The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia

<p>Abstract</p> <p>Background</p> <p>Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers such as a lack of resources impede the implementation of activities in aged care facilities. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care.</p> <p>Methods/Design</p> <p>We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will be randomly assigned by facility to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition.</p> <p>Discussion</p> <p>We hypothesise that training family carers to deliver personalised activities to their relatives in a residential setting will make visits more satisfying and may consequently improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry - <a href="http://www.anzctr.org.au/ACTRN12611000998943.aspx">ACTRN12611000998943</a></p

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

Background: Older migrants with dementia and limited English language proficiency in residential care may have unmet needs for social interaction. This project compared verbal communication and prescribed psychiatric medication of Greek and Italian residents with dementia in ethno-specific and mainstream residential care. Methods: Participants were 82 older Australians of Greek or Italian background who had been diagnosed with dementia and were residing in mainstream or ethno-specific care. Residents were observed and their language use was recorded. An assessment of cognitive impairment was conducted. A structured interview was held with a family member and a staff member. Results: The observed rate of resident-to-resident communication was higher in the ethno-specific facilities. Staff-to-resident interaction rate did not differ between the facility types. Residents in ethno-specific care were prescribed antipsychotics at a significantly lower rate. Conclusions: Residents with dementia and limited English language proficiency in mainstream care would benefit from greater opportunities to interact with peers in their own language. Prescribed medication should be monitored to ensure that these residents are not misinterpreted as “disruptive,” or are not actually more agitated due to difficulty in communicating their needs

Comparison of family satisfaction in Australian ethno-specific and mainstream aged care facilities

The aim in this study was to identify specific aspects of care that increased satisfaction of family members of Greek and Italian residents with dementia in mainstream or ethno-specific aged care facilities in Australia. Relatives of 83 aged care residents with Greek or Italian backgrounds who were also cognitively impaired were interviewed. They rated their satisfaction with the facility and suggested improvements regarding the care provided. Family members with relatives in ethno-specific care were more satisfied, in terms of the facility’s ability to meet the resident’s language and cultural needs, social/leisure activities, and the food provided. The presence of a bilingual staff member and greater perceived reduction in family caregiver stress upon admission were associated with higher satisfaction. Results implicate the role of activities programs, catering, resident interaction, supporting caregivers upon admission, and bilingual staff members to increase family satisfaction, with the potential to improve the care provided to residents in mainstream care

A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with dementia

Background: Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition. Methods: We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement. Results: Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions. Conclusion: Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents’ needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities’ resources. Trial Registration: Australian New Zealand Clinical Trials Registry – ACTRN12609000564257