Factors influencing management of agitation in aged care facilities: A qualitative study of staff perceptions.
aged care
ageing
agitation management
dementia
older person
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
14
04
2020
revised:
17
09
2020
accepted:
18
09
2020
pubmed:
23
10
2020
medline:
4
6
2021
entrez:
22
10
2020
Statut:
ppublish
Résumé
Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings. To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour. Qualitative descriptive. Semi-structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines (see. Appendix S1). Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction. While participants strived to deliver individualized person-centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents. For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings.
AIM
OBJECTIVE
To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour.
DESIGN
METHODS
Qualitative descriptive.
METHODS
METHODS
Semi-structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines (see. Appendix S1).
RESULTS
RESULTS
Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction.
CONCLUSIONS
CONCLUSIONS
While participants strived to deliver individualized person-centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents.
RELEVANCE TO CLINICAL PRACTICE
CONCLUSIONS
For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.
Types de publication
Journal Article
Langues
eng
Pagination
136-144Subventions
Organisme : Australian Postgraduate Award
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Australian Government (2019). Decision making tool: Supporting a restraint free environment in residential aged care. .
Australian Institute of Health and Welfare (2015). Ageing: Aged care statistics. Retrieved from http://www.aihw.gov.au/ageing/
Azermai, M., Vander Stichele, R. R., Van Bortel, L. M., & Elseviers, M. M. (2014). Barriers to antipsychotic discontinuation in nursing homes: An exploratory study. Aging and Mental Health, 18(3), 34-53.
Backhouse, T., Camino, J., & Mioshi, R. (2018). What do we know about behavioral crises in Dementia? A systematic review. Journal of Alzheimer's Disease, 62(1), 99-113.
Blue, B. (2015). Signs and symptoms of anxiety and depression in older people. Retrieved from https://www.beyondblue.org.au/who-does-it-affect/older-people/signs-and-symptoms-of-depression-in-older-people
Bradshaw, C., Atkinson, S., & Dowdy, O. (2017). Employing a qualitative descriptive approach in health care research. Global Qualitative Nursing Research, 4, 1-8.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2314. https://doi.org/10.1212/wnl.44.12.2308
Cummings, J., Mintzer, J., Brodaty, H., Sano, M., Banerjee, S., Devanand, D. P., Gauthier, S., Howard, R., Lanctôt, K., Lyketsos, C. G., Peskind, E., Porsteinsson, A. P., Reich, E., Sampaio, C., Steffens, D., Wortmann, M., & Zhong, K. (2015). Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. International Psychogeriatrics, 27(1), 7-17. https://doi.org/10.1017/s1041610214001963
Dombruck, M. (2015). Psychological self-tool: self soothing techniques. Retrieved from https://www.cascadementalhealth.org/poc/view_doc.php?type=doc&id=9761&cn=353
Duxbury, J., Pulsford, D., Hadi, M., & Sykes, S. (2013). Staff and relatives' perspectives on the aggressive behaviour of older people with dementia in residential care: A qualitative study. Journal of Psychiatric Mental Health Nursing, 20(9), 792-800. https://doi.org/10.1111/jpm.12018
Edberg, A., Bird, M., Richards, D., Woods, R., Keeley, T., & Davis-Quarrell, V. (2008). Strain in nursing care of people with dementia: nurses experiences in Australia, Sweden and the United Kingdom. Ageing and Mental Health, 12(2), 236-243.
Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K., & Kyngäs, H. (2014). Qualitative content analysis: a focus on trustworthiness. Sage Open, 4(1), 1-10. https://doi.org/10.1177/2158244014522633
Gallagher, D., & Herrmann, N. (2015). Agitation and aggression in Alzheimer's Disease: An update on pharmacological and psychosocial approaches to care. Neurodegenerative Disease Management, 5(1), 77-83.
Gulpers, M., Bleijlevens, M., Ambergen, T., Capezuti, E., van Rossum, E., & Hamers, J. (2013). Reduction of belt restraint use: Long-term effects of the EXBELT intervention. Journal of the American Geriatric Society, 61(1), 107-112. https://doi.org/10.1111/jgs.12057
Haut, A., Kolbe, N., Strupeit, S., Mayer, H., & Meyer, G. (2010). Attitudes of relatives of nursing home residents towards physical restraints. Journal of Nursing Scholarship, 42(4), 448-456.
Hofmann, H., & Hahn, S. (2014). Characteristics of nursing home residents and physical restraint: A systematic literature review. Journal of Clinical Nursing, 23(21/22), 3012-3024. https://doi.org/10.1111/jocn.12384
Jessop, T., Harrison, F., Cations, M., Draper, B., Chenoweth, L., Hilmer, S., & Brodarty, H. (2017). Halting antipsychotic use in long-term care (HALT); a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioural and psychological symptoms. International Psychogeriatrics, 29(8), 1391-1403.
Jeste, D., & Maglione, J. (2013). Atypical antipsychotics for older adults: are they safe and effective as we once thought. Journal of Comparative Effectiveness Research, 2(4), 355-358. https://doi.org/10.2217/cer.13.33
Kodar, D., Hunt, G., & Davison, T. (2014). Staff's views on managing symptoms of dementia in nursing home residents. Nursing Older People, 26(10), 31-36.
Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy, 45, 214-222.
Livingston, G., Barber, J., Marston, L., Stringer, A., Panca, M., Hunter, R., Cooper, C., Laybourne, A., La Frenais, F., Reeves, S., Manela, M., Lambe, K., Banerjee, S., & Rapaport, P. (2019). Clinical and cost-effectiveness of the managing agitation and raising quality of life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. Lancet Psychiatry, 6, 293-304.
Mental Health Commission of NSW (2017). Living well in later life: The case for change. Mental Health Commission of NSW.
Morley, J. (2010). Clinical pratice in nursing homes as a key for progress. Journal of Nutrition, Health and Ageing, 14(7), 586-593.
National Health and Medical Research Council, Australian Research Council and Universities Australia (2018). Australian code for the responsible conduct of research. Commonwealth of Australia.
Neville, C., & Teri, L. (2011). Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. International Journal of Mental Health Nursing, 20(3), 195-201.
New South Wales Nursing and Midwifery Association (2016). Who will keep me safe. Retrieved from http://www.nswnma.asn.au/wp-content/uploads/2016/02/Elder-Abuse-in-Residential-Aged-Care-FINAL.pdf
Pritchard, J., & Brighty, A. (2015). Caring for older people experiencing agitation. Nursing Standard, 29(30), 49-58.
Rapaport, P., Livingston, G., Hamilton, O., Turner, R., Stringer, A., Robertson, S., & Cooper, C. (2018). How do care homes staff understand, manage and respond to agitation in people with dementia? A qualitative study. British Medical Journal Open, 8, e022260. https://doi.org/10.1136/bmjopen-2018-022260
Runci, S. J., Eppingstall, B. J., & O'Conner, D. W. (2012). A comparison of verbal communication and psychiatric medication use by Greek and Italian residents with dementia in Australian ethno-specific and mainstream aged care facilities. International Psychogeriatrics, 24(5), 733-741. https://doi.org/10.1017/S1041610211002134
Sano, M., Soto, M., Carrillo, M., Cummings, J., Hendrix, S., Mintzer, J., & the EU/US/CRAD Task Force members (2018). Identifying better outcome measures to improve treatment of agitation in dementia: A report from the EU/US/CTAD task force. Journal of Alzheimers Disease, 5(2), 98-102.
Siddiqui, W., Gupta, V., & Huecker, M. (2020). Agitation [Updated 2020 Apr 17]. In StatPearls [Internet]. : StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493153/
Thakur, M., & Gwyther, L. (2015). Agitation in older adults. In D. Steffens, G. Blazer, & M. Thankur (Eds.), American psychiatric publishing textbook of geriatric psychiatry (5th ed., pp. 507-527). American Pyschological Publishing.
Treddlie, C., & Tashakkori, A. (2012). Common “core” characteristics of mixed methods research: A review of critical issues and call for greater convergence. American Behavioural Scientist, 56(6), 774-788.
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nursing and Health Sciences, 15, 398-405.
Vickland, V., Chilko, N., Draper, B., Low, L., O'Conner, D., & Brodaty, H. (2012). Individualised guidelines for the management of aggression in dementia - Part 1: Key concepts. International Psychogeriatrics, 24(7), 1112-1124.
Watson, K., Hatcher, D., & Good, A. (2019). A randomised controlled trial of Lavender (Lavandula angustifolia) and Lemon Balm (Melissa officinalis) essential oils for the treatment of agitated behaviour in older people with and without dementia. Complementary Therapies in Medicine, 42, 366-373.
Zwijsen, S. A., Kabboord, A., Eefsting, J. A., Hertogh, C. M. P. M., Pot, A. M., Gerritsen, D. L., & Smalbrugge, M. (2014). Nurses in distress? An explorative study into the relation between distress and individual neuropsychiatric symptoms of people with dementia in nursing homes. International Journal of Geriatric Pyschiatry, 29(4), 384-391.