The management of behavioural problems associated with dementia in rural aged care

Ervin, Kaye; Finlayson, Sarah; Cross, Mervyn J.

doi:10.1016/j.colegn.2012.02.003

Cited by 30 publications

(50 citation statements)

References 19 publications

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“…Furthermore, no senior nursing staff members participated in the training at either site, increasing the chance of barriers to translating the training into practice. Previous research does however suggest that nurses at all levels influence prescribing patterns in aged care settings [27] . Further research in this setting demonstrated sustained reductions in antipsychotic use [28] which continued to decrease with education aimed at this specific cohort.…”

Section: Discussionmentioning

confidence: 99%

“…This study differed in that the focus of the education intervention was nurses in the aged care setting. Nurses were targeted due to literature suggesting that nurses influence prescribing in aged care settings by requesting medications to treat and manage various conditions, including BPSD [53] and confirmation of this practice has been obtained from the results of a previous research study within the same settings [27] .…”

Section: Discussionmentioning

confidence: 99%

“…Previous research and quality improvement activities conducted locally at several rural residential aged care facilities [27] revealed high rates of antipsychotic drug use. Anecdotally nurses in these facilities reported high rates of serious behavioural and psychological symptoms of dementia (BPSD).…”

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confidence: 99%

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Reducing the use of antipsychotics in dementia care through staff education and family participation

Ervin

Cross

Koschel

2012

JNEP

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Background: The widespread use of antipsychotic medication to treat the behavioural and psychological symptoms of dementia in residential aged care facilities is a world wide concern. Despite evidence of the numerous adverse effects of antipsychotic drugs, and the efficacy of non-pharmacological approaches, prescription rates are increasing in aged care. Methods:This controlled before and after study aimed to investigate if an education intervention with family participation in dementia care improved the use of antipsychotic drugs. Antipsychotic use was measured by audit of residents' clinical records. Three similar rural residential aged care facilities (RACF's) participated in the study. At site 1 and 2 staff undertook training in dementia care using an on-line learning tool and peer reviewed literature on the use of antipsychotic drugs in dementia. Additionally, family members participated in 'resident life story telling' at site 2. Site 3 acted as the control.Results: At sites 1 and 2, twenty five staff (25%) volunteered to participate in training. No training was provided at the control site. Across the three sites 47 residents had a clinical diagnosis of dementia with 30 of this group prescribed antipsychotic medication at baseline. At the intervention sites the use of antipsychotic medication reduced from 85% to 69% at site 1 and from 50% to 38% at site 2. At the control site medication use increased from 61% from 69%. Conclusion:Dementia education for staff, especially with family participation in resident life story telling, may reduce antipsychotic medication use in residential aged care. Additionally, positive clinical implications such as reduction in falls were observed. The encouraging findings of this small study support further investigation in a larger sample.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reducing the use of antipsychotics in dementia care through staff education and family participation

Ervin

Cross

Koschel

2012

JNEP

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“…7 20 Interventions targeting these admissions, according to a recent systematic review, 20 include, improving palliative care provision, [21][22][23] improving ACP interventions, 24 25 improving treatment of pneumonia and chronic obstructive pulmonary disease within facilities [26][27][28] and providing ambulatory geriatric care through geriatrician review of residents within RACFs. 19 29 30 Dementia, estimated to affect over 50% of RACF residents, 18 31 32 hinders the decision-making capacity of the resident, especially at times of acute illness. The prevalence of dementia also means that at the time of admission to the RACF, many residents will no longer be able to undertake their own ACP.…”

Section: Introductionmentioning

confidence: 99%

Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial

et al. 2017

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IntroductionSystematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration.Methods and analysisThis is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration.DisseminationThe results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area.Trial registration numberACTRN12615000298516, Results.

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“…The three facilities were chosen due to their similarity and an existing relationship with researchers from the University of Melbourne's Rural Health Academic Network, which provides research and education within the prescribed region. The towns in which the facilities were located varied in population from as little as 5,000 -14,000 people, but all relied on agriculture as the main industry [7] .…”

Section: Settingmentioning

confidence: 99%

Staff perceptions of families in rural residential aged care

Ervin

Cross

Koschel

2012

JHA

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Objective: The aim of the project was to identify staff opinions of families in rural residential aged care, in light of the negative perceptions reported in the literature, to determine any similar opinions which may be barriers to introducing increased person-centred care practices.Method: A convenience sample of staff from three rural aged care facilities voluntarily participated in a quantative survey by completing and returning a questionnaire on their opinion about working with families in aged care settings.Results: Forty six staff responded (46.9% return rate); with 85% of staff reporting that families should be encouraged to participate in the care of their relatives. However, the findings also report 87% of staff perceived that family members were hostile without good reason and 76% report families were angry with aged care workers and undermined their treatment efforts. Conclusions:Although numerous studies exploring staff/family relationships in Australian and overseas settings are reported in the literature, this is the first rural focused study of its kind. Family participation in all aged care settings is essential for provision of person-centred care practices. Current negative perceptions of families expressed by rural aged care staff requires further research to explore possible solutions to improving staff/family relationships.

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The management of behavioural problems associated with dementia in rural aged care

Cited by 30 publications

References 19 publications

Reducing the use of antipsychotics in dementia care through staff education and family participation

Reducing the use of antipsychotics in dementia care through staff education and family participation

Implementation of ‘Goals of Patient Care’ medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial

Staff perceptions of families in rural residential aged care

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