Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

Abstract

Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care.

Humanitude in the humanization of elderly care: experience reports in a health service

“…In the process of implementing MCH, the main difficulty was related to the lack of nurse formation on relational techniques, making it harder to appropriate and apply this care methodology in practice, which was also confirmed by another study (9) . The strategies used were related to the need to accompaniment and sensitization on the techniques that professionalize care, in agreement to other studies on this theme (5,9) . MCH breaks with paradigms on the possibility of being completely based on techniques for care in humanitude, and any care giver can be trained in it, regardless of having or not a empathic profile, for example.…”

“…For professionals, it was clear that there was a better understanding of the behaviors of the person being cared for, better emotion management, and professional satisfaction due to the positive results obtained (8,9) . For the ones being cared for, it was highlighted the reduction of refusal of care (5,8,9) and the increase in the participation in self-care (8) . For care giving, it was verified more ease in the care for elderly with dementia due to the harmonious environment provided during the care.…”

“…For care giving, it was verified more ease in the care for elderly with dementia due to the harmonious environment provided during the care. This environment is related to professional capacitation in relational techniques and to the appropriation of MCH, which, through the structured sequence of relational procedures, eases the operationalization and systematization of the relationship in practice (7,9) , avoiding the performance of forced and unexpected care, creating, for the ones being cared for, a feeling of having their freedom respected, as well as their dignity and autonomy, contributing for the reduction of agitation and increasement of acceptance of care (5) . At an institutional level, it was observed a shift in care culture, creating an environment and organizational atmosphere that can promote assistance humanization (8,9 .…”

“…Thus, an individual with NCD may be deeply affected by the condition imposed by the environment and by care givers, as they may not be sufficiently prepared to care for these individuals (4) . Since the care given is not adequate, it creates a harmful environment, both for the people being cared for, since they are not understood, with the increase in anxiety and disorganization levels, and for the care givers, since they do not know how to handle the situation, potentializing emotional distress and professional dissatisfaction (5)(6)(7) .…”

“…The implementation of the Humanitude Care Methodology (MCH) has demonstrated efficacy in preventing and reducing agitation behaviors in dementia patients; acceptance of care; gains in regaining autonomy and independence of people with NCD (5,(7)(8)(9) . These gains in well-being and serenity provide a harmonious environment for the performance of care, positively affecting the health of care givers, and in the satisfaction and feeling of accomplishment of the professionals involved in it (8,9) .…”