Table 2 Study characteristics
General information | Study design and methods | Participants | Intervention/survey name/interview guideline |
|---|---|---|---|
(A) Behavior that challenges supporting a person with dementia in long-term care | |||
Primary publication: [60] Additional publication: no information Country: Australia Setting: residential aged care facilities | Aim: to determine the effectiveness and acceptability of the concept mapping approach Study design: quasi-experimental, pre/post testing design ▪ Methods: staff questionnaires, care plan audits, concept mapping audits | Sites ▪ Residential aged care facilities (n = 11) Study population ▪ Nursing staffa | Concept mapping Case conferences with: ▪ Two formal assessments and perspectives of the team were brought in the mapping process ▪ The content of the concept map needed to be accurate, fact- or evidence-based and linked to existing concepts ▪ The concept map needed to be validated against what was known about the person by family and staff ▪ The concept map guided care plan development/evaluation and helped to identify potential risks for staff and clients Target population of the intervention: ▪ Nursing staff (registered and enrolled nurses, personal care workers) |
Primary publication: [59] Additional publication: [73] Country: USA Setting: nursing home | Aim: to implement the Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) Study design: quality improvement project ▪ Methods: routine data (residents), tests, observations (nursing staff), assessments (facility), document analysis (nursing staff/facility) | Sites ▪ Nursing home (n = 1) Study population ▪ Nursing staffa ▪ Residentsa | EIT-4-BPSD Consists of four steps: 1. Step: Assessing the environment and policies 2. Step: Educating staff 3. Step: Establishing person-centered care plans 4. Step: Mentoring and motivating staff Target population of the intervention: ▪ Facility ▪ Nursing staff ▪ Residents, who were 55 years and older with at least one behavior that challenges supporting a person with dementia within the past month |
Primary publication: [61] Additional publications: [74, 75] Country: Australia Setting: residential dementia care home | Aim: to understand the inconsistent results of the main study and investigation of factors that enabled and inhibited the implementation of the intervention Study design: process evaluation of a randomized controlled trial ▪ Methods: interviews with care managers, nurses, and care staff, surveys with family members, staff reports, field notes, care plans | Sites ▪ Residential dementia care homes (n = 38) Study population ▪ Care managers (n = 29) ▪ Nurses and care staff (n = 70) ▪ Family members (n = 73) | Person-centered care (PCC) and person-centered dementia environment (PCE) PCC consists of: ▪ Educational sessions for the staff with a focus on paying attention to residents’ feelings when agitated, person-centered interactions, and person-centered care planning to meet psychosocial needs of the residents ▪ On-site supervision ▪ Telephone support PCE consisted of: ▪ Environmental audit ▪ Audit results regarding safety, accessibility, utility, colors, objects, and familiarity of outdoor and social space were considered, and facilities were modified Target population of the intervention: ▪ Nursing and care staff and facilities ▪ Indirect people with dementia aged ≥ 60 years |
Primary publication: [62] Additional publication: no information Country: USA Setting: long-term care facility | Aim: to improve the skills of care staff for the care of people with dementia experiencing behavior that challenges supporting a person with dementia Study design: educational project ▪ Methods: questionnaire | Sites ▪ Long-term care facility (n = 1) Study population First educational session: ▪ Staff from all departments (n = 165) Second to fifths educational session: ▪ Staff (n = 70) | Educational program The intervention consisted of five 30–45 min educational sessions: ▪ Introduction to dementia and the STAR-VA program ▪ (Non)verbal communication with people with/without dementia living in a long-term care facility setting ▪ Presentation and explanation of the DICE approach for behavior that challenges supporting a person with dementia ▪ Summary Target population of the intervention: ▪ Staff (registered nurses, licensed practice nurses, certified nursing assistants, activity staff, unit secretary, social workers, dietitians, nurse practitioners, housekeepers, dietary staff, charge nurses, unit managers, MDS coordinators and MDS supervisors) |
Primary publication: [63] Additional publication: [76, 80] Country: UK Setting: nursing homes | Aim: to determine the feasibility of the implementation and effectiveness of a dual-purpose pharmacy-health psychology intervention Study design: open label, mixed method, feasibility study ▪ Methods: interviews, reflective comments via interviews, questionnaire, medication records | Sites ▪ Nursing homes (n = 5) Study population ▪ Nursing home staff (n = 142) ▪ General healthcare staff (n = 22) ▪ People with dementia (n = 108) | Dual-focused medication review-behavioral change intervention Workshop: ▪ For nursing home staff, three educational workshops with a focus on person-centered care and the understanding that unmet needs could cause behavior that challenges supporting a person with dementia were conducted ▪ Aim of the workshop: to provide staff with skills for the investigation of unmet needs, knowing the person, individualized interventions to meet person needs, understanding that engaging in behavior that challenges supporting a person with dementia is not to be understood as engaging in bad behavior or being a bad person ▪ The training was conducted along the VIPS (Valuing, Individualized, Perspective, and Social) model and included educational elements regarding medication to manage behavior that challenges supporting a person with dementia, guidelines to reduce medication and favor psychosocial interventions and videos, demonstration of person-centered practices, and information about the abovementioned topics; the importance of self-care and good communication among care staff was discussed ▪ Primary healthcare staff received a modified version of the education workshops Medication review: ▪ Medication review was provided by two experienced clinical pharmacists ▪ A therapeutic alliance was formed between the clinical pharmacist, the person with dementia and their personal relative ▪ Information about the medications and adverse effects were collected ▪ Medication plans were reviewed, with a focus on medications for behavior that challenges supporting a person with dementia, and all other medications ▪ Information and recommendations about the review were provided to the general practitioner in writing and by telephone Target population of the intervention: ▪ Nursing home staff ▪ General healthcare staff [general practitioner (trainees), practice nurses, practice-based pharmacist] ▪ People with dementia who received medication to treat behavior that challenges supporting a person with dementia |
Primary publication: [64] Additional publication: no information Country: USA Setting: nursing homes | Aim: to change the culture of care in nursing homes, establishing a person-centered model, and reducing the treatment of behavior that challenges supporting a person with dementia with antipsychotic medications Study design: quality improvement initiative ▪ Methods: survey, chart reviews, questionnaire | Sites ▪ One dementia care unit of a nursing home Study population ▪ Administrative team (facility administrator, medical director, director of nursing, human resources, clinical nurse educator, and the scheduler) ▪ Direct care team [doctors n = 3, (hospice) nurse practitioner n = 2, unit nurse manager (n = 1), activity director (n = 1 with two assistants, certified nurse assistants n = 18 and licensed practical nurses n = 10 on the unit, clinical nurse educator, wound care nurse, and social worker] ▪ Residents (n = 39) ▪ Families of the residentsa | No specific name The interventions targeted residents and staff Residents: ▪ Waking up time of the residents postponed by two hours ▪ Increase in guided activities during the day ▪ Bathing could be postponed to the evening ▪ Adjustment of the time for the administration of the medication Staff: ▪ Establishing a resident-guided schedule for morning caregiving, medication administration and breakfasts routine ▪ Increase staff to resident ratio ▪ Workshops to educate on culture change and risk of antipsychotics Target population of the intervention: ▪ All residents of the dementia care unit ▪ Administrative team ▪ Direct care team |
Primary publication: [65] Additional publications: [77,78,79, 83] Country: USA Setting: nursing homes | Aim: to implement, test, and evaluate the implementation strategy of the Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) Study design: pilot study (single-group repeated measures study), testing implementation strategy and process evaluation ▪ Methods: focus groups, medical records, assessments, care plans, checklist, test, observations | Sites Pilot study: ▪ Nursing homes (n = 2) Implementation study: ▪ Nursing homes (n = 55) Study population Pilot study: ▪ Residents (n = 21) Implementation study and process evaluation: ▪ Nursing home staff [(n = 93), administrator n = 5, director of nursing n = 17, staff nurse n = 18, nursing assistant n = 6, social worker/social service n = 12, recreation therapist/activity staff n = 17, others n = 10] ▪ Residents (n = 553) | EIT-4-BPSD Consists of an initial brainstorming and four steps: ▪ Initial 4-h brainstorming session with site champion and stakeholder team 1. Step: Assessing the environment and policies 2. Step: Educating staff 3. Step: Establishing person-centered care plans 4. Step: Mentoring and motivating staff Control group (education only) ▪ Step 2: Educating staff Target population of the intervention: ▪ Facility ▪ Nursing home staff ▪ Residents, who were 55 years and older with at least one behavior that challenges supporting a person with dementia within the past month |
(B) Delirium in acute care | |||
Primary publication: [66] Additional publication: no information Country: USA Setting: acute care hospital | Aim: to investigate the feasibility of the computerized decision support component of a multicomponent intervention Study design: prospective, cohort, pilot study ▪ Methods: instruments, interview, surveys, telephone calls, field notes, hospital information services staff information, feedbacks | Sites ▪ One adult medical-surgical unit in an acute care hospital Study population ▪ Registered nurses (n = 55) ▪ Licensed practice nurses (n = 19) ▪ Patients with dementia (n = 15) | Early Nurse Detection of Delirium Superimposed on Dementia The intervention consisted of four components: ▪ Education for nurses with a focus on detection and management of delirium superimposed on dementia ▪ Delirium decision support screens integrated in a computerized decision support system ▪ A champion to support the implementation per unit ▪ A feedback system to individual nurses on each intervention with the aim to further facilitate assessment and management of delirium superimposed on dementia Target population of the intervention: ▪ Registered and licensed practice nurses ▪ Patients with dementia aged ≥ 65 years |
Primary publication: [67] Additional publication: no information Country: Australia Setting: acute hospitals | Aim: to evaluate the implementation of a model of care Study design: pre/post implementation study ▪ Methods: medical record, audits, surveys, interviews | Sites ▪ Acute hospitals (n = 6) Study population ▪ Nursing staff (pre n = 432; post n = 283) ▪ Patients (pre n = 347; post n = 396) | Confused Hospitalized Older Persons (CHOPs) The intervention consists of seven principles: ▪ Cognitive screening ▪ Identification and prevention strategies for delirium ▪ Assessment of older people with confusion ▪ Communication to support person-centered care ▪ Staff education related to caring for older people with confusion ▪ Supportive care environments for older people with confusion Target population of the intervention: ▪ Nursing staff ▪ Direct and indirect patients aged ≥ 65 years |
Primary publication: [69] Additional publication: [68] Country: Australia Setting: acute hospital | Aim: to implement a multifaceted practice change intervention to enhance the capacity of the nursing staff to provide quality care Study design: implementation study ▪ Methods: observation, audits, assessments | Sites ▪ Wards (n = 6) in one acute hospital Study population ▪ Registered nurses (n = 34) ▪ Patients (n = 181) | Cognition Champions (CogChamps) The intervention consisted of three steps: ▪ 2 education workshops for CogChamps ▪ development of an individualized action plan by CogChamps ▪ Implementation of actions plans by CogChamps Target population of the intervention: ▪ Registered nurses with two or more years of clinical experience ▪ Indirect patients aged ≥ 65 years |
(C) Postacute care needs | |||
Primary publication: [72] Additional publication: [81] Country: Australia Setting: hospital | Aim: to improve hospital discharge processes for older people with dementia Study design: effectiveness-implementation hybrid design Methods: conducting three phases: ▪ Phase 1 organizational readiness: analysis of policy and practice documents related to discharge, interviews, workshops summaries ▪ Phase 2 development of a discharge intervention: survey, meeting minutes, workshop summaries ▪ Phase 3 implementation and evaluation: survey, interviews, meeting minutes, administrative data, study notes | Sites ▪ 4 wards (with 24 to 32 beds) in 3 hospitals Study population ▪ Phase 1: clinical staff and families of patients with dementia in participating wardsa ▪ Phase 2: Queensland health clinical staffa, researchersa, consumersa, representatives (state wide clinical networks for older persons health and dementia)a ▪ Phase 3: clinical staff and families of patients with dementia in participating wardsa, local hospital staffa and stakeholdersa in each hospital, patients with dementia (n = 44) | Partnering for Discharge The intervention consists of four elements: ▪ My Hospital Guide: a person-centered guide with information for the people with dementia and their relatives about the hospital stay and offers ▪ My Journal: a document with information and questions regarding care and discharge, held by the patient or family ▪ This is me: a document that records the person’s background, preferences, and interests ▪ Family meeting within 72 h of admission Target population of the intervention: ▪ patients aged ≥ 65 years diagnosed with dementia (primary or additional diagnosis) ▪ family members of patients with diagnosed dementia |
Primary publication: [71] Additional publication: no information Country: Australia Setting: residential care facility | Aim: to evaluate the implementation and effectiveness of the TC CAMP Study design: evaluation (process and outcome) Methods: individual and focus group interviews, file audits (medical records) | Sites ▪ 6 restorative care places in a dementia unit in one residential facility Study population ▪ TC Camp staff (n = 7) ▪ Health service staff (n = 7) ▪ Representatives of the facility to which clients were discharged (n = 3) ▪ Clients with dementia (n = 11) ▪ Family members/carers (n = 7) | Transition Care Cognitive Assessment and Management Pilot (TC CAMP) TC Camp is based on a person-centered approach as a goal-oriented and time-limited healthcare service for people with dementia who were discharged from the hospital TC Camp includes the following components: ▪ Clinical nurse consultant (CNC) [Role of the CNC: Case management including family meetings, cognitive assessment, behavior management, discharge planning, and staff education) ▪ Geriatrician ▪ Occupational therapist ▪ Other health professions if required ▪ Person centered tool “Key to me” ▪ Individualized care/behavioral and discharge plan Target population of the intervention: ▪ Patients aged ≥ 65 years with cognitive impairment (MMSE ≤ 24) |
Primary publication: [70] Additional publication: [82] Country: USA Setting: hospital, postacute setting | Aim: to examine barriers and facilitators for implementing a transitional care intervention for cognitively impaired older adults and their caregivers Study design: exploratory qualitative design Methods: case summaries (of each patient caregiver dyad), case conference field notes | Sites ▪ Hospitalsa Study population ▪ Advanced practice nurses (APNs) (n = 3) ▪ Caregivers of patients with dementia (n = 16) ▪ Patients with dementia (n = 15) | Transitional Care Model (TCM) The TCM is based on the APN role and includes hospital, home, and discharge components General: ▪ The APN develops goals with the patients and their caregivers, identifies teaching and learning needs, and considers other needs and issues impacting the care ▪ Scheduled visits from the APN: first visit within 24 h after admission, daily visits during the hospitalization, first visit within 24 h after discharge, weekly visits during the first month after discharge plus telephone contact, if needed, at least once per week when no home visit is scheduled, at least semimonthly visits during the intervention period Hospital components: ▪ Relationship building with the patients/carers, implementing prevention strategies (e.g., effects of cognitive impairment), developing and implementing of individualized care plans Home component: ▪ Starts immediately after the discharge, availability of the APN 7 days per week (8 a. m.–8 p. m.), development of an individual emergency care plan (for the time when the APN is unavailable), support and structuring of the first visit to the primary care or specialist healthcare provider Discharge: ▪ APNs use their clinical assessment skills to determine the time of the intervention, the termination of the discharge is guided by medical stability, patient and caregiver goals, and the skills of the caregiver to identify early symptoms that require intervention and strategies to prevent poor outcomes Target population of the intervention: ▪ Patients aged ≥ 65 years with cognitive impairment (six-item screen ≤ 4) living at home ▪ Caregiver |