What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer's Association Dementia Care Provider Roundtable

Fazio, Sam; Zimmerman, Sheryl; Doyle, Patrick J.; Shubeck, Emily; Carpenter, Molly J.; Coram, Pauline; Klinger, Juliet Holt; Jackson, Letitia; Pace, Douglas; Kallmyer, Beth; Pike, Joanne

doi:10.1016/j.jamda.2020.05.017

Cited by 31 publications

(33 citation statements)

References 39 publications

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“…We identified challenges, facilitators, and contextual factors that explain variability in the implementation of EIT-4-BPSD across sites and presented them within the RE-AIM framework. As such, this study contributes to the recognized need to evaluate evidence-based protocols for BPSD [ 2 ]. The reach of site level engagement in the study represented a readiness to adopt evidence based BPSD approaches.…”

Section: Discussionmentioning

confidence: 99%

“…There is a glaring need for transparent, pragmatic research in the area of non-pharmacological interventions to manage behavioral and psychological symptoms of distress in dementia (BPSD) [ 1 ]. BPSD are conceptualized as behavioral responses to the physical and social environment and include verbal/physical aggression, inappropriate vocalizations, anxiety, psychosis, depression, wandering, resistiveness to care, and sexually inappropriate behaviors [ 2 ]. BPSD are not solely related to neuropathology; other social, psychological, and environmental mechanisms underlie their expression [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…BPSD are conceptualized as behavioral responses to the physical and social environment and include verbal/physical aggression, inappropriate vocalizations, anxiety, psychosis, depression, wandering, resistiveness to care, and sexually inappropriate behaviors [ 2 ]. BPSD are not solely related to neuropathology; other social, psychological, and environmental mechanisms underlie their expression [ 2 ]. BPSD are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

Behrens

Boltz

Riley

et al. 2021

BMC Health Serv Res

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Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

Behrens

Boltz

Riley

et al. 2021

BMC Health Serv Res

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“…Consultations among health care providers will improve outcomes and promote safety in the community. 30…”

Section: Interprofessional Considerationsmentioning

confidence: 99%

Community-Based Best Practices for Early Identification and Referrals for Dementia

Mason

Serianni

Julian

2021

Topics in Geriatric Rehabilitation

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The purpose of this article is to describe the typical aging process and compare this to mild cognitive impairment and early symptoms of dementia, specifically cognitive-communicative and swallowing deficits, to help professionals better identify dementia in the care of community-based adults.Objective: To evaluate the role and importance of the speech-language pathologist in early identification and management of dementia. Suggested interprofessional considerations for best practice for early identification, management, and referral are also addressed. Conclusion: Speech-language pathologists are critical for assessing and treating those with early stages of dementia and mild cognitive impairment. It is critical for medical professionals to recognize the speech pathologist's role in treating those with cognitive impairments and swallowing disorders.

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“…However, people in moderate to late stages of dementia usually have difficulties with goal setting and communication in general. Healthcare professionals in dementia care are currently mainly facilitated by training courses [ 10 ] and protocols [ 11 ] for delivering personalised care.…”

Section: Introductionmentioning

confidence: 99%

Know-Me: A Toolkit for Designing Personalised Dementia Care

Wang

Albayrak

Hogervorst

et al. 2021

IJERPH

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Personalisation is a crucial element in providing person-centred care for people with dementia. This paper presents the development and evaluation of a design toolkit to facilitate the work of designers and healthcare professionals in personalising dementia care. This toolkit, named “Know-me”, was grounded in the findings of Ergonomics in Aging, Co-design, and Data-enabled Design, derived from literature review and from the field during a four-year doctorate project. “Know-me” was designed to be easily accessible, flexible, and engaging, providing concrete and hands-on guidance for designers and healthcare professionals to use in designing for personalised dementia care. A proof-of-concept evaluation of the “Know-me” toolkit was conducted via student projects on design for dementia care. During this process, we found that “Know-me” could be adapted flexibly so that the care team could use some of the tools by themselves. A feature-by-feature comparison of the “Know-me” toolkit with similar state-of-the-art toolkits was conducted, and based upon this, the strengths and weaknesses of the “Know-me” toolkit are discussed. This preliminary study indicates that the “Know-me” toolkit is a helpful addition to the current pool of toolkits on designing for dementia care.

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What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer's Association Dementia Care Provider Roundtable

Cited by 31 publications

References 39 publications

Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives

Community-Based Best Practices for Early Identification and Referrals for Dementia

Know-Me: A Toolkit for Designing Personalised Dementia Care

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