Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, Sherry A. Greenberg, PhD, RN, GNP-BC, FGSA, FAANP, FAAN, GAPNA’s President, discusses care strategies for older adults with dementia inside and outside of long-term care facilities. Dr Greenberg also gives insight on the role family members of geriatric patients play in caring for patients who do not reside in long-term care facilities.

Person-Centered Care Plans for Nursing Home Residents With Behavioral and Psychological Symptoms of Dementia

Journal of Gerontological Nursing. 2020;46(11):17-27

Care plans of 553 nursing home residents in 55 nursing homes were examined for how staff approached documentation of behavioral and psychological symptoms of dementia (BPSD). Researchers found that residents who were younger, male, had lower functional and cognitive abilities, and longer length of stay were associated with increased documentation of person-centered care approaches. Facilities that were non-profit, had less certified nursing assistant staffing hours, and more residents taking antipsychotic medications also linked to increased documentation of person-centered care approaches.1

Commentary by Dr Greenberg:


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Older adults with dementia living in nursing homes may or may not exhibit behavioral and psychological symptoms. These symptoms may include aggression, agitation, wandering, disruptive vocalization, apathy, sexually inappropriate behavior, and resistance to care. Those who do exhibit BPSD need a comprehensive interprofessional assessment and management plan. This is usually best managed using a person-centered, nonpharmacological approach to care. A person-centered approach to care incorporates what matters to the older adult and family such as personal preferences and interests.

This study explored the documentation of BPSD in nursing home resident care plans, including approaches in addressing BPSD symptoms and whether resident and/or facility characteristics are associated with documentation of person-centered care approaches.

Clinicians have the responsibility to develop, implement, evaluate, and document all aspects of care, including management of BPSD, using a person-centered approach. This is regardless of resident or facility characteristics or inherent challenges, such as low staffing ratios or low availability of resources. Interprofessional staff members need ongoing education about evidence-based strategies to implement on a resident’s behalf and appropriately document all components of care. Reinforcement will lead to quality, person-centered care delivery to older adults living with dementia in long-term care settings.

Fatigue in Family Caregivers of Individuals With Dementia: Associations of Sleep, Depression, and Care Recipients’ Functionality

Journal of Gerontological Nursing. 2020;46(9):14-18.

In a cross-sectional study, researchers collected subjective and objective data on caregivers taking care of a family member with dementia. The authors established links between caregivers’ sleep quality, difficulty falling asleep, depression, and the care-recipients’ functionality with the family caregivers’ fatigue.2

Commentary by Dr Greenberg:

According to the Alzheimer’s Association, only 8% of patients with dementia do not receive help from family members or other informal care providers.3 This study examined factors associated with fatigue among caregivers of persons with dementia. Family caregivers have multiple responsibilities in caring for their loved one with dementia, as well as children and themselves, many living in the same household.

Additionally, family caregivers are unpaid volunteers who have not received formal training in caregiving and who may be balancing their home life with their paid work.

Caregiving for those with dementia may be ongoing for many years. Though some caregivers may be more equipped than others to take on roles and tasks, long-term caregiving can have negative effects on the individual such as increased fatigue, burden, stress, depression, decreased sleep quality, risk of mistreatment, and decreased quality of care provision.

The significance of these effects may vary over time. The authors found that those providing care to less functional recipients experience greater fatigue and that physical and emotional demands may increase over time. All healthcare providers should assess caregivers for fatigue, sleep quality, and unmet physical and psychologic needs. Healthcare providers may then intervene and provide resources to family caregivers such as support groups, suggestions for respite care, and self-care strategies. This, in turn, will help promote more effective caregiving to patients with dementia while keeping the needs of the caregiver in mind.

Feasibility of Tele-Prompt: A Tablet-Based Prompted Voiding Intervention to Support Informal Caregivers of Older Adults With Urinary Incontinence

Geriatric Nursing. 2020;41(4):411-420.

Caregivers of older adults with urinary incontinence (UI) attended 6 weekly coaching sessions to learn more about UI and build their skillset of management strategies. The intervention was facilitated via a tablet. Caregivers rated the intervention highly, stating that it was beneficial, they would recommend it to a friend, and their family member’s UI symptoms improved.4

Commentary by Dr Greenberg:

Although common among older adults, UI is not a normal part of aging. The burden of care for an older adult with UI, including those with cognitive impairment, is a known reason for placing a loved one in a long-term care facility. Interventions to improve provision of care and reduce caregiver burden is key to good outcomes.

Informal caregivers are adult learners capable of being trained in novel ways to manage certain healthcare issues in the community such as UI. This study aimed to educate informal caregivers about prompted voiding techniques and to improve their skills to manage UI. Reinforcement of technology-based education may be best supported by regularly scheduled discussions with a healthcare provider, such as a nurse practitioner as in this study protocol, to answer questions, clarify clinical points, discuss and monitor caregiver recipient progress, and address challenges encountered.

Innovative technological interventions with educational and clinical support from a healthcare provider are effective methods to improve outcomes for informal caregivers as well as care recipients. These outcomes may include decreasing caregiver burden and/or depression, increasing caregiver self-efficacy in the management of the clinical issue, improving or maintaining function such as continence of older adults, and decreasing risk of institutionalization for older adults. Advanced practice providers are well-positioned to educate and support caregivers in the management of UI for community-dwelling older adults.

References

  1. Sefcik JS, Madrigal C, Heid AR, et al. Person-centered care plans for nursing home residents with behavioral and psychological symptoms of dementiaJ Gerontol Nurs. 2020;46(11):17-27. doi:10.3928/00989134-20201012-03
  2. Chang YP, Lorenz RA, Phillips M, Peng HL, Szigeti K. Fatigue in family caregivers of individuals with dementia: associations of sleep, depression, and care recipients’ functionalityJ Gerontol Nurs. 2020;46(9):14-18. doi:10.3928/00989134-20200527-01 2020
  3. Alzheimer’s disease facts and figures. Alzheimer’s Association. Accessed January 6, 2020. https://www.alz.org/media/Documents/alzheimers-facts-and-figures_1.pdf
  4. Davis NJ, Clark PC, Johnson TM 2nd, Wyman JF. Feasibility of Tele-Prompt: a tablet-based prompted voiding intervention to support informal caregivers of older adults with urinary incontinenceGeriatr Nurs. 2020;41(4):411-420. doi:10.1016/j.gerinurse.2020.01.002