Crises in the homes of people with dementia and appropriate interventions

Abstract

Research Aim: To understand crises in the homes of people with dementia living with their family carers and crisis interventions which support families in crisis. Methods: A range of research methodologies were undertaken with a variety of stakeholders to understand crises in the homes of people with dementia. These included three systematic reviews, focus groups, narrative inquiry analysis, national stakeholder questionnaire and two discrete choice experiments (DCEs). Results: The systematic review looking at risk factors associated to hospital admissions for people with dementia found that physical health problems, such as falls/ fractures and infections were highly associated with admissions for people with dementia. Family carers often accepted BPSD symptoms as part of their relative’s dementia diagnosis and it was the physical health problems and vulnerability issues, such as risks/ hazards in the home which concerned people with dementia and their families. Health/ social care professionals’ opinions were similar to the family carers but the DCE revealed that behavioural problems such as aggressive behaviour were significant risk factors of crisis according to staff. The systematic reviews suggested that crisis interventions help to reduce institutionalisation and number of admissions to hospital. The other studies revealed that highly costly medical interventions did not significantly improve matters for family carers and their relatives and there was a strong preference towards interventions which enabled families to maintain their independence for longer at home as well as empower them to cope more effectively in a crisis through education & training, practical home adaptations and assistive technology. Conclusion: It is hoped that the model of crisis process, risks and interventions which has been proposed in this PhD may become a useful tool for researchers, policy makers and clinicians to help understand the complex process of crises involving people with dementia and how to intervene with a crisis