reliability was highest for depression and lowest for psychosis. The correlation between caregiver reports and professional assessments was highest for agitation, intermediate for psychosis, and lowest for depression. The match between caregiver and clinician assessments of patient behaviors appears to vary significantly by the type of behavior assessed.

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Section: Discussionmentioning

confidence: 99%

Caregiver and Clinician Assessment of Behavioral Disturbances: The California Dementia Behavior Questionnaire

Victoroff

Nielson

Mungas

1997

Int. Psychogeriatr.

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“…Most people are distressed by behaviours such as screaming, repetitive questions, violence or behaviour of great intensity. Nevertheless, in many cases, individual characteristics of family carers 51,52 or care staff are often as important as severity of behaviour in determining whether or not, or to what degree, the behaviour is perceived as challenging. These factors include limited understanding of the changes associated with dementia; lack of support; limited skills; pejorative attitudes to people with dementia or older people; and mood disorders in caregivers.…”

Section: Elusiveness Of the Syndrome: Aetiology And Other Contextual mentioning

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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“…Violence is emerging as a significant clinical challenge in families living with a relative diagnosed with Alzheimer's disease or a related dementia [21,41,42,[44][45][46]. Regardless of the perpetrator, when aggressive and violent behaviors occur, the health and wellbeing of the entire family are at risk.…”

Section: Limitations and Future Researchmentioning

confidence: 99%

“…Factors such as abuse history [18,19], age and gender of perpetrators [20][21][22][23], pathology of the perpetrator [24][25][26] dependence [27][28][29], social isolation [17,18,[30][31][32][33], depression [25,[34][35][36][37][38], and caregiver emotional problems [25,26,37,39,40] have been postulated to be related to mistreatment. In addition, cognitive impairment has been identified as a unique risk factor that may increase risk for mistreatment in older persons [1,33,38,41,42].…”

Section: Introductionmentioning

confidence: 99%

“…Abuse of dementia patients by family caregivers is reported to be common [21,41,42,44,45] and prior aggression in the dementia patient, premorbid relationship between the patient and caregiver, and frequent behavioral problems have been linked to aggression and violent behavior [21,41,42,44,45]. Steinmetz (1988) was one of the first to suggest that abuse may be interactive, that is, related to the patient's verbal and physical abuse of the caregiver, and this idea has received support from other researchers [46].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Conflict Resolution Style over Time: The Risk for Persons with Alzheimer’s Dementia

Corvin¹

2014

Aging Sci

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Background: Elder mistreatment is a serious issue affecting between 300,000 and 800,000 older adults. Elder mistreatment has serious consequences for older adults and can include immunological dysfunction, increased mortality and emotional difficulties such as depression, feelings of inadequacy and self-contempt. Sub-groups such as persons with Alzheimer's disease have heightened risk for elder mistreatment, but it is not clear whether this heightened risk represents life-long patterns of abuse between persons or whether they represent a change in conflict style over time as a result of changes associated with dementia.

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Predictors and Consequences of Aggressive Behavior by Community-Based Dementia Patients

Cited by 202 publications

References 0 publications

Caregiver and Clinician Assessment of Behavioral Disturbances: The California Dementia Behavior Questionnaire

Caregiver and Clinician Assessment of Behavioral Disturbances: The California Dementia Behavior Questionnaire

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

Changes in Conflict Resolution Style over Time: The Risk for Persons with Alzheimer’s Dementia

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