What Are the Barriers to Performing Nonpharmacological Interventions for Behavioral Symptoms in the Nursing Home?

Abstract

OBJECTIVE Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. DESIGN A descriptive study of barriers to intervention delivery in a controlled trial. SETTINGS The study was conducted in 6 nursing homes in Maryland. PARTICIPANTS 89 agitated nursing home residents with dementia. INTERVENTION Personalized interventions were developed using the TREA decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. MEASUREMENTS Barriers to Intervention Delivery Assessment (BIDA), ADL, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. RESULTS Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and for external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, while higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. CONCLUSION Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.

Pain management in patients with dementia

“…In fact, pain is thought to be one of the most important causal factors of BPSD 5. However, this causal link is often difficult to identify due to the complexities of BPSD, which change over the stages of dementia and are more frequent in the later stages of the disease 6. BPSD arising as a result of pain, such as agitation and aggression, can be extremely distressing for both the individual and their caregiver, and can lead to the inappropriate prescribing of antipsychotic medication instead of adequate pain treatment.…”

Pain and agitation in dementia: a review of the literature

“…Burns and McIlfatrick (2015) literature review identified that caregivers find it difficult to differentiate between behavioural change due to pain or other problems, such as, delirium. Cohen-Mansfield et al(2012) in an earlier study also found that pain is under recognised which results in an over prescribing of anti-psychotic medication and an under prescribing of analgesia. The implication for practice is that incorrect assessments of resident's behaviour could overlook pain as a cause of changes in behaviour and result in the administration of potentially harmful medication that increases agitation.…”

Implementation of a Nursing Home Quality Improvement Project to Reduce Resident Pain

“…The findings from this study can guide strategies to address project barriers and maximize project facilitators. 23 Nurses have an influential role in leading initiatives to improve quality of care for residents. Staff development and education were found to be perceived by staff as important to project success, and QI training could potentially be improved by including research findings that address staff experiences with QI project implementation.…”