Person centered care/planning occurs when the individuals in need of services are allowed to have say over what they want out of their life and the team assisting the person listens, sees the person as an individual and develop a plan that will assist them in meeting their goals. An example of this could be that Sally, a person with dementia in a nursing home loved to tend to her garden when she lived on her own, since moving into the nursing home she has not been able to do this and has been acting out. The staff with a person centered plan would try to obtain a way (this requires creativity at times) to replicate good experiences that Sally had in order to give her back some of her independence. She may not have a garden, but maybe she could plant flowers outside, or in pots to have for her room. If the staff were aware of others wanting the same thing, they could start a garden club or assist the residents in potting plants for their rooms or loved ones.
Lakeview Ranch is a residence that focuses on preventative care by increasing nursing/patient ratios, in house RN staffing, specialized staff training including attention to residents emotional needs and medication reviews (Berry, et al 2008). By specifying the difference between “agitation and resistiveness to care” the caregivers will be able to provide better management techniques as well as improve their self-efficacy in dealing with behaviors (Volicer & Hurley, 2003). Beth Nolan’s study went from April 1992-May 1995 where data was collected on 413 new residents in 87 different nursing home facilities located in Washington, North Carolina and Michigan (Nolan, 2003). This study looked at the aggressive behavior of people with dementia in relation to recall, recognition, medication use and ability to care for them selves.
Many people with dementia are on medications to control behaviors. These studies looked at lowering or removing medication to see if behaviors were still present.
The last studies looked at training, patient history, and caregiver skills to see if an increase in knowledge would lead to fewer behaviors The Taiwan study had the groups divided evenly. This study used two groups: the control and the experimental group (Huei-Ling, et al, 2003). Scores for agitation, aggression, and caregivers self efficacy were recorded before the training and three months after the training. Speziale’s training consisted of learning more about dementia and how it affects the brain as well as learning personal histories of residents and better intervention and prevention strategies (Speziale, 2009). Mary Egan did a study in which looked at the correlation with sharing patient history with staff and a decrease in patient problem behaviors and change in staff perception of residents (Egan et al, 2007). Skovdahl & Kihlgren also wanted to see if attitudes of staff could prevent or promote behaviors of patients with dementia.
Physical behaviors decreased on both sides of the Taiwan study.
Dementia And Aggression Psy 492 M7a2 Levea. B
Dementia and Aggression: Can aggression be reduced with better quality of care? PSY 492 Billie Jo LeVea 8-16-10
Dementia: what is it? <ul><li>“ There are over 24 million people worldwide diagnosed with dementia (Mental Health, 2009). Dementia refers to a group of symptoms that are caused by changes in brain function. Signs of dementia include changes in memory, personality, and behavior. Dementia makes it hard for a person to carry out normal daily activities” (Mental Health, 2009). </li></ul><ul><li>How is the best way to handle these behaviors? Can these behaviors be controlled? </li></ul>
The Hypothesis <ul><li>Proper training specific to dementia and its effects coupled with person centered care, can lower aggressive behaviors in people suffering from dementia. </li></ul>
The First Set of Studies <ul><li>The Lakeview Ranch study looked at cost analysis for treating people with dementia by taking a sample of past as well as current residents of a residence known as Lakeview Ranch and compared it to regional care costs (Berry, et al 2008). </li></ul><ul><li>Beth Nolan did a study that addressed the cognitive functioning of a person and how that related to behaviors. </li></ul><ul><li>Sutor’s study looked at the aggression in dementia patients as a combination of environmental, medical and psychiatric issues and addressing all aspects of these causes in treatment plans. </li></ul><ul><li>Volicer & Hurley did a study that focused on the terminology that was used when dealing with patients with dementia and how this is related in the medical field, nursing homes and to the caregivers. </li></ul>
The Findings Beth Nolan results showed that as daily living skills decreased there was a slight increase in aggressive behavior (Nolan, 2003). The highest correlation was with recall and recognition; as these abilities lessened, the aggressive behaviors increased (Nolan, 2003) This study shows that aggressive behavior seems to be most prevalent as memory functioning worsens. Sutor found by understanding that medical and psychiatric illnesses can also cause for aggression as well as lack of communication or poor caregiver skills; it is necessary to assess the person in a multi faceted approach to cover all areas of their history and provide a multi systematic approach to care (Sutor, et al, 2001). Volicer & Hurley’ s study showed going through different frameworks including behavioral, psychiatric and comprehensive models and using the appropriate terminology will allow for better quality of care. Findings of the Lakeview Ranch study show that the residents of Lakeview Ranch have less medication cost as well as less behaviorally related hospitalizations compared to the regional costs.
Studies based on Medication Regimen <ul><li>Neufeld did a study on 40 people in the nursing home in NYC with dementia had their medication (haloperidol) tapered off to see if their aggressive behaviors had increased (Neufeld & Marchello, 1994). </li></ul><ul><li>Marchello also did a study in a Jewish Home and Hospital for the Aged and their use of haloperidol for patients with Alzheimer’s who had aggressive behaviors. The facility has a special Alzheimer’s Special Care Unit and the researchers took patients that were diagnosed with moderate Alzheimer’s, were dependent in activities of daily living and had displayed behaviors that are typical of this stage of the disease. The people were then given the option to go to the special unit or stay where they currently were (Marchello, 1994). </li></ul>
The Findings <ul><li>Results of Neufeld’s study showed that the drug could be withheld on Mondays and Thursdays with no increase in aggressive behaviors (Neufeld & Marchello, 1994). </li></ul><ul><li>What Marchello’s study found was those in the special care unit (37) had less behaviors then those in the control group (25) and therefore the use of haloperidol dropped (Marchello, 1994). </li></ul>
Studies Based on Training and Client Care <ul><li>In Taiwan, a study was done on 48 patients with dementia who families are their caregivers. The experimental group received a two session in their home caregiver training while the control group only received written material (Huei Ling, et al 2003). </li></ul><ul><li>Speziale’s study the GPA techniques (gentle persuasive approach) training was given to staff working in an Ontario nursing home facility. The study then measured the response of staff attitudes pre and post training as well as the incidences of aggression and physical intervention by staff (Speziale, et al, 2009). </li></ul><ul><li>Egan studied 4 women residents aged 77-93 that were diagnosed with dementia and showed aggressive behaviors, including verbal and physical aggression (Egan, et al 2007). Life histories were gathered from family and included both happiness and hardships and were posted for staff to view. </li></ul><ul><li>Skovdahl & Kihlgren’s study looked at 15 formal caregivers to people with dementia. The study looked at the group’s reflections of their attitudes of they felt about behavioral patients and how to best handle situations (Skovdahl, et al, 2003). </li></ul>
The Findings Results Of Skovdahl’s study showed that the important part of creating good working relations with each other was the increase need for support. This could include feedback, confirmation and supervision. Residents had fewer behaviors if they felt respected and caregivers who look at the resident’s behaviors for meaning and have mastery caregiver skills were more successful in curbing behaviors (Skovdahl, 2003). Changes in behavior were noticed in 3 of the 4 residents in Egan’s study. Ten staff was interviewed and all felt that the life history was very helpful and half the staff reported a change in the care they provided after reading the life histories (Egan, et al 2007). Results of Speziale’s study showed that aggressive behavior declined in 6 months, staff response was better and the use of physical restraints decreased. The results of Taiwan study showed that those who received the in home training had higher self-efficacy scales as well as better management skills. The patients had less non-physically aggressive behaviors as well.
Results <ul><li>Aggressive behaviors in people with dementia can be lessened if the people caring for them are properly trained on understanding dementia, the stages in which one can go through, underlying factors that can progress these stages and how to effectively deal with each area, including the aggression. </li></ul><ul><li>Better facilities and training mean less expense, better care and better behaviors. </li></ul>
Future areas to Research <ul><li>If the proper training and person centered plans are used, will it slow down the cognitive decline? </li></ul><ul><li>If proper training is provided for caregivers, will this decrease the need for nursing home placement? </li></ul><ul><li>If people with dementia have input into their care in the beginning, will this lead to less behaviors in the end? </li></ul>
References <ul><li>Berry, J., Karasik, R., Reichl, M., & Takamatsu, A.. (2008). Managing challenging aggressive behavior in persons with dementia: cost effectiveness of prevention versus treatment. The gerontologist: 61st annual scientific meeting "resilience in an aging... Special issue iii , 48 , 638. Retrieved July 7, 2010, from ProQuest health and medical complete. (Document ID: 1647961911). </li></ul><ul><li> </li></ul><ul><li>Huei-ling, H., Yea-Ing lotus, S., Min-chi, C., Sien-Tsong, C., & Li-Chan, L. (2003). A pilot study on a home-based caregiver training program for improving caregiver self-efficacy and decreasing the behavioral problems of elders with dementia in Taiwan. International journal of geriatric psychiatry , 18 (4), 337. Retrieved from psychology and behavioral sciences collection database. </li></ul><ul><li>Ladislav Volicer, & Ann C Hurley (2003) management of behavioral symptoms in progressive degenerative dementias. The journals of gerontology: series A biological sciences and medical sciences, 58A (9), M837-45. Retrieved July 7, 2010, from ProQuest biology journals. (Document ID: 463170671). </li></ul><ul><li> </li></ul><ul><li>Marchello, Vincent. (1994, July). Chemical restraints: what factors reduce need? Nursing homes, 43 (6), 22. Retrieved July 14, 2010, from ProQuest nursing & allied health source. (Document ID: 54584). </li></ul><ul><li> </li></ul><ul><li>Mary Y Egan, sally Munroe, Camille Hubert, Trish Rossiter, & et al. (2007). Caring for residents with dementia and aggressive behavior: impact of life history knowledge. Journal of Gerontological nursing, 33 (2), 24-30. Retrieved July 7, 2010, from ProQuest health and medical complete. (Document ID: 1201471641). </li></ul><ul><li> </li></ul><ul><li> </li></ul>
References <ul><li>Nolan, Beth A. D. (2003). Predicting aggressive behavior based on memory functioning: A longitudinal study of persons with Dementia of the Alzheimer's Type. Ph.D. dissertation, The University of Kansas, United States -- Kansas. Retrieved July 8, 2010, from Dissertations & Theses: Full Text.(Publication No. AAT 3161781). </li></ul><ul><li>Neufeld, Richard, & Marchello, Vincent. (1994, July). Report on two projects. Nursing Homes, 43 (6), 21. Retrieved July 14, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 5397963). </li></ul><ul><li> </li></ul><ul><li>Skovdahl, K., Kihlgren, A., & Kihlgren, M. (2003). Different attitudes when handling aggressive behaviour in dementia--narratives from two caregiver groups Aging & Mental Health , 7 (4), 277. Retrieved from Psychology and Behavioral Sciences Collection database. </li></ul><ul><li> </li></ul><ul><li>Speziale, J., Black, E., Coatsworth-Puspoky, R., Ross, T., & O'Regan, T.. (2009). Moving Forward: Evaluating a Curriculum for Managing Responsive Behaviors in a Geriatric Psychiatry Inpatient Population. The Gerontologist, 49 (4), 570-576. Retrieved July 7, 2010, from Research Library. (Document ID: 1805175261). </li></ul><ul><li> </li></ul><ul><li>Sutor, Bruce; Rummans, Teresa A; Smith, Glenn E. "Assessment and management of behavioral </li></ul><ul><li>disturbances in nursing home patients with dementia." Mayo Clinic Proceedings </li></ul><ul><li>5(2001):540. </li></ul>