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  • 1
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    Elder‐Clowning in Long‐Term Dementia Care: Results of a Pilot Study
    Wiley ; 2016
    In:  Journal of the American Geriatrics Society Vol. 64, No. 2 ( 2016-02), p. 347-353
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 64, No. 2 ( 2016-02), p. 347-353
    Abstract: To assess the effects of elder‐clowning on moderate to severe behavioral and psychological symptoms of dementia ( BPSD ) in nursing home residents with dementia, primarily of the Alzheimer's type. Design Before‐and‐after study. Setting Nursing home. Participants Nursing home residents with moderate to severe BPSD , as defined according to a Neuropsychiatric Inventory—Nursing Home version ( NPI ‐ NH ) score of 10 or greater (N = 23), and their care aides. Intervention A pair of elder‐clowns visited all residents twice weekly (~10 minutes per visit) for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as song, musical instruments, and dance to individualize resident engagement. Measurements Primary outcomes were BPSD measured using the the NPI ‐ NH , quality of life measured using Dementia Care Mapping ( DCM ), and nursing burden of care measured using the Modified Nursing Care Assessment Scale (M‐ NCAS ). Secondary outcomes were occupational disruptiveness measured using the NPI ‐ NH , agitation measured using the Cohen Mansfield Agitation Inventory ( CMAI ), and psychiatric medication use. Results Over 12 weeks, NPI ‐ NH scores declined significantly ( t 22  = −2.68, P  = .01), and DCM quality‐of‐life scores improved significantly ( F 1,50  = 23.09, P  〈  .001). CMAI agitation scores decreased nominally, but the difference was not statistically significant ( t 22  = −1.86, P  = .07). Occupational disruptiveness score significantly improved ( t 22  = −2.58, P  = .02), but there was no appreciable change in M‐ NCAS scores of staff burden of care. Conclusion Results suggest that elder‐clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer's type. Elder‐clowning is a promising intervention that may improve Alzheimer's disease care for nursing home residents.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2016.64.issue-2
    DOI: 10.1111/jgs.13941
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2040494-3
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  • 2
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    Use of Psychotropics in Sydney Nursing Homes: Associations With Depression, Psychosis, and Behavioral Disturbances
    Cambridge University Press (CUP) ; 2001
    In:  International Psychogeriatrics Vol. 13, No. 1 ( 2001-03), p. 107-120
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 13, No. 1 ( 2001-03), p. 107-120
    Abstract: The purpose of this study was to determine the prevalence of psychotropic use in nursing home residents, the extent to which psychotropic dosage is consistent with published guidelines, and the relationships between psychotropic class and psychiatric and behavioral disturbances. Six hundred forty-seven subjects, mean age 82.3 years, residing in 11 nursing homes in the eastern suburbs of Sydney, Australia, were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the Abbreviated Mental Test Scale, and the Even Briefer Assessment Scale for Depression (EBAS-DEP). Details of psychotropic prescription and diagnoses of depression, dementia, and psychosis were obtained from nursing home charts. Psychotropics were prescribed for 333 (51.5%) residents, 381 (58.9%) if “as required” (PRN) use is included. Prescription of multiple psychotropics was present in 148 (22.7%) residents. Antidepressants were prescribed for 19.8% of residents, with subtherapeutic doses less likely in residents on selective serotonin reuptake inhibitors. On logistic regression, the use of antidepressants was predicted by the affective disturbances subscale on the BEHAVE-AD. Only 30.4% of residents with significant depressive symptoms on the EBAS-DEP were prescribed antidepressants. Antipsychotics were prescribed for 21.3% residents at a mean dosage of 73 mg chlorpromazine equivalence. Residents on antipsychotics had significantly higher scores on the delusions, hallucinations, activity disturbance, and aggressiveness subscales of the BEHAVE-AD. On logistic regression, only the activity disturbance subscale and chart diagnoses of dementia and psychosis were significant predictors. Psychosis (58.8%) and behavioral disturbances (91.9%) were more prevalent in residents prescribed antipsychotics than in residents not prescribed antipsychotics (42.5% and 76.6%, respectively). High rates of behavioral and psychological symptoms of dementia remained in residents prescribed antipsychotics and high rates of depressive symptoms in residents prescribed antidepressants, suggesting a role for nonpharmacological strategies.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610201007505
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2001
    detail.hit.zdb_id: 2147136-8
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  • 3
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    Caregivers' experience of the decision-making process for placing a person with dementia into a nursing home: comparing caregivers from Chinese ethnic minority with those from English-speaking backgrounds
    Cambridge University Press (CUP) ; 2014
    In:  International Psychogeriatrics Vol. 26, No. 3 ( 2014-03), p. 413-424
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 26, No. 3 ( 2014-03), p. 413-424
    Abstract: The experience of care transitions for people with dementia from ethnic minority groups has been poorly researched. Few studies have examined the decision to put someone on a waiting list for a nursing home and then actually accept a place. Many nursing homes have long waiting lists, but sometimes offers of a place are declined. Our aims were to investigate the decision-making process for placing a person with dementia on a waiting list for a nursing home, why offers of a place are accepted or declined, and the influence of cultural factors, comparing caregivers from Chinese and English-speaking backgrounds. Methods: Semi-structured interviews with 27 caregivers of people with dementia on waiting lists or living in nursing homes (20 Chinese background and seven English-speaking background) were conducted, with thematic analysis of factors affecting caregivers’ decision-making. Results: Caregivers were at different stages of decision-making when they applied for a waiting list – some were ready for placement, others applied “just in case,” and for some there was no waiting time because of an urgent need for placement. Caregivers’ decisions were influenced by their emotions and expectations of nursing homes. The decision-making process was similar for both cultural groups, but Chinese caregivers spoke more about their sense of duty, the need for a Chinese specific facility, and declining a place because of family disagreement. Conclusions: Understanding cultural issues, including stereotypes and concerns about nursing homes, and providing better information about admission processes may help caregivers by allaying their anxiety about nursing home placement.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610213002020
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2014
    detail.hit.zdb_id: 2147136-8
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  • 4
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    What is the effectiveness of acute hospital treatment of older people with mental disorders?
    Cambridge University Press (CUP) ; 2005
    In:  International Psychogeriatrics Vol. 17, No. 4 ( 2005-12), p. 539-555
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    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 17, No. 4 ( 2005-12), p. 539-555
    Abstract: Aim: To appraise the effectiveness of acute hospital service delivery in old age psychiatry. Method: A systematic literature search of the Medline, PsycINFO, CINAHL, EMBASE and Cochrane Collaboration databases was undertaken to obtain articles published in English from 1966 to May 2004 about old age psychiatry services. Articles were excluded if they did not focus on subjects over 60 years of age, did not include quantitative data on outcomes, or if the intervention was purely pharmacological or a specific non-pharmacological technique. The two authors independently assessed data quality. The overall quality of the evidence for the effectiveness of old age mental health service delivery was rated on an evidence hierarchy that has four levels of evidence. Results: Forty-six studies were identified that met our criteria. The only randomized controlled trials (RCTs) were of consultation/liaison service provision and delirium prevention and hence the best quality evidence is for interventions to prevent delirium, reduce costs and length of stay (LOS) in medical wards (level II). There is lower quality (level III/IV), albeit consistently positive, evidence that acute hospital treatment by old age psychiatry services is effective. By contrast, there is no evidence (level I) that non-psychiatric hospital medical services improve mental health outcomes. Conclusion: There are gaps in our knowledge regarding the effectiveness of acute hospital treatment of mental disorders in old age. Multicenter studies involving comparisons of day hospitals, multidisciplinary community teams and acute hospital settings (old age mental health and adult mental health, with and without post-discharge community care) are required.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610205001663
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2005
    detail.hit.zdb_id: 2147136-8
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  • 5
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    Study protocol for a randomized controlled trial of humor therapy in residential care: the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE)
    Cambridge University Press (CUP) ; 2012
    In:  International Psychogeriatrics Vol. 24, No. 12 ( 2012-12), p. 2037-2044
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 24, No. 12 ( 2012-12), p. 2037-2044
    Abstract: Background: Humor therapy is a non-pharmacological intervention with potential to improve mood and quality of life for institutionalized older persons, including those with dementia. The primary aims of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) are to examine the effects of humor therapy on residents’ mood, quality of life, social engagement, and agitation. Methods: SMILE is a single-blinded cluster-randomized controlled trial where 398 consented residents in 35 residential aged care facilities will be allocated to receive humor therapy or usual care. Residents allocated to the intervention group will engage in humor therapy with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine two-hour sessions over 12 weeks as well as engaging humorously with LaughterBosses during the course of daily care. The usual care control group will not engage in any formal humor therapy. Researchers, blind to treatment allocation, will assess residents at baseline (week 0), post-intervention (week 13), and follow-up (week 26). The measurement suite includes the Cornell Scale for Depression in Dementia, the Dementia Quality of Life Scale, the Multidimensional Observation Scale for Elderly Subjects, the Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory. Observations of residents’ engagement will be recorded at each humor therapy session. Conclusions: SMILE is the first large rigorous study of humor therapy in aged care.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610212000683
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2012
    detail.hit.zdb_id: 2147136-8
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  • 6
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    Do people with early stage dementia experience Prescribed Disengagement ® ? A systematic review of qualitative studies
    Cambridge University Press (CUP) ; 2018
    In:  International Psychogeriatrics Vol. 30, No. 6 ( 2018-06), p. 807-831
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 30, No. 6 ( 2018-06), p. 807-831
    Abstract: Prescribed Disengagement ® is the description of the post-diagnostic advice given to people after a diagnosis of dementia, which explicitly or implicitly suggests that the person should be slowing down or pulling back from activities. This results in isolation, loss of hope, self-esteem and self-identity, and threatens social health. This study aims to review whether Prescribed Disengagement ® can be identified in the literature on subjective experiences of people living with early dementia. Methods: A systematic search was performed. Inclusion criteria were original empirical qualitative studies published in English that addressed the subjective experiences of living with a diagnosis of objectively defined early dementia. Thematic synthesis was undertaken. Results: Thirty-five papers involving 373 participants were included. Following a diagnosis, people with dementia struggled with self-identity, independence, control and status, activities, stigma, and how to view the future. Reactions in these areas ranged from active and positive to negative and passive. Many studies reported participants’ dissatisfaction with the way the diagnosis was communicated. There was insufficient information provided about dementia and limited treatments and support offered. The diagnosis process and post-diagnostic support may have contributed to disempowerment of the person with dementia, made it more difficult to accept the diagnosis, and exacerbated negative views and self-stigma around dementia. Conclusions: These results do not support the idea of Prescribed Disengagement ® . However disengagement may have been implied during the diagnosis process and post-diagnostic support. Research is needed on how to improve the communication of dementia diagnosis and support people to live well post-diagnosis.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610217001545
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2147136-8
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  • 7
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    What do children need to know about dementia? The perspectives of children and people with personal experience of dementia
    Cambridge University Press (CUP) ; 2018
    In:  International Psychogeriatrics Vol. 30, No. 5 ( 2018-05), p. 673-684
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 30, No. 5 ( 2018-05), p. 673-684
    Abstract: The vision for dementia-friendly communities is challenged by limited public awareness and stigma about dementia. The study aim was to elicit stakeholder priorities for the message content of an education program to improve dementia awareness among youth; specifically, what do children need to know about dementia? Methods: A qualitative inquiry using interviews and focus groups was used. Purposive sampling achieved maximum variation in dementia experience and participant characteristics. Focus groups with Scouts in the community aged 9–12 years old ( n = 22) used innovative techniques to explore children's attitudes towards people with dementia. Participants with personal experience of dementia were five people with early-stage dementia; 12 adult primary carers; four non-primary carers; and six grandchildren of a person with dementia. They were asked what is important for children to understand about dementia and what attitudes they may like an education program to confer. Content analysis was performed using NVivo10. Results: Strong themes to emerge were that children need to know the whole truth about dementia; that individuals with dementia are “still people,” that it is “not the fault” of the person with dementia; and that dementia is different and typically unpredictable for everyone. Discussions also indicated a need to educate children about ways to relate to a person with dementia, and to appreciate “positives” within a relationship. Conclusions: Children are our future citizens. Developing an education program for children with this message content may be fundamental to de-stigmatizing dementia and laying the foundation to dementia-friendly communities.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610217002022
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2147136-8
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  • 8
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    Desired characteristics and outcomes of community care services for persons with dementia: What is important according to clients, service providers and policy? : Desirable characteristics of community care
    Wiley ; 2013
    In:  Australasian Journal on Ageing Vol. 32, No. 2 ( 2013-06), p. 91-96
    Details
    In: Australasian Journal on Ageing, Wiley, Vol. 32, No. 2 ( 2013-06), p. 91-96
    Type of Medium: Online Resource
    ISSN: 1440-6381
    URL: Article
    DOI: 10.1111/j.1741-6612.2012.00625.x
    Language: English
    Publisher: Wiley
    Publication Date: 2013
    detail.hit.zdb_id: 2118648-0
    SSG: 5,2
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  • 9
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    C ommunity care for the E lderly: N eeds and S ervice U se S tudy ( CENSUS ): Who receives home care packages and what are the outcomes?
    Wiley ; 2015
    In:  Australasian Journal on Ageing Vol. 34, No. 3 ( 2015-09)
    Details
    In: Australasian Journal on Ageing, Wiley, Vol. 34, No. 3 ( 2015-09)
    Abstract: Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. Method Analyses of data collected every four months for 12 months from 55 community‐dwelling older adults eligible for government‐subsidised packaged care and their carers. Results Thirty of fifty‐five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non‐package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. Conclusions Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation.
    Type of Medium: Online Resource
    ISSN: 1440-6381 , 1741-6612
    URL: Issue
    URL: Article
    DOI: 10.1111/ajag.2015.34.issue-3
    DOI: 10.1111/ajag.12155
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2118648-0
    SSG: 5,2
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  • 10
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    Models of home care services for persons with dementia: a narrative review
    Cambridge University Press (CUP) ; 2015
    In:  International Psychogeriatrics Vol. 27, No. 10 ( 2015-10), p. 1593-1600
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP), Vol. 27, No. 10 ( 2015-10), p. 1593-1600
    Abstract: Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. Methods: We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Results: Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. Conclusions: There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610215000137
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2015
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