Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes

BACKGROUND: Although Behavioral and Psychological Symptoms of Dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioral symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. OBJECTIVE: To study the prevalence and correlates of agitation in residents with dementia, in Norwegian nursing homes. METHODS: This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). RESULTS: Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. CONCLUSION: Symptoms of agitation were common, but may nevertheless be lower compared to findings in other geographical areas. Further studies are warranted to test this hypothesis, and if confirmed, to explore possible causes for such differences.     

Depressive symptoms and all-cause mortality after heart transplantation

BACKGROUND: Several studies indicate that heart transplantation (HTx) is associated with depression and reduced quality of life. However, the impact of depression on the prognosis for HTx-patients has not yet been sufficiently established. The aim of the present study was to prospectively investigate the influence of depression on mortality in patients with HTx, adjusting for other known risk factors. METHODS: In a prospective, cross-sectional study with minimum 5-year follow-up, symptoms of depression were assessed in 147 HTx-patients using the Beck Depression Inventory (BDI). RESULTS: Mild to severe depressive symptoms (BDI > or =10) were observed in 36 patients (24.5%). Depressive symptoms on inclusion increased the risk of mortality during the follow-up period. The risk remained significant after adjusting for several somatic and lifestyle risk factors, and the adjusted relative risk associated with depression (risk ratio: 2.32; 95% CI: 1.13-4.79; P=0.02) was comparable to the adjusted relative risk associated with time since HTx. CONCLUSIONS: Symptoms of depression predict mortality independently of somatic and lifestyle risk factors in HTx patients, and this group of patients should be screened for depressive symptoms.     

Feasibility of a staff training and support programme to improve pain assessment and management in people with dementia living in care homes

Objectives

The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN‐Dem).

Methods

PAIN‐Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN‐Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks.

Results

Delivery of training was a key driver for success and feasibility of the PAIN‐Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy‐in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen.

Conclusions

This study shows good initial feasibility of the PAIN‐Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN‐Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd.