School of Nursingwww.ohsu.edu/son

School of Nursingwww.ohsu.edu/son

Identification and Management of Disorders Associated with Dementia

Glenise McKenzie, PhD, RN,

School of Nursingwww.ohsu.edu/son

Acknowledgements

Oregon Health and Science University (OHSU)

Robert Wood Johnson Foundation Sigma Theta Tau Betty Gray Foundation (OHSU)

School of Nursingwww.ohsu.edu/son

Overview

Background “Why should we care?”

Assisted Living and Dementia “What is happening?”

Insights from my research experience “What might help?”

School of Nursingwww.ohsu.edu/son

Background

Who is affected by dementia? So what…for the residents?

So what ….for the caregivers?

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Background

Caregivers

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What are behavioral and psychological symptoms of dementia(BPSD)?

Psychological symptoms Behavioral symptoms

delusions hallucinations misidentifications depression anxiety sleeplessness apathy

physical aggression

wandering restlessness disinhibition repetitive

questions

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Background

What is happening with dementia care and the BPSD in assisted living? Percentage of clients with BPSD Memory Care units Expected growth

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Evidence-based Care for BPSDNonpharmacologic Strategies:

1. Identify the precipitating factor and treat/avoid the triggers (Need-driven behavior, behavior as communication)2. Communication/approach and distraction techniques3. Behavioral problem solving (ABC)

4. Environmental Modifications• Open areas and outside access• Aromatherapy-lavender• Light, music, massage and pet therapy

5. Exercise and structured activity therapies

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My Research “Organization of Work in Assisted Living:

Occupational Health and Safety Implications for Direct Care Workers”. (Quantitative - survey)

“Staff Training in Assisted-living Residences (STAR)” (L. Teri, PI -intervention study)

"The Role of Medication Aides and Licensed Nurses in Assisted Living Workplace: Factors and Occupational Health Implications”. (Qualitative)

“Management of Psychosocial and Behavioral Symptoms of Dementia: A Qualitative Study of Strengths and Gaps in Assisted Living Facilities” (Qualitative)

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Promoting mental health of older adults and their

caregivers

Dementia Related Symptoms

Community Dwelling

Residing in Assisted Living

Settings

Older Adults Assisted Living

Staff

Family Caregivers

Caregivers

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Findings

Summary of findings from completed studies:

High levels of work stress and emotional distress in direct care workers (DCWs) in ALFs

DCWs work stress and distress associated with individual and system-level factors

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Findings

Behavioral based training for ALF staff improved behavior and mood of residents with dementia and improved mood and confidence of staff (1:1 strategies and case studies)

Implementing and sustaining interventions in the “real world” is challenging!

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Findings

Examples of supervisor comments about CNAs post training “CNAs are calmer during care, they are

understanding residents cognitive status better” – RN

“Using more positive distraction techniques in residents with dementia” – RN

“Knowing how to (better) handle a resident altercation” - RN

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Findings

Direct care staff self-report 77% reported they saw a “difference

working with residents” when they used training components

65% reported use of specific component in their daily interactions with residents

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Findings

Strategies that support management of BPSD: • person-directed care: focus on needs and

preferences of person exhibiting behavior • management practices: empower and support staff

Factors that impede BPSD in rural ALFs include:• lack of behavioral and psychiatric expertise

resources • lack of access to targeted training in behavioral

management strategies

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Recommendations

Additional education/training is needed for unlicensed and licensed staff caring for these clients in community-based settings (especially in rural areas)

Delivery of training should include “hands-on” chances to practice behavioral strategies

Incorporate examples from caregivers and problem solve during training

Consider alternative delivery methods for rural areas (tele-medicine; phone conferencing)

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Conclusions

BPSD is part of dementia and more folks with dementia are coming our way

Preparing caregivers improves their lives as well as the residents lives

Moving promising programs into the “real world” requires ongoing research/evaluation

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Discussion