Understanding dementia care in care home setting in China: An exploratory qualitative study

Abstract

Dementia education for healthcare providers has gained growing attention in China.This study aimed to explore the current dementia care practices in care home setting in China because people with dementia have increased need for residential care as the cognitive function worsens. An exploratory qualitative study was conducted among care staff and residents with dementia in four care homes in a metropolitan city in China between May and August 2019. Participant observations were conducted to understand how the care environment and activities affect residents with dementia. Care records were reviewed to explore the kind of care provided. In-depth individual interviews were conducted with a purposive sample of 15 care staff members of different ranks to clarify the care practices and understand their training needs with dementia care. Field notes of observations, nursing care records and interviews transcripts were triangulated for qualitative content analysis. The theme emerged is 'suboptimal dementia care practices'. Four categories about dementia care practices in care homes were identified: (a) care environment (hospital-like layout, inappropriate lighting, environmental noise, inappropriate use of colour and unclear signage), (b) care culture (being medical-oriented, overlooking individual uniqueness and privacy), (c) attitudes towards dementia (treating as children, being authoritative, adopting punitive approaches, trying to respect the residents and having a positive learning attitude) and (d) dementia care competence (questing for specific training and resources, questing for culturally specific practices and strengthening communication with family). Creating a dementia-friendly and enabling environment, shifting the care culture paradigm from disease-oriented to person-centred and developing culturally sensitive care practices are imperative. Dementia care education for care home staff using a systematic, comprehensive approach is fundamental to achieve these goals.

Translation and validation of Chinese version of sense of competence in dementia care staff scale in healthcare providers: a cross-sectional study

“…It is noteworthy that the care assistants scored higher than the health professionals in subscale ‘Professionalism’. This may be because health professionals in nursing homes and hospitals are mainly responsible for the medical care and are less involved in personal care for people with dementia [ 51 ]. More works are needed to explore the differences and similarities in their perceived competencies between the two groups as this would provide insights into intervention development for equipping care staff with knowledge as well as appropriate attitude and skills [ 52 ] .…”

“…For example, many healthcare providers could not differentiate symptoms of dementia from those of mental disorders [ 19 ]. Nursing home staff misbelieved that residents with dementia are uncommunicative and thus were not willing to talk to them [ 51 ] and could not understand their care needs [ 53 ]. Education for healthcare providers on the relevant pathophysiology and communication skills is pertinent for capacity building in dementia care in China.…”

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

“…The lack of dementia-related training and community-based support services designed for people with dementia and their families can lead to exhaustion among family caregivers ( 18 ). Family caregivers in low- and middle-income countries often experience a higher level of distress due to the lack of resources and support mechanisms in the public healthcare system to help them properly managing BPSD ( 15 , 19 ).…”

Feasibility of a Culturally Specific DEmentia Competence Education for Nursing Home Taskforce (DECENT) Programme: A Mixed-Method Approach

“…At present, an estimated 9.5 million people live with dementia [ 18 , 19 ], and approximately 44.5% to 56.4% residents in nursing homes live with dementia in China [ 20 , 21 ]. However, nursing home staff in mainland China generally have poor dementia knowledge [ 22 ], and the current care practice is dominated by medical-oriented care culture and punitive approaches towards challenging behaviours [ 23 ]. Despite the substantial demand for quality dementia care in nursing homes, relevant care competencies are being neglected by existing staff training [ 23 ].…”