A best‐evidence review of intervention studies for minimizing resistance‐to‐care behaviours for older adults with dementia in nursing homes

Abstract

Aim. To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. Background. Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff. Design. Best-evidence review. Data Sources. We searched for non-pharmacological intervention studies published from 1990-2012, written in English. Review Methods. The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute. Results. Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours. Conclusion. Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.

Finding the fundamental needs behind resistance to care: Using the Fundamentals of Care Practice Process

“…Since resistance to care is one of the main reasons for prescribing antipsychotics (Cornege‐Blokland, Kleijer, Hertogh, & van Marum, ), it is essential to focus on this phenomenon. Additionally, RTCBs cause lack of care which will have important consequences on well‐being, quality of life and additional health problems (Konno, Kang, & Makimoto, ). Moreover, inadequately providing fundamental care leads to insufficient nursing care and complications for patients such as posthospital syndrome, delirium or pneumonia (Kalisch, Xie, & Dabney, ; Kalish, ; MacMillan, ).…”

The association between positive–negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross‐sectional study

“…Furthermore, although in the vast majority of countries PwD are usually admitted to a long‐term care institution at some point (LTCI) (Konno et al . ) where other professional caregivers will be involved in direct care, ICs continue to play an essential role (Zabalegui et al . ).…”

“…Generally, they take on the responsibility of attempting to compensate for patients' lack of independence from the early stages of the disease, where only mild memory impairment is noted, to the later stages when PwD require help with all basic activities of daily living (ADL). Furthermore, although in the vast majority of countries PwD are usually admitted to a long-term care institution at some point (LTCI) (Konno et al 2014) where other professional caregivers will be involved in direct care, ICs continue to play an essential role . In some countries, ICs lack specific training, so that they depend entirely on caregiver commitment arising from affection and a sense of responsibility for the care recipient (Zabalegui et al 2008, Sansoni et al 2013.…”

Addressing Adventitious Behaviors Associated with Dementia

“…Holism is noted to be a foundational tenet with regards to implementing individualized care to patients with dementia. This should be characterized by rendering culturally competent and patient-centered care based on specifications related to the individual patient [14].…”