Non-Pharmacological Interventions For Behavioural And Psychological Symptoms Of Dementia In Care Homes

Study Design

Discuss about the Learning Contract for National Institute for Health Care.

People who suffer from dementia and living in the care homes often experience distressing behavioural episodes in addition to psychological symptoms of dementia (BPSD). The symptoms of this condition is perceived through the occurrences of aggression, agitation, along with signs of anxiety and sexual disinhibition accompanied by walking about and questioning repeatedly (Koder, Hunt & Davison, 2014). These patients are often prescribed with antipsychotic medications. This antipsychotic medication is often given to these patients suffering from BPSD as the first line of treatment. However, most of these medications are associated with some limited efficacy. Therefore, this had led to the development and application of various non- pharmacological interventions (NPIs) which in turn includes certain therapies like aromatherapy, multisensory stimulation, massage accompanied by animal therapy and music therapy. The National Institute for Health Care and Excellence (NICE) have suggested such therapies (Brechin, 2013). This study aims to highlight the use of NPIs in order to work with individuals who are experiencing BPSD on a day-to-day basis especially in the care homes setting. Additionally the paper illustrates the influence of care practises on the organizational factors that manages the care home environment.

The study will implement an in-depth ethnographic case study that will be conducted in total four care homes. This ethnographic case study will include conduction of interviews with the respondents who will be 40 of the care home staffs. Additionally 384 hours of participant observations will be considered for the conduction of the ethnographic case study. There will be a number of 37 interviews approximately with the care home staffs along with the administration mapping of the psychotropic medications which were prescribed for some of the residents of the care home. The results will be obtained using the previous postal survey conducted with the managers of the care homes. They were able to select the homes that were suitable to target the purposive sampling used for the case studies. For this study the responses who were eligible for responses who will be sorted as well as analysed. The homes will be selected as the potential sites for response that will be perceived to be more caring for the people experiencing BPSD. Priority will be given to the homes that provide guide to contact for participation. An increase in the likelihood of gaining relevant findings was the reason for guidance (Backhouse et al., 2016).

Data Collection and Analysis

Recruitment will be conducted through the provision of a cover letter along with a follow up phone call prior to the arranging of the interview. A total of 10 managers of the care homes will be contacted from a about 80 eligible care homes. Out of these the total number who will agree to the meeting will be considered at different times over a 5- to 6-week period and several number of interviews will be conducted with them. Data will not be written down or will not include the residents or the staff non-participants. A verbal information about the conducted of the study will be provided to the participants. There will be a requirement of consent from all of these participants to take part in the study.

In order to conduct data analysis, the data obtained will be typed and will be anonymised and stored securely. For extensive qualitative data set analysis, the framework approach will be used. This type of transparent approach will have five phases involving familiarisation that involves the immersion in the data in order to recognise the key themes. The other phases are identified a thematic framework that involves assembling of the ideas from the identified research questions along with the stage of familiarisation made into a framework and finally indexing that will involve the thematic framework.

The background of the study concerns the use of antipsychotic medications has been used to manage behavioural and psychological symptoms of dementia (BPSD) all these years. However, studies have shown that there are certain potential risks associated with the use of these antipsychotic medications for the individuals who are suffering from dementia, therefore in such cases it is better to use the non-pharmacological interventions (NPIs), which according to several studies have been proved as safe alternatives to these antipsychotic medications (Livingston et al., 2014). However, it is still not clear that how these interventions can be applied in the setting of the care homes to help the individuals who are suffering from BPSD. The application of the interventions is still unclear since there is a lack of literature regarding this topic (Brechin, 2013). The literature that is present is weak in nature as it mainly comprises of overviews of systematic reviews and systematic reviews. These mainly assesses whether NPIs are effective for BPSD which in turn is limited due to the poor quality of the existing studies along with the inconsistency that is present across studies in addition to consideration of small sample sizes, or the availability of very little evidence (Ma et al., 2014).

Findings

The analysis of the data will be aimed at breaking down the data collection into each of the case study. Different aspects will be generated from the given framework. Themes will be identified using this framework. This particular article will be able to show relation between the findings and the strategies and behaviours of the theme. The observed data will be able to show the activities that will be used in several ways. The activities can be observed such as the watching of television, reading of newspapers and solving jigsaws that usually occurred without staff contact. The activities such as the massage, aromatherapy along with reflexology, or nail varnishing and helping staff with jobs and doll therapy will be occurring with individuals however there was no necessity whose residents will be needing the behaviours that they are experiencing . The activities that involving those like the exercises, or reminiscence along with cognitive stimulation, music therapy in addition to arts and crafts, entertainment and church services might be provided as the group activities. There are certain activities like walking outside accompanied with gardening or cooking might also be provided as either group or individual activities. The barriers that might be included in the residents of the activities which could be either staff- or resident-led. Some staff members who avoided the inclusion of residents who were suffering with severe physical or mental difficulties or those experiencing BPSD in activities. Therefore, the residents who were experiencing BPSD, and for whom NPIs are recommended as first-line treatments and those with greater physical impairment or mental impairment, could perhaps have less access to these activities than residents with higher capacity and functioning. Finally the finally will be able to show that the care-home staff are taking steps to work hard to engage the residents successfully in order to improve their well-being (Koder, Hunt & Davison, 2014). Conduction of individual interventions could be used as the first line of treatments for these BPSD patients through the implementation of aromatherapy, music therapy or massage. The activities, which were recommended to be the first-line of treatment by NICE like the individually tailored aromatherapy long with massage or animal-assisted therapy and multisensory stimulation and music or dancing, might not appear to be identified by staff as the major activities especially for use with those residents of the care home experiencing BPSD (Ma et al., 2014). The researcher (TB) who will be conducting the data collection for this study should be having several years of paid care work who have experience working with older people. This experience will help the researchers to cope up with the emotional aspects of the work. This help to enable development of good rapport and trust which needs to be built between the researcher and participants that will help in enhancing the quality of the data (Backhouse et al., 2016).

Conclusion

From the above discussion, it can be concluded that the work that takes place in the care homes needs improvement for elevating the general well-being of the residents if the nursing care homes. This in turn is potentially prevalent for those individuals who are suffering from BPSD. However, there is an existence of a gap between rhetoric and practice in this case that needs to be addressed through the implementation of the activities with are customised interventions especially for the residents suffering from BPSD. Furthermore, the study shows that the residents who might benefit the most from NPIs and from the given that activities were generally those who have an elevated mental capacity and functioning. Finally, there is a need of an action to be taken that will help to aid the incorporation of NPIs into the care that is usually practiced so that they can be used in the moment that is specific with these individuals such as the behaviours to occur.

References

Backhouse, T., Killett, A., Penhale, B., & Gray, R. (2016). The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies. Age and ageing, 45(6), 856-863.

Brechin, D. (2013). Alternatives to antipsychotic medication: psychological approaches in managing psychological and behavioural distress in people with dementia. British Psychological Society.

Koder, D., Hunt, G. E., & Davison, T. (2014). Staff’s views on managing symptoms of dementia in nursing home residents. Nursing Older People (2014+), 26(10), 31.

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., … & Cooper, C. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. The British Journal of Psychiatry, 205(6), 436-442.

Ma, H., Huang, Y., Cong, Z., Wang, Y., Jiang, W., Gao, S., & Zhu, G. (2014). The efficacy and safety of atypical antipsychotics for the treatment of dementia: a meta-analysis of randomized placebo-controlled trials. Journal of Alzheimer’s Disease, 42(3), 915-937.