SettleIN: Using a Manualised Intervention to Facilitate the Adjustment of Older Adults with Dementia Following Placement into Residential Care

Abstract

The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A pilot randomised controlled trial was conducted. Nineteen new residents with dementia and 21 staff participants were recruited. Residents were randomly assigned to receive the SettleIN programme or residential care as usual. Resident quality of life, mood and overall adjustment were measured at baseline and post-intervention, in week seven. Interviews were conducted with staff in week seven to explore intervention feasibility. Despite medium to large effect sizes, there was no significant difference in mean change scores between the two conditions, with regards to quality of life, psychological wellbeing or overall adjustment outcomes. Qualitative feedback indicated that SettleIN was not feasible across all areas, with problems around recruitment and practicality. However, SettleIN was deemed feasible in terms of retention and acceptability among staff. The majority of staff felt that SettleIN was beneficial for residents but that organisational and programme factors impacted upon intervention feasibility. Further exploration of organisational barriers is needed in order to reduce the impact of such factors on care home research.

Effectiveness of Resilience Interventions on Psychosocial Outcomes for Persons With Neurocognitive Disorders: A Systematic Review and Meta-Analysis

“…In terms of social behavior, one study indicated significant differences in favor of resilience interventions compared with controls ( 38 ). Meanwhile, no significant differences were found in neuropsychiatric symptoms ( 39 – 41 , 43 , 44 ), adjustment ( 26 ), stress ( 29 ), and anxiety ( 29 ) in favor of resilience interventions compared with controls. Besides, the results of other outcomes' assessments were inconsistent.…”

“…Participants in most studies ( n = 10) were persons with dementia ( 26 , 28 , 29 , 38 , 41 – 44 , 46 , 47 ), one as persons with MCI ( 39 ), one as persons with MCI and early dementia ( 27 ), one as persons with dementia or cognitive impairment ( 45 ), and one was Alzheimer's ( 40 ). The number of participants ranged from 19 to 726, and seven studies had more than 100 participants.…”

“…We identified six resilience approaches based on content descriptions, including integrated approaches ( n = 5), exercise regimen or activity programs ( n = 4), psychological interventional technique ( n = 2), a psychiatric intervention ( n = 1), disease/case management ( n = 1), and cognitive stimulation therapy ( n = 1). Among five studies with integrated approaches, one was individualized person-centered care provided by standard procedures to diminish turmoil in care home residents with dementia ( 41 ), one was multimodal non-drug therapy on dementia's symptom and care need ( 38 ), one was multidimensional home-based care coordination provided by an interdisciplinary team to maximize independence for persons with MCI living home ( 39 ), one was a staff-led intervention that comprises four mandatory modules and one optional module to facilitate the adaptation of seniors with dementia after placement into residential care ( 26 ), and one was a psychosocial intervention including multifaceted and semi-tailored counseling, education, and support ( 40 ).…”

“…The outcomes of resilience-centered interventions are psychosocial, such as improving QOL, restoring normal performance, maintaining mental health, improving adaptability ( 25 ), better adjustment ( 26 ), enhancing mental well-being ( 27 ), reducing care dependence, good social relations, positive self-image ( 28 ), reducing burden or stress ( 27 , 29 ), enhancing intent or meaning of life, and obtaining self-esteem, positive emotions, self-efficacy, boldness, active coping, optimism, social support, adaptation, and cognitive flexibility (including positive reassessment and acceptance) ( 16 ). However, one question arises regarding how to measure resilience-centered intervention outcomes in different resilience approaches.…”

“…For example, Ghanei Gheshlagh et al ( 7 ) used three scales, which are Resilience Scale-25 (RS-25), Connor–Davidson Resilience Scale-10 (CDRISC-10), and Connor–Davidson Resilience Scale-25 (CDRISC-25), to assess the effectiveness of the resilience process for people with chronic physical diseases. Saint-Bryant et al ( 26 ) used the Cornell Scale for Depression in Dementia (CSDD), Quality of Life Alzheimer's Disease scale (QOL-AD), and the Index of Relocation Adjustment Scale (IRA) to measure depression, QOL, and adjustment conditions as the outcomes of resilience process for older adults with dementia.…”