- Email: [email protected]
INTIMACY AND DEMENTIA
P974
Poster Presentations: Tuesday, July 26, 2016
age. Associated costs are expected to rise exponentially due to unprecedented life expectancy and expanding ethnically and racially diverse persons living with ADRD. Geographically, Palm Beach County (PBC), home to Florida Atlantic University [FAU] and the Christine E. Lynn College of Nursing [CON] Louis and Anne Green Memory and Wellness [MWC], is among the largest of Florida’s 67 counties with more than 1.3 million residents living in rural and densely populated urban areas2. Approximately 55,000 PBC residents have ADRD representing 10% of all persons with ADRD in the state.1These figures indicate an urgent need to expand the MWC dementia-capable services beyond the immediate geographical area to more rural areas of the county. To meet this need the FAU MWC, a state designated Memory Disorder Clinic, has partnered with community agencies – Palm Beach County Department of Community Services/Division of Senior Services, Assisted Living Facilities, and Faith-based communities – to enhance access to specialized dementia care and supportive services thus transforming existing models of care, support, education and community outreach. Specific program objectives are to: 1) provide and facilitate dementia-specific care-coordination services for communityresiding older adults with moderate to severe ADRD living alone or with a caregiver; 2) expand biopsychosocial healthcare services to address physical, cognitive and mental health needs of homebound individuals with intellectual and developmental disabilities with or at risk of ADRD; 3) establish, cultivate, and sustain trusting relationships that encourage disclosure of caregiver needs; 4) develop and implement dementia-specific Train-the-Trainer programs for healthcare professionals and direct care staff serving individuals with ADRD and their caregivers. The focus of this program is to more effectively meet the critical and complex biopsychosocial care needs of our growing culturally diverse, vulnerable aging population living with ADRD. References: 1. Alzheimer’s Association, (2015) Alzheimer’s Disease facts and figures. Alzheimer’s & Dementia, 11(3) Brown, R. S. 2. Palm Beach County Chamber of Commerce (2015). Palm Beach County Resident Guide. P3-332
LISTEN TO US: UNDERSTANDING SELFPERCEPTION OF PEOPLE WITH DEMENTIA AND ITS IMPACT ON CARING STAFF IN RESIDENTIAL CARE HOMES IN HONG KONG
CHI Man Kenny Chui, The Chinese University of Hong Kong, Hong Kong, Hong Kong. Contact e-mail: [email protected] Background: The term “dementia” in Asia including China, Japan, Singapore, Taiwan, Hong Kong, South Korea, etc. has been translated as “Chi Dai Zheng” (痴呆症) before which carries a very negative connotation. The linguistic descriptions about “dementia” indicate to the loss and negative understanding. I review that the vital implication of using the above term leads to the perception of people with dementia as “total loss of self” or “living death” and “social death” (Chiu & Li, 2012; Chiu et al., 2014). Dementia is one of the most common reasons for applying residential care homes and HK is one of the most high institutionalization rate countries which is 6.8% of the population. Over 50% of elders get different levels of neuro-cognitive impairment in the residential care homes from the local studies. People consider how to deal with the increasing number of dementia and the kinds of care model to be provided in residential care homes. Methods: Qualitative research with thematic analysis. Part I, interviews and observes 10 people with dementia and 10 caring staff in the subvented and non- subvented residential care homes. Part II, two one-session sharing organizes to inform the caring staff about the participants’ self-
perception. Part III, there will be two focus groups which collect the feedback about the impacts of the trained caring staff after the sharing session. Results: Themes about elements of self-perceptions among people with dementia, staff’s perception of dementia and the change of staff’ caring attitude. Finding the cultural difference and further development of person-centred care in HK. This study identifies self-perception of people with dementia who live in the residential care home and their subjective interpretations of self. Adopting a humanistic approach, this study goes beyond the dominance of medical explanations and treatment to enlarge the perspective of health care professions. The research reveals 1) how the participants perceive themselves; 2) how caring staff perceive the participants; 3) How the interactions between the participants and caring staff in the residential care homes co-constructed the interpretations; 4) the self-perception of the participants and 5) the impact of caring staff after being informed the participants’ self. P3-333
MEANINGFUL ENGAGEMENT OF PEOPLE WITH DEMENTIA
Mary Schulz, Jim Mann, Alzheimer Society of Canada, Toronto, ON, Canada. Contact e-mail: [email protected] Background: People living with dementia tell us, Nothing about us,
without us. With this mantra in mind, the Alzheimer Society of Canada (ASC) embarked on an initiative to enhance the engagement of persons with dementia in our work. By systematically incorporating the expertise of people with dementia and their families in fulfilling our mandate, we aim to improve the quality of our work and make it even more relevant, accountable and credible to stakeholders. During this process, ASC has examined and enhanced our own engagement practices while ensuring that what we learn is accessible not only throughout our organization nationwide but also to other organizations. Methods: In September 2012, ASC created an Advisory Group of people with dementia to inform our engagement of people with dementia in the mission-driven areas of our work. The Advisory Group first developed an ethical framework to guide the creation of a training plan and Resource Guide to assist organizations in meaningfully engaging people with dementia in all areas of their operations. The “Meaningful Engagement of People with Dementia” Training Plan was pilot tested at 6 different sites across Canada with the co-facilitation in each site by a person with dementia. Evaluation results of the training sessions were incorporated into the final draft of both the Training Plan and Resource Guide. Results: An ethical framework for engagement, a Training Plan and Resource Guide were developed in both English and French. By using these resources within the Alzheimer Societies across Canada, we strive to increase the number of people with dementia volunteering, achieve consistency and upgrade the way in which persons with dementia are approached and invited to become involved in our work and in how they continue to be engaged. Conclusion: Using the resources developed, staff and volunteers are challenged to consider new opportunities to engage people with dementia in meaningful and ethical ways that not only benefit them but the organization, as well. P3-334
INTIMACY AND DEMENTIA
Mary Schulz1, Sylvia Davidson2, 1Alzheimer Society of Canada, Toronto, ON, Canada; 2Baycrest, Toronto, ON, Canada. Contact e-mail: MSchulz@ alzheimer.ca Background: The subject of intimacy and aging remains one of our
last taboos. Factor dementia into this mix and one confronts many
Poster Presentations: Tuesday, July 26, 2016
challenging practice dilemmas, often influenced by strong opinions, values and beliefs. Health care providers in all settings, but most notably in care environments where there may be privacy, consent and capacity concerns, face these challenges with very little support, few resources and much misinformation. Methods: The Alzheimer Society of Canada partnered with subject matter experts in both law and dementia care to develop a workshop to help health care providers address issues of intimacy in their dementia care practice. Two types of resources formed the basis of this workshop: 1) Plain language legal resources for health care providers to apply consent and capacity laws appropriately into practice. 2) “Responsive behaviour framework” to assist health care providers in understanding what triggers, including a desire for intimate contact, might be influencing an individual’s behaviour and to offer a systematic approach to intervention. Results: A collaboration of legal, practice and dementia subject matter experts has led to the development of resources to help health care providers to a) reflect on their values, attitudes and beliefs in considering the rights of adults living with dementia to express their sexuality and need for intimacy, b) understand how personal beliefs may influence practice, c) learn person centred strategies to enhance the quality of life of persons with dementia in their care. Conclusion: This session will solicit practice scenarios from participants in order to apply person-centred strategies and resources to increase staff skill and sensitivity when approaching challenging situations involving persons with dementia and the expression of their sexuality and need for intimacy. P3-335
A SURVEY OF SOCIAL WORK STUDENTS’ ATTITUDES TOWARDS WORKING WITH PEOPLE WITH DEMENTIA
Lisa Kelly1, Anthea Vreugdenhil2, 1University of Tasmania, Launceston, Australia; 2University of Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: With growing numbers of older people in the population, social workers will increasingly be working with people with dementia and their families. Social work students need to be adequately prepared to work in this field through the development of appropriate knowledge, skills, and attitudes. Attitudes are particularly important, with research suggesting a strong link between negative attitudes of care workers and lower quality dementia care. The aims of this study were to assess the attitudes of social work students towards people with dementia and to examine how these attitudes shape perceptions about working in this field. Methods: This study used a cross-sectional, self-completed, anonymous survey to explore the attitudes of 127 Australian social work students towards working with people with dementia. Students were enrolled in the Bachelor and Master of Social Work qualifying courses at the University of Tasmania and the response rate was 79% of total enrolment (160 students). The survey questionnaire included a validated scale for assessing care worker attitudes towards people with dementia: the Approaches to Dementia Questionnaire (ADQ), which comprised two sub-scales measuring the dimensions of Hope and Personhood. There were additional questions about dementia interventions. Results: Social work students’ attitudes towards people with dementia were generally positive, however their mean score for the Hope sub-scale was significantly lower than for the Personhood sub-scale (mean score 3.64 versus 4.30; t ¼-15.79, p<0.001). Students with less positive attitudes towards people with dementia overall were less hopeful about the possibility of improving quality of life for this group (Chi2¼11.08, p<0.001). There was a positive association between
P975
students’ ADQ scores and their desire to work with people with dementia (Chi2¼20.2, p<0.001) although only 15% of students (n¼18) agreed strongly that they would like to work with people with dementia. Conclusions: This study suggests that while many social work students have positive attitudes towards people with dementia, relatively few are keen to work with this group upon graduation. More work is needed to ensure that all social work students are well-equipped for working with people with dementia and to explore strategies to increase interest in working in this field. P3-336
ATTITUDES AND SKILLS OF PSYCHIATRIC NURSES TO UNDERSTAND THE WISHES OF PATIENTS WITH DEMENTIA WHO HAVE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN JAPAN
Mie Urabe, Kyoto Prefectural University of Medicine, Kyoto, Japan. Contact e-mail: [email protected] Background: In order to provide better care for patients with dementia, it is important to try to understand their wishes and to make an effort to obtain their consent for each care procedure. However, understanding their wishes is difficult, especially when patients suffer from behavioral and psychological symptoms of dementia (BPSD). The aim of this study is to describe attitudes and skills of experienced psychiatric nurses to understand the wishes of patients with dementia and obtain their consent to each care procedure. Methods: Participants were five experienced psychiatric nurses who had been caring for patients with dementia with severe BPSD in Japan (4 male, 1 female; the average age is 43.4 years old; average dementia care experience 10.2 years). Semi-structured interviews lasting 30 min to 1 h. were given to each participants according to their practice of observation and attempt to understand patient’s wishes. The data were analyzed qualitatively and then categorized into groups. This study was approved by the ethical review board of Kyoto Prefectural University of Medicine. Results: The categories obtained were as follows: “category 1: The way nurses tailor language in regards to cognitive function and individuality”; “category 2: Responses for preventing over excitement and maintaining a calm psychological state”; “category 3: Interaction between dementia patients and nurses”; “category 4: Evaluation of treatment acceptance”; “category 5: Assessment of background factors of anger, aggression, and refusal”; “category 6: Safety management in treatment”; and “category 7 : Difficulty to assess and understand the patient’s wishes.” Conclusions: The participations determined the patient’s wishes by watching hand motion, behavior, facial expression, and the movement of eyes of the patients. Moreover, they paid attention not to arouse negative emotions to prevent excitement and maintain a calm psychological state. These skills should be transferred to nurses who have little experience in taking care of patients with dementia.
P3-337
DEMENTIA CARE LEARNING NEEDS AMONG PRIMARY CARE CLINICIANS: DOES THIS VARY BY PRACTICE SETTING?
Linda Lee1, Loretta M. Hillier2, Wayne W. Weston3, 1Centre for Family Medicine Family Health Team/McMaster University, Kitchener, ON, Canada; 2St. Joseph’s Health Care London, London, ON, Canada; 3Western University, London, ON, Canada. Contact e-mail: [email protected] Background/Purpose: It is well documented that limited knowledge
of dementia care in primary care is a barrier to optimal management. The purpose of this study was to compare the self-perceived
Poster Presentations: Tuesday, July 26, 2016
age. Associated costs are expected to rise exponentially due to unprecedented life expectancy and expanding ethnically and racially diverse persons living with ADRD. Geographically, Palm Beach County (PBC), home to Florida Atlantic University [FAU] and the Christine E. Lynn College of Nursing [CON] Louis and Anne Green Memory and Wellness [MWC], is among the largest of Florida’s 67 counties with more than 1.3 million residents living in rural and densely populated urban areas2. Approximately 55,000 PBC residents have ADRD representing 10% of all persons with ADRD in the state.1These figures indicate an urgent need to expand the MWC dementia-capable services beyond the immediate geographical area to more rural areas of the county. To meet this need the FAU MWC, a state designated Memory Disorder Clinic, has partnered with community agencies – Palm Beach County Department of Community Services/Division of Senior Services, Assisted Living Facilities, and Faith-based communities – to enhance access to specialized dementia care and supportive services thus transforming existing models of care, support, education and community outreach. Specific program objectives are to: 1) provide and facilitate dementia-specific care-coordination services for communityresiding older adults with moderate to severe ADRD living alone or with a caregiver; 2) expand biopsychosocial healthcare services to address physical, cognitive and mental health needs of homebound individuals with intellectual and developmental disabilities with or at risk of ADRD; 3) establish, cultivate, and sustain trusting relationships that encourage disclosure of caregiver needs; 4) develop and implement dementia-specific Train-the-Trainer programs for healthcare professionals and direct care staff serving individuals with ADRD and their caregivers. The focus of this program is to more effectively meet the critical and complex biopsychosocial care needs of our growing culturally diverse, vulnerable aging population living with ADRD. References: 1. Alzheimer’s Association, (2015) Alzheimer’s Disease facts and figures. Alzheimer’s & Dementia, 11(3) Brown, R. S. 2. Palm Beach County Chamber of Commerce (2015). Palm Beach County Resident Guide. P3-332
LISTEN TO US: UNDERSTANDING SELFPERCEPTION OF PEOPLE WITH DEMENTIA AND ITS IMPACT ON CARING STAFF IN RESIDENTIAL CARE HOMES IN HONG KONG
CHI Man Kenny Chui, The Chinese University of Hong Kong, Hong Kong, Hong Kong. Contact e-mail: [email protected] Background: The term “dementia” in Asia including China, Japan, Singapore, Taiwan, Hong Kong, South Korea, etc. has been translated as “Chi Dai Zheng” (痴呆症) before which carries a very negative connotation. The linguistic descriptions about “dementia” indicate to the loss and negative understanding. I review that the vital implication of using the above term leads to the perception of people with dementia as “total loss of self” or “living death” and “social death” (Chiu & Li, 2012; Chiu et al., 2014). Dementia is one of the most common reasons for applying residential care homes and HK is one of the most high institutionalization rate countries which is 6.8% of the population. Over 50% of elders get different levels of neuro-cognitive impairment in the residential care homes from the local studies. People consider how to deal with the increasing number of dementia and the kinds of care model to be provided in residential care homes. Methods: Qualitative research with thematic analysis. Part I, interviews and observes 10 people with dementia and 10 caring staff in the subvented and non- subvented residential care homes. Part II, two one-session sharing organizes to inform the caring staff about the participants’ self-
perception. Part III, there will be two focus groups which collect the feedback about the impacts of the trained caring staff after the sharing session. Results: Themes about elements of self-perceptions among people with dementia, staff’s perception of dementia and the change of staff’ caring attitude. Finding the cultural difference and further development of person-centred care in HK. This study identifies self-perception of people with dementia who live in the residential care home and their subjective interpretations of self. Adopting a humanistic approach, this study goes beyond the dominance of medical explanations and treatment to enlarge the perspective of health care professions. The research reveals 1) how the participants perceive themselves; 2) how caring staff perceive the participants; 3) How the interactions between the participants and caring staff in the residential care homes co-constructed the interpretations; 4) the self-perception of the participants and 5) the impact of caring staff after being informed the participants’ self. P3-333
MEANINGFUL ENGAGEMENT OF PEOPLE WITH DEMENTIA
Mary Schulz, Jim Mann, Alzheimer Society of Canada, Toronto, ON, Canada. Contact e-mail: [email protected] Background: People living with dementia tell us, Nothing about us,
without us. With this mantra in mind, the Alzheimer Society of Canada (ASC) embarked on an initiative to enhance the engagement of persons with dementia in our work. By systematically incorporating the expertise of people with dementia and their families in fulfilling our mandate, we aim to improve the quality of our work and make it even more relevant, accountable and credible to stakeholders. During this process, ASC has examined and enhanced our own engagement practices while ensuring that what we learn is accessible not only throughout our organization nationwide but also to other organizations. Methods: In September 2012, ASC created an Advisory Group of people with dementia to inform our engagement of people with dementia in the mission-driven areas of our work. The Advisory Group first developed an ethical framework to guide the creation of a training plan and Resource Guide to assist organizations in meaningfully engaging people with dementia in all areas of their operations. The “Meaningful Engagement of People with Dementia” Training Plan was pilot tested at 6 different sites across Canada with the co-facilitation in each site by a person with dementia. Evaluation results of the training sessions were incorporated into the final draft of both the Training Plan and Resource Guide. Results: An ethical framework for engagement, a Training Plan and Resource Guide were developed in both English and French. By using these resources within the Alzheimer Societies across Canada, we strive to increase the number of people with dementia volunteering, achieve consistency and upgrade the way in which persons with dementia are approached and invited to become involved in our work and in how they continue to be engaged. Conclusion: Using the resources developed, staff and volunteers are challenged to consider new opportunities to engage people with dementia in meaningful and ethical ways that not only benefit them but the organization, as well. P3-334
INTIMACY AND DEMENTIA
Mary Schulz1, Sylvia Davidson2, 1Alzheimer Society of Canada, Toronto, ON, Canada; 2Baycrest, Toronto, ON, Canada. Contact e-mail: MSchulz@ alzheimer.ca Background: The subject of intimacy and aging remains one of our
last taboos. Factor dementia into this mix and one confronts many
Poster Presentations: Tuesday, July 26, 2016
challenging practice dilemmas, often influenced by strong opinions, values and beliefs. Health care providers in all settings, but most notably in care environments where there may be privacy, consent and capacity concerns, face these challenges with very little support, few resources and much misinformation. Methods: The Alzheimer Society of Canada partnered with subject matter experts in both law and dementia care to develop a workshop to help health care providers address issues of intimacy in their dementia care practice. Two types of resources formed the basis of this workshop: 1) Plain language legal resources for health care providers to apply consent and capacity laws appropriately into practice. 2) “Responsive behaviour framework” to assist health care providers in understanding what triggers, including a desire for intimate contact, might be influencing an individual’s behaviour and to offer a systematic approach to intervention. Results: A collaboration of legal, practice and dementia subject matter experts has led to the development of resources to help health care providers to a) reflect on their values, attitudes and beliefs in considering the rights of adults living with dementia to express their sexuality and need for intimacy, b) understand how personal beliefs may influence practice, c) learn person centred strategies to enhance the quality of life of persons with dementia in their care. Conclusion: This session will solicit practice scenarios from participants in order to apply person-centred strategies and resources to increase staff skill and sensitivity when approaching challenging situations involving persons with dementia and the expression of their sexuality and need for intimacy. P3-335
A SURVEY OF SOCIAL WORK STUDENTS’ ATTITUDES TOWARDS WORKING WITH PEOPLE WITH DEMENTIA
Lisa Kelly1, Anthea Vreugdenhil2, 1University of Tasmania, Launceston, Australia; 2University of Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: With growing numbers of older people in the population, social workers will increasingly be working with people with dementia and their families. Social work students need to be adequately prepared to work in this field through the development of appropriate knowledge, skills, and attitudes. Attitudes are particularly important, with research suggesting a strong link between negative attitudes of care workers and lower quality dementia care. The aims of this study were to assess the attitudes of social work students towards people with dementia and to examine how these attitudes shape perceptions about working in this field. Methods: This study used a cross-sectional, self-completed, anonymous survey to explore the attitudes of 127 Australian social work students towards working with people with dementia. Students were enrolled in the Bachelor and Master of Social Work qualifying courses at the University of Tasmania and the response rate was 79% of total enrolment (160 students). The survey questionnaire included a validated scale for assessing care worker attitudes towards people with dementia: the Approaches to Dementia Questionnaire (ADQ), which comprised two sub-scales measuring the dimensions of Hope and Personhood. There were additional questions about dementia interventions. Results: Social work students’ attitudes towards people with dementia were generally positive, however their mean score for the Hope sub-scale was significantly lower than for the Personhood sub-scale (mean score 3.64 versus 4.30; t ¼-15.79, p<0.001). Students with less positive attitudes towards people with dementia overall were less hopeful about the possibility of improving quality of life for this group (Chi2¼11.08, p<0.001). There was a positive association between
P975
students’ ADQ scores and their desire to work with people with dementia (Chi2¼20.2, p<0.001) although only 15% of students (n¼18) agreed strongly that they would like to work with people with dementia. Conclusions: This study suggests that while many social work students have positive attitudes towards people with dementia, relatively few are keen to work with this group upon graduation. More work is needed to ensure that all social work students are well-equipped for working with people with dementia and to explore strategies to increase interest in working in this field. P3-336
ATTITUDES AND SKILLS OF PSYCHIATRIC NURSES TO UNDERSTAND THE WISHES OF PATIENTS WITH DEMENTIA WHO HAVE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN JAPAN
Mie Urabe, Kyoto Prefectural University of Medicine, Kyoto, Japan. Contact e-mail: [email protected] Background: In order to provide better care for patients with dementia, it is important to try to understand their wishes and to make an effort to obtain their consent for each care procedure. However, understanding their wishes is difficult, especially when patients suffer from behavioral and psychological symptoms of dementia (BPSD). The aim of this study is to describe attitudes and skills of experienced psychiatric nurses to understand the wishes of patients with dementia and obtain their consent to each care procedure. Methods: Participants were five experienced psychiatric nurses who had been caring for patients with dementia with severe BPSD in Japan (4 male, 1 female; the average age is 43.4 years old; average dementia care experience 10.2 years). Semi-structured interviews lasting 30 min to 1 h. were given to each participants according to their practice of observation and attempt to understand patient’s wishes. The data were analyzed qualitatively and then categorized into groups. This study was approved by the ethical review board of Kyoto Prefectural University of Medicine. Results: The categories obtained were as follows: “category 1: The way nurses tailor language in regards to cognitive function and individuality”; “category 2: Responses for preventing over excitement and maintaining a calm psychological state”; “category 3: Interaction between dementia patients and nurses”; “category 4: Evaluation of treatment acceptance”; “category 5: Assessment of background factors of anger, aggression, and refusal”; “category 6: Safety management in treatment”; and “category 7 : Difficulty to assess and understand the patient’s wishes.” Conclusions: The participations determined the patient’s wishes by watching hand motion, behavior, facial expression, and the movement of eyes of the patients. Moreover, they paid attention not to arouse negative emotions to prevent excitement and maintain a calm psychological state. These skills should be transferred to nurses who have little experience in taking care of patients with dementia.
P3-337
DEMENTIA CARE LEARNING NEEDS AMONG PRIMARY CARE CLINICIANS: DOES THIS VARY BY PRACTICE SETTING?
Linda Lee1, Loretta M. Hillier2, Wayne W. Weston3, 1Centre for Family Medicine Family Health Team/McMaster University, Kitchener, ON, Canada; 2St. Joseph’s Health Care London, London, ON, Canada; 3Western University, London, ON, Canada. Contact e-mail: [email protected] Background/Purpose: It is well documented that limited knowledge
of dementia care in primary care is a barrier to optimal management. The purpose of this study was to compare the self-perceived