Special care units for dementia individuals with behavioural problems

Lai, Claudia K. Y.; Yeung, Jonas; Mok, Vincent; Chi, Iris

doi:10.1002/14651858.cd006470.pub2

Cited by 59 publications

(48 citation statements)

References 43 publications

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“…24 These findings may be reassuring to the families of the 70 percent of assisted living residents with moderate or severe dementia who do not reside in special care units. Best practices include pleasant sensory stimulation 25,26 and the use of protocols for individualized care 27,28 and to improve function.…”

Section: Discussionmentioning

confidence: 89%

Dementia Prevalence And Care In Assisted Living

Zimmerman

Sloane²,

Reed³

2014

Health Affairs

196

149

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Assisted living residences have become prominent sites of longterm residential care for older adults with dementia. Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs. Policy-relevant recommendations from our study include the need to examine the use of psychotropic medications and cultures related to prescribing, better train assisted living staff to handle medications and provide nonpharmacological treatments, use best practices in caring for people with dementia, and promote consumer education regarding policies and practices in assisted living.

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Section: Discussionmentioning

confidence: 89%

Dementia Prevalence And Care In Assisted Living

Zimmerman

Sloane²,

Reed³

2014

Health Affairs

196

149

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“…Special inpatient units include the features of trained staff and a modified physical environment [16]. This study was conducted in 1 specialized psychogeriatric ward with 17 beds, well-trained staff, and daily multidisciplinary team meetings, which may partly explain the improvement in NPI.…”

Section: Discussionmentioning

confidence: 99%

Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia

Alanen

Pitkänen²,

Suontaka-Jamalainen³

et al. 2015

Dement Geriatr Cogn Disord

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Aims: To explore the impact of hospitalization on neuropsychiatric symptoms (NPS) and the level of functioning in patients with dementia. Our aim was also to study the influence of psychotropic medications. Methods: Behavioral disturbances, cognition and functional status of 89 patients were assessed using the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination, Barthel Index, and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCSADL). Results: The total NPI score decreased from 34.6 to 19.5 (p < 0.001), and ADL decreased from 32.2 to 21.7 (p < 0.001) during the hospital stay (mean of 44 days). For a change in ADL, only the effect of anxiolytics was significant (p = 0.045). For a change in NPI with antipsychotic and anxiolytic doses and Mini-Mental State Examination as covariates, no significant relationship was found. Conclusion: NPS improved significantly during hospitalization, but neither antipsychotic nor anxiolytic medication use explained this improvement. In patients using anxiolytics, the functional decline was substantial. These results do not support anxiolytic use in demented patients with NPS.

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“…The review 26 (2009) aimed to evaluate the effect of SCUs on behavioral problems, mood, need for use of restraints and use of psychotropics in treating dementia. Since no RCTs met the inclusion criteria, eight non-RCTs were selected, among which only four could be combined in a meta-analysis.…”

Section: Special Care Units For Behavioral Problemsmentioning

confidence: 99%

What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

et al. 2017

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BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies. RESUMO INTRODUÇÃO:Demência é uma condição com alta prevalência e incidência global. Sua característica crônica e progressiva tem impacto em aspectos físicos, psicossociais e na saúde pública. Nosso objetivo foi resumir evidências de revisões Cochrane sobre intervenções não farmacológicas para distúrbios cognitivos e demências. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas conduzida na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina, Universidade Federal de São Paulo. MÉTODOS: Foram incluídas revisões Cochrane sobre intervenções não farmacológicas para disfunções cognitivas e/ou qualquer tipo de demência, após a avaliação realizada de forma independente por dois autores. RESULTADOS: Vinte e quatro revisões foram incluídas. As revisões mostraram que ingestão de carboidratos e a terapia de validação podem ser benéficas para distúrbios cognitivos. Para demência, existe benefício potencial de programas de atividade física, treino cognitivo, tratamentos psicológicos, aromaterapia, terapia com luz, reabilitação cognitiva, estimulação cognitiva, oxigenoterapia hiperbárica associada a donepezila, análise funcional, terapia de reminiscência, estimulação elétrica transcutânea, decisão estruturada em op...

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Special care units for dementia individuals with behavioural problems

Cited by 59 publications

References 43 publications

Dementia Prevalence And Care In Assisted Living

Dementia Prevalence And Care In Assisted Living

Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia

What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

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