Sensory stimulation for people with dementia. The effect of the Sonas programme on communication

Avhandling (ph.d.) - VID vitenskapelige høgskole, Oslo, 2017The increase in communication difficulties among people living with dementia and their reduced ability to interpret sensory stimulation, emphasize the need to find appropriate interventions to overcome these challenges. A variety of sensory stimulation interventions has been developed; however, neither the effect of these interventions nor their characteristics are clear. In addition, strategies developed to improve communication in people with dementia are limited, as well as psychometrically tested communication scales to assess their communication ability.Paper I: Strøm, B., Ytrehus, S., & Grov, E. (2016). Sensory stimulation for persons with dementia: A review of the literature. Journal of Clinical Nursing, 25(13-14), 1805-1834. DOI: 10.1111/jocn.13169 / Not in the file in Brage because of copyright restrictions.Paper II: Strøm, B. S., Engedal, K., Benth, J. S. & Grov, E. K (2016). Psychometric evaluation of the Holden communication Scale (HCS) for persons with dementia. BMJ open, 6, DOI:10.1136/bmjopen-2016-013447Paper III: Strøm, B., Engedal, K., Benth, J., & Grov, E. (2017). Effect of the Sonas Programme on Communication in People with Dementia: A Randomized Controlled Trial. Dementia and Geriatric Cognitive Disorders Extra, 7(1), 122-135. DOI: 10.1159/00046814

Overview of research on the Sonas® programme

This review found evidence of a significant effect of the Sonas programme on communication ability among people with severe dementia. However, it is difficult to compare the outcomes of the studies as they vary in terms of sample size, length of intervention period, frequency and delivery. Furthermore, while there is training for people who wish to deliver the Sonas intervention, some studies involved the delivery of Sonas sessions by untrained staff. Some studies did include persons without dementia. A comparison is also difficult because several of the studies have methodological weaknesses and no measure used for adherence to the Sonas intervention.publishedVersio

A Psychometric Evaluation of the Threadgold Communication Tool for Persons with Dementia

The objective of this study was to investigate the psychometric properties of the Threadgold Communication Tool (TCT). Method: Internal consistency reliability was measured using Cronbach’s α coefficient and inter-item correlation. Test-retest was performed to examine the instrument’s stability. Exploratory principal component analysis (PCA) with oblimin rotation was carried out to evaluate construct validity. Finally, the score on each item of the TCT was correlated with the person’s Mini Mental State Examination (MMSE) and Barthel Index of activities of daily living scores. Results: A total of 51 persons participated, with a mean age of 86.7 (SD 6.6) years, of whom 46 were women with moderate-to-severe dementia [mean MMSE score 7.5 (SD 6.7)]. There were two measurement points 2 weeks apart. The results showed a satisfactory level for internal consistency and a high test-retest reliability (r = 0.76). The corrected item-total correlation ranged between 0.50 and 0.87, and a two-factor structure was revealed at the PCA. ‘Vocalizing’ seemed to measure another aspect of communication and was the only item which was negatively loaded. Conclusion: Despite the low sample size in this study, the results revealed the TCT as a reliable and valid instrument, suitable for measuring communication among people with dementia. We suggest clarifying the understanding of ‘vocalizing’ before considering removing it from the scale

Engagement in everyday activities among people living in Indian nursing homes: the association with person-centredness

Introduction: It has been reported that residents living in nursing homes are often inactive and lonely and are offered a limited number of activities. However, high engagement in activities has been reported to improve residents’ quality of life and engagement in personalized activities can even reduce agitation and enhance positive mood. Information regarding occupational patterns and purpose in life is well established in Western countries. However, we know next to nothing about how people living in Indian nursing homes spend their days. Objective: To explore the participation in everyday activities among older people in Indian nursing homes and the extent to which engagement in activities is associated with personcentred care. Methods: The study was conducted in 6 nursing homes in India, comprising 147 residents. In all, 23 nursing staff took part and completed a 26-item questionnaire about resident activities based on the Multi-Dimensional Dementia Assessment Scale and the Person- Directed Care Questionnaire. Person-centredness was measured with the Person-Centred Care Assessment Tool. Results: We found low participation in everyday activities among the residents. Participation in religious activities was the most frequent, whereas the least used activities were excursions, participating in cultural activities, taking part in educational programmes, visiting a restaurant and going to the cinema. A significant positive association was found between person-centred care and participation in religious activities, engagement in an activity programme and physical activity. Conclusions: The most frequently attended activity was religious activities. Person-centred care was associated with participation in religious activities, engagement in an activity programme, physical activity, spending time in the garden and playing and listening to music.publishedVersio

Impact of the Sonas Programme on Communication over a Period of 24 Weeks in People with Moderate-to-Severe Dementia

Objectives: The primary aim was to examine how communication abilities changed over time among nursing home residents with moderate-to-severe dementia who were attending the Sonas programme and to explore whether changes in communication abilities were related to cognitive ability. Method: A longitudinal secondary descriptive study method was employed, where 56 people with moderate-to-severe dementia attended a 45-min Sonas group session twice a week for 24 weeks. The Threadgold Communication Tool (TCT) was completed every 4 weeks. Results: The impact of the Sonas programme on communication showed a significant non-linear trend in the TCT, with an increase in communication abilities during the first 16 weeks, regardless of the level of the residents’ cognitive abilities. Thereafter it levelled out. No interaction was found between time and the frequency of attendances at Sonas sessions. Both verbal and non-verbal communication increased from the baseline, with non-verbal communication increasing quickly and verbal communication increasing marginally. Conclusion: Communication abilities increased with the time of the intervention, but the peak was achieved after 16 weeks, after which the effect levelled out. This suggest that the Sonas programme should be used for a period of at least 16 weeks before evaluating its effect

Nursing staff’s knowledge and attitudes towards Dementia in an Indian nursing home: A qualitative interview study

Background: Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude. Aim: To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India. Method: An explorative and descriptive qualitative design was used. Two semistructured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services. Findings: The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia – a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way. Conclusion: The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.publishedVersio

Measurement instruments for parental stress in the postpartum period: A scoping review

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured. Objectives: This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties. Methods: We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0–12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively. Results: From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments. Discussion: There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments’ psychometric properties is slight. There is a need for further research.publishedVersio

Sammenheng og overganger i tjenestene - Kunnskapsnotat

Reformen Leve hele livet, som Solberg II-regjeringen la frem i mai 2018, skal bidra til at eldre kan mestre livet lenger, ha trygghet for at de får god hjelp når de har behov for det, at pårørende kan bidra uten at de blir utslitt og at ansatte kan bruke sin kompetanse i tjenestene. I Meld. St. 15 (2017–2018) presenteres og beskrives reformen. Meldingen vektlegger i særlig grad å skape et mer aldersvennlig Norge og finne nye og innovative løsninger på utfordringer knyttet til aktivitet og fellesskap, mat og måltider, helsehjelp, sammenheng og overganger i tjenestene (Helse- og omsorgsdepartementet, 2018a, s. 54). Én av reformens målsettinger er å skape et mer sammenhengende tjenestetilbud som kan bidra til økt kontinuitet, trygghet og forutsigbarhet i pasientforløpet til eldre (over 65 år) og deres pårørende. På oppdrag fra Helsedirektoratet har Senter for omsorgsforskning laget denne kunnskapsoppsummeringen om sammenheng og overganger i tjenestene for personer som er i målgruppa for kvalitetsreformen Leve hele livet. Den presenterer faglige, juridiske og politiske dokumenter som regulerer og legger føringer for temaet, og den identifiserer, omtaler og oppsummerer forsknings- og utviklingsarbeid knyttet til utfordringer og tiltak innen reformområdet «sammenheng og overganger i tjenestene». Disse forsknings- og utviklingsarbeidene er publisert i perioden 2008–2019. Oppsummeringen baserer seg i all hovedsak på empiri fra en norsk og/eller nordisk kontekst og er skrevet på et skandinavisk språk eller engelsk. Internasjonale kunnskapsoppsummeringer og enkeltstående studier er imidlertid tatt med hvis de er vurdert til å ha særskilt overføringsverdi og relevans for en norsk kontekst

Sammenheng og overganger i tjenestene

Reformen Leve hele livet, som Solberg II-regjeringen la frem i mai 2018, skal bidra til at eldre kan mestre livet lenger, ha trygghet for at de får god hjelp når de har behov for det, at pårørende kan bidra uten at de blir utslitt og at ansatte kan bruke sin kompetanse i tjenestene. I Meld. St. 15 (2017–2018) presenteres og beskrives reformen. Meldingen vektlegger i særlig grad å skape et mer aldersvennlig Norge og finne nye og innovative løsninger på utfordringer knyttet til aktivitet og fellesskap, mat og måltider, helsehjelp, sammenheng og overganger i tjenestene (Helse- og omsorgsdepartementet, 2018a, s. 54). Én av reformens målsettinger er å skape et mer sammenhengende tjenestetilbud som kan bidra til økt kontinuitet, trygghet og forutsigbarhet i pasientforløpet til eldre (over 65 år) og deres pårørende. På oppdrag fra Helsedirektoratet har Senter for omsorgsforskning laget denne kunnskapsoppsummeringen om sammenheng og overganger i tjenestene for personer som er i målgruppa for kvalitetsreformen Leve hele livet. Den presenterer faglige, juridiske og politiske dokumenter som regulerer og legger føringer for temaet, og den identifiserer, omtaler og oppsummerer forsknings- og utviklingsarbeid knyttet til utfordringer og tiltak innen reformområdet «sammenheng og overganger i tjenestene». Disse forsknings- og utviklingsarbeidene er publisert i perioden 2008–2019. Oppsummeringen baserer seg i all hovedsak på empiri fra en norsk og/eller nordisk kontekst og er skrevet på et skandinavisk språk eller engelsk. Internasjonale kunnskapsoppsummeringer og enkeltstående studier er imidlertid tatt med hvis de er vurdert til å ha særskilt overføringsverdi og relevans for en norsk kontekst

Welfare technology interventions among older people living at home—A systematic review of RCT studies

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The main goal of health services is for the elderly to maintain their mental and physical health and live at home independently for as long as possible. Various technical welfare solutions have been introduced and tested to support an independent life. The aim of this systematic review was to examine different types of interventions and assess the effectiveness of welfare technology (WT) interventions for older people living at home. This study was prospectively registered in PROSPERO (CRD42020190316) and followed the PRISMA statement. Primary randomized control trial (RCT) studies published between 2015 and 2020 were identified through the following databases: Academic, AMED, Cochrane Reviews, EBSCOhost, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Scopus, and Web of Science. Twelve out of 687 papers met the criteria for eligibility. We used riskof-bias assessment (RoB 2) for the included studies. Based on the RoB 2 outcomes that showed a high risk of bias (>50%) and high heterogeneity of quantitative data, we decided to narratively summarize the study characteristics, outcome measures, and implications for practice. The included studies were conducted in six countries, namely the USA, Sweden, Korea, Italy, Singapore, and the UK. One was conducted in three European countries (the Netherlands, Sweden, and Switzerland). A total of 8437 participants were sampled, and individual study sample sizes ranged from 12 to 6742. Most of the studies were two-armed RCTs, except for two that were three-armed. The duration of the welfare technology tested in the studies ranged from four weeks to six months. The employed technologies were commercial solutions, including telephones, smartphones, computers, telemonitors, and robots. The type of interventions were balance training, physical exercise and function, cognitive training, monitoring of symptoms, activation of emergency medical systems, self-care, reduction of death risk, and medical alert protection systems. The latter studies were the first of their kind and suggested that physician-led telemonitoring could reduce length of hospital stay. In summary, welfare technology seems to offer solutions to supporting elderly people at home. The results showed a wide range of uses for technologies for improving mental and physical health. All studies showed encouraging results for improving the participants’ health status.publishedVersio