Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior.
Challenging behavior
Dementia
Long-term care
Organizational
Physical environment
Sensory stimuli
Treatment
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
14 Aug 2024
14 Aug 2024
Historique:
received:
11
04
2024
accepted:
29
07
2024
medline:
15
8
2024
pubmed:
15
8
2024
entrez:
14
8
2024
Statut:
epublish
Résumé
People with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior. Three data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places. Patients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one's own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient's biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low. Highly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.
Sections du résumé
BACKGROUND
BACKGROUND
People with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior.
METHODS
METHODS
Three data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places.
RESULTS
RESULTS
Patients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one's own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient's biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low.
CONCLUSION
CONCLUSIONS
Highly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.
Identifiants
pubmed: 39143456
doi: 10.1186/s12877-024-05257-x
pii: 10.1186/s12877-024-05257-x
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
681Subventions
Organisme : Netherlands Organization for Health Research and Development (ZonMw)
ID : 839120009
Organisme : Netherlands Organization for Health Research and Development (ZonMw)
ID : 839120009
Informations de copyright
© 2024. The Author(s).
Références
Gerritsen DL, Smalbrugge M, Veldwijk-Rouwenhorst AE, Wetzels R, Zuidema SU, Koopmans R. the difficulty with studying challenging behavior. J Am Med Dir Assoc. 2019;20(7):879–81.
pubmed: 30910553
doi: 10.1016/j.jamda.2019.01.148
Selbaek G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc. 2013;14(3):161–9.
pubmed: 23168112
doi: 10.1016/j.jamda.2012.09.027
Livingston G, Barber J, Marston L, Rapaport P, Livingston D, Cousins S, et al. Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study. BJPsych Open. 2017;3(4):171–8.
pubmed: 28794896
pmcid: 5530006
doi: 10.1192/bjpo.bp.117.005181
Henskens M, Nauta IM, Vrijkotte S, Drost KT, Milders MV, Scherder EJA. Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: a cross-sectional study. PLoS One. 2019;14(12):e0223704.
pubmed: 31860641
pmcid: 6924675
doi: 10.1371/journal.pone.0223704
Majer R, Adeyi O, Bagoly Z, Simon V, Csiba L, Kardos L, et al. Neuropsychiatric symptoms, quality of life and caregivers’ burden in dementia. Open Med (Wars). 2020;15(1):905–14.
pubmed: 33336048
doi: 10.1515/med-2020-0124
Brites R, Brandao T, Moniz Pereira F, Hipolito J, Nunes O. Effects of supporting patients with dementia: a study with dyads. Perspect Psychiatr Care. 2020;56(3):614–20.
pubmed: 31970779
Black W, Almeida OP. A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int Psychogeriatr. 2004;16(3):295–315.
pubmed: 15559754
doi: 10.1017/S1041610204000468
Svendsboe E, Terum T, Testad I, Aarsland D, Ulstein I, Corbett A, Rongve A. Caregiver burden in family carers of people with dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry. 2016;31(9):1075–83.
pubmed: 26765199
doi: 10.1002/gps.4433
Backhouse T, Camino J, Mioshi E. What do we know about behavioral crises in dementia? A systematic review. J Alzheimers Dis. 2018;62(1):99–113.
pubmed: 29439334
doi: 10.3233/JAD-170679
Buylova Gola A, Morris S, Candy B, Davis S, King M, Kupeli N, et al. Healthcare utilization and monetary costs associated with agitation in UK care home residents with advanced dementia: a prospective cohort study. Int Psychogeriatr. 2020. https://doi.org/10.1017/S1041610219002059 .
Veldwijk-Rouwenhorst AE, Smalbrugge M, Wetzels R, Bor H, Zuidema SU, Koopmans RTCM, Gerritsen DL. Nursing home residents with dementia and very frequent agitation: a particular group. Am J Geriatr Psychiatry. 2017;25(12):1339–48.
pubmed: 28886978
doi: 10.1016/j.jagp.2017.08.002
Palm R, Sorg CGG, Strobel A, Gerritsen DL, Holle B. Severe agitation in dementia: an explorative secondary data analysis on the prevalence and associated factors in nursing home residents. J Alzheimers Dis. 2018;66(4):1463–70.
pubmed: 30412491
pmcid: 6294574
doi: 10.3233/JAD-180647
Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Bor H, Wetzels R, Gerritsen DL, Koopmans R. Very frequent physical aggression and vocalizations in nursing home residents with dementia. Aging Ment Health. 2021;25(8):1442–51.
pubmed: 32602746
doi: 10.1080/13607863.2020.1786799
Verbeek H, van Rossum E, Zwakhalen SM, Kempen GI, Hamers JP. Small, homelike care environments for older people with dementia: a literature review. Int Psychogeriatr. 2009;21(2):252–64.
pubmed: 19102801
doi: 10.1017/S104161020800820X
Bergmann JM, Hoffmann AL, Müller-Widmer R, Palm R. Typology of dementia-specific care units: a nationwide survey study in Germany. Innov Aging. 2023;7(6):igad062.
pubmed: 37601899
pmcid: 10433786
doi: 10.1093/geroni/igad062
Joyce NR, McGuire TG, Bartels SJ, Mitchell SL, Grabowski DC. The impact of dementia special care units on quality of care: an instrumental variables analysis. Health Serv Res. 2018;53(5):3657–79.
pubmed: 29736944
pmcid: 6153167
doi: 10.1111/1475-6773.12867
Backhaus R, Verbeek H, van Rossum E, Capezuti E, Hamers JPH. Baccalaureate-educated registered nurses in nursing homes: experiences and opinions of administrators and nursing staff. J Adv Nurs. 2018;74(1):75–88.
pubmed: 28702942
doi: 10.1111/jan.13391
Koopmans RTCM, Pellegrom M, van der Geer ER. The Dutch move beyond the concept of nursing home physician specialists. J Am Med Dir Assoc. 2017;18(9):746–9.
pubmed: 28668662
doi: 10.1016/j.jamda.2017.05.013
Zwijsen SA, Smalbrugge M, Eefsting JA, Twisk JWR, Gerritsen DL, Pot AM, Hertogh C. Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. J Am Med Dir Assoc. 2014;15(7):531 e1-e10.
pubmed: 24878214
doi: 10.1016/j.jamda.2014.04.007
Verenso. Elderly care physicians in the Netherlands: Verenso, the Dutch Association of Elderly Care Physicians and Social Geriatricians; 2015. https://www.verenso.nl/_asset/_public/Vereniging/ALV/Ledenprojecten/VER0026_Professionalprofile_broch_DEF.pdf . Accessed 31 Oct 2023.
FGZPT. Psychologists in health care in the Netherlands: - health care psychologist - psychotherapist - clinical psychologist - clinical neuropsychologist: Federatie van Gezondheidspsychologen en Psychotherapeuten; 2014. https://www.fgzpt.nl/e2/site/fgzpt/custom/site/upload/file/pdf/180725_fgzpt_bro_neuro_eng_24082017_aangepast_tel_en_mail.pdf . Accessed 1 Oct 2023.
European Union europass. Description of the eight EQF levels: European Union; 2005 https://europa.eu/europass/en/description-eight-eqf-levels . Accessed 31 Oct 2023.
Maessen K, van Vught A, Gerritsen DL, Lovink MH, Vermeulen H, Persoon A. Development and validation of the Dutch EBPAS-ve and EBPQ-ve for nursing assistants and nurses with a vocational education. Worldviews Evid Based Nurs. 2019;16(5):371–80.
pubmed: 31489765
doi: 10.1111/wvn.12389
van Bussel EF, Richard E, Arts DL, Nooyens AC, Coloma PM, de Waal MW, et al. Dementia incidence trend over 1992–2014 in the Netherlands: analysis of primary care data. PLoS Med. 2017;14(3):e1002235.
pubmed: 28267788
pmcid: 5340347
doi: 10.1371/journal.pmed.1002235
Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–25.
doi: 10.1016/S2468-2667(21)00249-8
Adlbrecht L, Bartholomeyczik S, Mayer H. Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation. BMC Geriatr. 2021;21(1):680.
pubmed: 34876048
pmcid: 8650270
doi: 10.1186/s12877-021-02637-5
Kok JS, Berg IJ, Scherder EJ. Special care units and traditional care in dementia: relationship with behavior, cognition, functional status and quality of life - a review. Dement Geriatr Cogn Dis Extra. 2013;3(1):360–75.
pubmed: 24403908
pmcid: 3884203
doi: 10.1159/000353441
Kroon H, Knispel, A., Hulsbosch, L., de Lange, A. Landelijke Monitor Ambulantisering en Hervorming Langdurige GGZ 2020. Utrecht: Netherlands Institute of Mental Health and Addiction; 2021. https://www.trimbos.nl/aanbod/webwinkel/af1838-landelijke-monitor-ambulantisering-en-hervorming-langdurige-ggz-2020/ . Accessed 2 Apr 2024.
de Bruin AF, Ettema H, van Kemenade Y. D-ZEP zorgt voor zorgvuldige analyse en aanpak. Denkbeeld. 2021;33(5):30–2.
doi: 10.1007/s12428-021-0901-7
Health and Youth Care Inspectorate. Verbetering nodig in zorg voor cliënten met zeer ernstig probleemgedrag bij dementie: Ministry of Health, Welfare and Sport; 2020. https://www.igj.nl/publicaties/publicaties/2020/01/13/probleemgedrag-bij-dementie . Accessed 2 Apr 2024.
Department of Health. Specialist Dementia Care Program framework: Australian Government; 2018. https://www.health.gov.au/our-work/specialist-dementia-care-program-sdcp . Accessed 2 Apr 2024.
Gresham M, Morris T, Min Chao S, Lorang C, Cunningham C. Specialist residential dementia care for people with severe and persistent behaviours: a ten-year retrospective review. Australas J Ageing. 2021;40(3):309–16.
pubmed: 34043267
doi: 10.1111/ajag.12964
Koopmans RT, Lavrijsen JC, Hoek F. Concrete steps toward academic medicine in long term care. J Am Med Dir Assoc. 2013;14(11):781–3.
pubmed: 24021540
doi: 10.1016/j.jamda.2013.08.004
Guest G, MacQueen K, Namey E. Applied Thematic Analysis. Thousand Oaks, California: SAGE Publications, Inc.; 2012. https://methods.sagepub.com/book/applied-thematic-analysis .
LimeSurvey GmbH. LimeSurvey: An Open Source survey tool (version 2.06+). 2015. https://www.limesurvey.org .
de Boer B, Hamers JP, Beerens HC, Zwakhalen SM, Tan FE, Verbeek H. Living at the farm, innovative nursing home care for people with dementia - study protocol of an observational longitudinal study. BMC Geriatr. 2015;15:144.
pubmed: 26527159
pmcid: 4630972
doi: 10.1186/s12877-015-0141-x
de Boer B, Beerens HC, Katterbach MA, Viduka M, Willemse BM, Verbeek H. The physical environment of nursing homes for people with dementia: traditional nursing homes, small-scale living facilities, and Green Care Farms. Healthcare (Basel). 2018;6(4):137.
pubmed: 30486306
pmcid: 6315793
doi: 10.3390/healthcare6040137
Rosteius K, de Boer B, Staudacher S, Schols J, Verbeek H. How the interrelated physical, social and organizational environment impacts daily life of residents with dementia on a Green Care Farm. Front Public Health. 2022;10:946962.
pubmed: 36106159
pmcid: 9467523
doi: 10.3389/fpubh.2022.946962
Mills A, Durepos G, Wiebe E. Encyclopedia of case study research. Thousand Oaks: SAGE Publications, Inc.; 2010. https://sk.sagepub.com/reference/casestudy .
doi: 10.4135/9781412957397
Evers J, de Boer F. The qualitative interview: art and skill. Utrecht: Eleven International Publishing; 2012.
ATLAS.ti Scientific Software Development GmbH. ATLAS.ti (version 8.3.16). 2018. https://atlasti.com .
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
pubmed: 17872937
doi: 10.1093/intqhc/mzm042
Champagne T. Sensory modulation in dementia care: assessment and activitites for sensory-enriched Care. 1st ed. London and Philadelphia: Jessica Kingsley Publishers; 2018.
Hendriks R. Clown’s view as respicio: looking respectfully to and after people with dementia. Med Health Care Philos. 2017;20(2):207–17.
pubmed: 27663884
doi: 10.1007/s11019-016-9734-1
Haynes T, Pratt ES. Bed enclosures: suitable safety net? Nurs Manage. 2009;40(12):36–9.
pubmed: 19966551
doi: 10.1097/01.NUMA.0000365470.32216.c3
Molleman PW, van Kesteren JB, Ubink-Bontekoe CJ, Zoomer-Hendriks MP, Wetzels R. Canopy-enclosed bed for dementia patients with behavioural problems. Ned Tijdschr Geneeskd. 2015;159:A9617.
pubmed: 26577384
Stokes G. Challenging behaviour in dementia: a person centred approach. 1st ed. Speechmark; 2000.
Pieper MJ, Francke AL, van der Steen JT, Scherder EJ, Twisk JW, Kovach CR, Achterberg WP. Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced Dementia: a cluster randomized controlled trial. J Am Geriatr Soc. 2016;64(2):261–9.
pubmed: 26804064
doi: 10.1111/jgs.13868
Zwijsen SA, Smalbrugge M, Zuidema SU, Koopmans RT, Bosmans JE, van Tulder MW, et al. Grip on challenging behaviour: a multidisciplinary care programme for managing behavioural problems in nursing home residents with dementia. Study protocol. BMC Health Serv Res. 2011;11:41.
pubmed: 21338502
pmcid: 3051882
doi: 10.1186/1472-6963-11-41
de Jonghe JFM, Kat MG, Kalisvaart KJ, Boelaarts L. Neuropsychiatric Inventory Questionnaire (NPI-Q): a validity study of the Dutch form. Tijdschr Gerontol Geriatr. 2003;34(3):74–7.
pubmed: 12741091
Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989;44(3):M77-84.
pubmed: 2715584
doi: 10.1093/geronj/44.3.M77
van Dijk G. Care of people who are powerless in daily living (PDL care): a theoretical approach. Groningen: University of Groningen; 2008.
Osborne H, Simpson J, Stokes G. The relationship between pre-morbid personality and challenging behaviour in people with dementia: a systematic review. Aging Ment Health. 2010;14(5):503–15.
pubmed: 20480417
doi: 10.1080/13607861003713208
Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Persoon A, Koopmans R, Gerritsen DL. Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia. BMC Geriatr. 2022;22(1):758.
pubmed: 36114482
pmcid: 9479311
doi: 10.1186/s12877-022-03438-0
van Voorden G, Koopmans RTCM, Smalbrugge M, Zuidema SU, van den Brink AMA, Persoon A, et al. Well-being, multidisciplinary work and a skillful team: essential elements of successful treatment in severe challenging behavior in dementia. Aging Ment Health. 2023. https://doi.org/10.1080/13607863.2023.2169248 .
Sánchez A, Marante-Moar MP, Sarabia C, de Labra C, Lorenzo T, Maseda A, Millán-Calenti JC. Multisensory stimulation as an intervention strategy for elderly patients with severe dementia: a pilot randomized controlled trial. Am J Alzheimers Dis Other Demen. 2016;31(4):341–50.
pubmed: 26631687
doi: 10.1177/1533317515618801
Ravn MB, Klingberg T, Petersen KS. The adult sensory profile™ in care homes targeting people diagnosed with dementia: a qualitative study from the care provider perspective. Rehabil Res Pract. 2018;2018:5091643.
pubmed: 30155306
pmcid: 6098864
Salize HJ, Dreßing H, Peitz M. Compulsory admission and involuntary treatment of mentally ill patients - legislation and practice in EU-Member States. Mannheim: European Commission; 2002.
Chen M, Goodwin JS, Bailey JE, Bowblis JR, Li S, Xu H. Longitudinal associations of staff shortages and staff levels with health outcomes in nursing homes. J Am Med Dir Assoc. 2023;24(11):1755-60.e7.
pubmed: 37263319
doi: 10.1016/j.jamda.2023.04.017
Milte R, Shulver W, Killington M, Bradley C, Ratcliffe J, Crotty M. Quality in residential care from the perspective of people living with dementia: the importance of personhood. Arch Gerontol Geriatr. 2016;63:9–17.
pubmed: 26791166
doi: 10.1016/j.archger.2015.11.007
Piirainen P, Pesonen H-M, Kyngäs H, Elo S. Challenging situations and competence of nursing staff in nursing homes for older people with dementia. Int J Older People Nurs. 2021;16(5):e12384.
pubmed: 34075711
doi: 10.1111/opn.12384
Geoffrion S, Hills DJ, Ross HM, Pich J, Hill AT, Dalsbø TK, et al. Education and training for preventing and minimizing workplace aggression directed toward healthcare workers. Cochrane Database Syst Rev. 2020;9:CD011860.
pubmed: 32898304
Kroezen M, Schäfer W, Sermeus W, Hansen J, Batenburg R. Healthcare assistants in EU Member States: an overview. Health Policy (New York). 2018;122(10):1109–17.
doi: 10.1016/j.healthpol.2018.07.004
Rasheed SP, Younas A, Sundus A. Self-awareness in nursing: a scoping review. J Clin Nurs. 2019;28(5–6):762–74.
pubmed: 30362645
doi: 10.1111/jocn.14708
Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of medical research council guidance. BMJ. 2021;374:n2061.
pubmed: 34593508
pmcid: 8482308
doi: 10.1136/bmj.n2061
Verhees LHF, Banning LCP, Stalman H, Koopmans RTCM, Gerritsen DL. Transferring people with dementia to severe challenging behavior specialized units, an in-depth exploration. Aging Ment Health. 2023. https://doi.org/10.1080/13607863.2023.2280673 .
Adlbrecht L, Bartholomeyczik S, Hildebrandt C, Mayer H. Social interactions of persons with dementia living in special care units in long-term care: a mixed-methods systematic review. Dementia. 2021;20(3):967–84.
pubmed: 32326748
doi: 10.1177/1471301220919937
Verbeek-Oudijk D, Koper I. Summary Life in a nursing home - National overview of the life situation, perceived quality of life and care for older nursing home residents in the Netherlands in 2019. The Hague: The Netherlands Institute for Social Research; 2021. https://www.scp.nl/binaries/scp/documenten/publicaties/2021/02/19/het-leven-in-een-verpleeghuis/Het+leven+in+een+verpleeghuis_Summary.pdf . Accessed 16 Apr 2024.