Managing symptoms of dementia in nursing home residents: staff's views

Art & science | research
NURSING OLDER PEOPLE December 2014 | Volume 26 | Number 10 31
Correspondence
[e-mail].
gov.au
Deborah Koder is senior
clinical psychologist, Specialist
Mental Health Service for
Older People, Royal Prince
Alfred Hospital, Sydney Local
Health District, Camperdown,
New South Wales, Australia
Glenn E Hunt is associate
professor and principal research
fellow, University of Sydney and
Concord Centre for Mental Health,
Concord Hospital, Concord,
New South Wales, Australia
Tanya Davison is senior research
fellow, Kingston Centre, Aged
Mental Health Research Unit,
Monash University, Victoria,
Australia
Date of submission
August 27 2014
Date of acceptance
October 7 2014
Peer review
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Staff’s views on managing
symptoms of dementia in
nursing home residents
Deborah Koder and colleagues present the findings of a survey
of the most common and distressing challenging behaviours
encountered and the preferred ways of coping with them
AS THE population ages, the number of people with
dementia increases. The prevalence of behavioural
and psychological symptoms of dementia (BPSD)
in nursing home residents has been cited as 78% (van
der Linde et al 2012). Staff attitudes towards BPSD,
including staff distress when caring for such
residents, is of increasing interest (Cubit et al 2007,
Schmidt et al 2012). Reactions of care staff to BPSD
are likely to influence the effectiveness of dealing
with residents’ behaviour. Recent studies have
sought to identify the most disruptive behaviours for
staff. For example, Backhouse et al (2014) reported
that aggression was the most difficult behaviour
to manage, as reported by 37% of their sample of
nursing home managers. An Australian survey also
cited physical aggression as the most distressing
behaviour for staff (Cubit et al 2007). Predictors
of difficulty in managing residents expressing
BPSD in other studies were found to be severity of
BPSD, level of supervisor support and degree of
person-centred approaches to care (Moniz-Cook
et al 2000, Moyle et al 2011, Pulsford et al 2011).
There has been increased focus on the use of
psychosocial strategies in the management of BPSD
and practice guidelines state that psychosocial
strategies should be the first-line treatment
for residents expressing BPSD, for example,
British Columbia (2012) and Richter et al (2012).
Abstract
Aim To identify the most common and distressing
behavioural and psychological symptoms of dementia
(BPSD) in nursing homes and to identify staff
preferences regarding its behavioural management.
Method A descriptive cross-sectional survey was
completed by a self-selected sample of 247 staff
working in 21 nursing homes in a defined catchment
area. The survey contained items relating to experience
in aged care work, attitudes towards BPSD, ratings
of the importance of certain behavioural strategies for
managing BPSD, and the Challenging Behaviour Scale.
Results Shouting, wandering and restlessness had the
highest incidence, frequency and difficulty ratings.
Frequency of BPSD and level of satisfaction with how
they were managed had the greatest effect on overall
level of difficulty in managing behaviours. Staff rated
discussing behavioural concerns at a group level
and with senior nursing staff as the most important
behavioural strategies.
Conclusion A strong relationship was found between
frequency and difficulty of BPSD. Therefore,
interventions targeted at lowering frequency of
BPSD are recommended. Communication across a
number of levels may enhance the implementation of
behavioural interventions.
Keywords
Alzheimer’s disease, behavioural and psychological
symptoms of dementia, challenging behaviour,
cross-sectional studies, dementia, nursing homes,
nursing interventions, psychomotor agitation