ChangingMinds –BPSD is a research- and development project, a part of a larger ChangingMinds –project 2007-2010 carried out at
The Central Union for the Welfare of the Aged.
Research team:
Eloniemi-Sulkava Ulla, PhD, Savikko Niina, PhD, Saarenheimo Marja, PhD, Pietilä Minna, PhD, Terhi Köykkä, registered nurse and PhD student, Heli Sillanpää-Nisula, Psychiatric nurse, Forder Marjo, Physiotherapist, Frosti Sonja, M.Sc
Background
• Alzheimer’s disease and related dementias are frequently accompanied by behavioural and psychological symptoms of dementia (BPSD) that are common in long term care settings of elderly people.
• BPSD decrease the quality of life of people with dementia and cause distress in nursing staff.
Aim
To create new treatment methods for supporting well-being of demented people with behavioural and psychological symptoms of dementia (BPSD)
Objectives
To determine the effects of a one-year multi-component and tailored intervention targeted at treating underlying causes of BPSD on
1. alleviation of BPSD of each person with dementia
2. prevalence and severity of BPSD in care wards
3. well-being of people with dementia
4. use of medication
Study methods
• randomized, controlled intervention study
• randomization based on several characteristics of the wards and the residents (case mix index, age and gender) (Resident Assessment Instrument, RAI)
• follow-ups at baseline, 6 months and 14 months
Follow-up measures (0, 6, 14 months)
1. Data collection by the study nurse
a. BPSD (Neuropsychiatric Inventory-Nursing Home, NPI-NH)
b. Depression (Cornell Scale for Depression in Dementia, Cornell)
c. Cognitive functioning (Clinical Dementia Rating Scale, CDR)
d. Physical functioning (Barthel Index)
e. Quality of life (Quality of life in late-stage dementia, QUALID)
f. Nutrition (Mini Nutritional Assessment, MNA)
g. Medication
2. Well-being and daily life of residents (Elo-D observation method)
3. Questionnaire of the staff’s work stressors and satisfaction
4. Qualitative process analysis
Participants
• Residents of the elderly long-term care units (N=400) with memory disorder and BPSD
• Intervention units (N=11) and control units (N=9): 430 staff members
INTERVENTION
Based on
1. holistic perspective where BPSD are seen as a person’s effort
to cope with and adapt to the present circumstances
2. integrated care approach
3. problem solving approach.
Treatment focus: the underlying multiple interacting causes of
each resident’s behaviour
Intervention elements:
1. Mentor nurse
2. Consulting geriatrician
3. Multidisciplinary sessions to create comprehensive care plans
Intervention includes:
1. Holistic nursing care
2. Good medical care
3. Nutrition treatment
4. Singing, exercise therapy and reminiscence during daily practice
5. Evaluating environmental issues in supporting agency of the residents
Depression