School of Nursing School of Nursing Identification and Management of Disorders Associated with Dementia Glenise McKenzie, PhD, RN,

School of Nursing Acknowledgements Oregon Health and Science University (OHSU) Robert Wood Johnson Foundation Sigma Theta Tau Betty Gray Foundation (OHSU)

School of Nursing Overview Background Why should we care? Assisted Living and Dementia What is happening? Insights from my research experience What might help?

School of Nursing Background Who is affected by dementia? So what…for the residents? So what ….for the caregivers?

School of Nursing Background Person with Dementia Cognitive changes Psychological and behavioral changes Activities of Daily Living – changes in abilities Caregivers

School of Nursing What are behavioral and psychological symptoms of dementia(BPSD)? Psychological symptomsBehavioral symptoms delusions hallucinations misidentifications depression anxiety sleeplessness apathy physical aggression wandering restlessness disinhibition repetitive questions

School of Nursing Background What is happening with dementia care and the BPSD in assisted living? Percentage of clients with BPSD Memory Care units Expected growth

School of Nursing Evidence-based Care for BPSD Nonpharmacologic Strategies: 1. Identify the precipitating factor and treat/avoid the triggers (Need-driven behavior, behavior as communication) 2. Communication/approach and distraction techniques 3. Behavioral problem solving (ABC) 4. Environmental Modifications Open areas and outside access Aromatherapy-lavender Light, music, massage and pet therapy 5. Exercise and structured activity therapies

School of Nursing My Research Organization of Work in Assisted Living: Occupational Health and Safety Implications for Direct Care Workers. (Quantitative - survey) Staff Training in Assisted-living Residences (STAR) (L. Teri, PI - intervention study) "The Role of Medication Aides and Licensed Nurses in Assisted Living Workplace: Factors and Occupational Health Implications. (Qualitative) Management of Psychosocial and Behavioral Symptoms of Dementia: A Qualitative Study of Strengths and Gaps in Assisted Living Facilities (Qualitative)

School of Nursing Promoting mental health of older adults and their caregivers Dementia Related Symptoms Community Dwelling Residing in Assisted Living Settings Older Adults Assisted Living Staff Family Caregivers Caregivers

School of Nursing Findings Summary of findings from completed studies: High levels of work stress and emotional distress in direct care workers (DCWs) in ALFs DCWs work stress and distress associated with individual and system-level factors

School of Nursing Findings Behavioral based training for ALF staff improved behavior and mood of residents with dementia and improved mood and confidence of staff (1:1 strategies and case studies) Implementing and sustaining interventions in the real world is challenging!

School of Nursing Findings Examples of supervisor comments about CNAs post training CNAs are calmer during care, they are understanding residents cognitive status better – RN Using more positive distraction techniques in residents with dementia – RN Knowing how to (better) handle a resident altercation - RN

School of Nursing Findings Direct care staff self-report 77% reported they saw a difference working with residents when they used training components 65% reported use of specific component in their daily interactions with residents

School of Nursing Findings Strategies that support management of BPSD: person-directed care: focus on needs and preferences of person exhibiting behavior management practices: empower and support staff Factors that impede BPSD in rural ALFs include: lack of behavioral and psychiatric expertise resources lack of access to targeted training in behavioral management strategies

School of Nursing Recommendations Additional education/training is needed for unlicensed and licensed staff caring for these clients in community-based settings (especially in rural areas) Delivery of training should include hands-on chances to practice behavioral strategies Incorporate examples from caregivers and problem solve during training Consider alternative delivery methods for rural areas (tele-medicine; phone conferencing)

School of Nursing Conclusions BPSD is part of dementia and more folks with dementia are coming our way Preparing caregivers improves their lives as well as the residents lives Moving promising programs into the real world requires ongoing research/evaluation

School of Nursing Discussion