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A life history intervention for individuals with dementia: a randomised controlled trial examining nursing staff empathy, perceived patient personhood and aggressive behaviours

Published online by Cambridge University Press:  18 August 2015

HEATHER ERITZ ,
THOMAS HADJISTAVROPOULOS ,
JAIME WILLIAMS ,
KRISTINE KROEKER ,
RONALD R. MARTIN ,
LISA M. LIX  and
PAULETTE V. HUNTER
HEATHER ERITZ
Affiliation:
Centre on Aging and Health, University of Regina, Canada. Department of Psychology, University of Regina, Canada.
THOMAS HADJISTAVROPOULOS*
Affiliation:
Centre on Aging and Health, University of Regina, Canada. Department of Psychology, University of Regina, Canada.
JAIME WILLIAMS
Affiliation:
Centre on Aging and Health, University of Regina, Canada.
KRISTINE KROEKER
Affiliation:
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
RONALD R. MARTIN
Affiliation:
Centre on Aging and Health, University of Regina, Canada. Faculty of Education, University of Regina, Canada.
LISA M. LIX
Affiliation:
Centre on Aging and Health, University of Regina, Canada. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
PAULETTE V. HUNTER
Affiliation:
Department of Psychology, University of Saskatchewan, Saskatoon, Canada.
*
Address for correspondence: Thomas Hadjistavropoulos, Centre on Aging and Health, University of Regina, 3737 Wascana Pkwy, Regina, SK, Canada S4S 0A2 E-mail: [email protected]
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Abstract

Behaviours of concern (e.g. aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.

Keywords

life historiesperson-centred caredementia care and aggressionquality of life
Type
Articles
Information
Ageing & Society , Volume 36 , Issue 10 , November 2016 , pp. 2061 - 2089
Copyright
Copyright © Cambridge University Press 2015 

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References

Algase, D. L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K. and Beattie, E. 1996. Need-driven dementia-compromised behavior: an alternative view of disruptive behavior. American Journal of Alzheimer's Disease and Other Dementias, 11, 6, 10–19.Google Scholar
Bauer, D. J., Preacher, K. J. and Gil, K. M. 2006. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations. Psychological Methods, 11, 2, 142–63.Google Scholar
Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 2, 77–101.CrossRefGoogle Scholar
Buron, B. 2008. Levels of personhood: a model for dementia care. Geriatric Nursing, 29, 5, 324–32.CrossRefGoogle Scholar
Buron, B. 2010. Life history collages: effects on nursing home staff caring for residents with dementia. Journal of Gerontological Nursing, 36, 12, 38–48.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S. and Rosenthal, A. S. 1989. A description of agitation in a nursing home. Journals of Gerontology: Medical Sciences, 44, 3, M77–84.Google Scholar
Davis, M. H. 1980. A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85. Available online at www.eckerd.edu/academics/psychology/files/Davis_1980.pdf Google Scholar
Devanand, D. P., Brockington, C. D., Moody, B. J., Brown, R. P., Mayeux, R., Endicott, J. and Sackeim, H. A. 1992. Behavioral Syndromes in Alzheimer's Disease, 4, 4, 161–84.Google ScholarPubMed
Dupuis, S. L., Wiersma, E. and Loiselle, L. 2004. The Nature of Responsive Behaviours in Long Term Care Settings. Murray Alzheimer Research and Education Program, University of Waterloo, Waterloo, Canada.Google Scholar
Egan, M. Y., Munroe, S., Hubert, C., Rossiter, T., Gauthier, A., Eisner, M., Fulford, N., Neilson, M., Daros, B. and Rodrigue, C. 2007. Caring for residents with dementia and impact of life history knowledge. Journal of Gerontological Nursing, 33, 2, 24–30.CrossRefGoogle ScholarPubMed
Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K. and Kyngäs, H. 2014. Qualitative content analysis: a focus on trustworthiness. Sage Open, 4, 1. doi:10.1177/2158244014522633.Google Scholar
Eritz, H. and Hadjistavropoulos, T. 2011. Do informal caregivers consider non-verbal behaviour when they assess pain in people with dementia? Journal of Pain, 12, 3, 331–9.CrossRefGoogle Scholar
Fields, S. K., Hojat, M., Gonnella, J. S., Mangione, S., Kane, G. and Magee, M. 2004. Comparisons of nurses and physicians on an operational measure of empathy. Evaluation and the Health Professions, 27, 1, 80–94.Google Scholar
Finkel, S. I., Lyons, J. S. and Anderson, R. L. 1992. Reliability and validity of the Cohen-Mansfield Agitation Inventory in institutionalized elderly. International Journal of Geriatric Psychiatry, 7, 7, 487–90.Google Scholar
Fisher, J. E., Drossel, C., Ferguson, K., Cherup, S. and Sylvester, M. 2008. Treating persons with dementia in context. In Gallagher-Thompson, D., Steffen, A. M. and Thompson, L. W. (eds), Handbook of Behavioural and Cognitive Therapies with Older Adults. Springer Science + Business Media, New York, 200–18.CrossRefGoogle Scholar
Gessert, C. E., Hyer, K., Kane, R. L., Rockwood, T., Brassard, A. B., Desjardins, K. and Kane, R. A. 2005. Cognitive impairment and quality-of-life: views of providers of long-term care services. Alzheimer Disease and Associated Disorders, 19, 2, 85–90.CrossRefGoogle ScholarPubMed
Gonzalez-Salvador, T., Lyketsos, C. G., Baker, A., Hovanec, L., Roques, C., Brandt, J. and Steele, C. 2000. Quality of life in dementia patients in long-term care. International Journal of Geriatric Psychiatry, 15, 2, 181–9.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
Hall, K. A. and O'Connor, D. W. 2004. Correlates of aggressive behaviour in dementia. International Psychogeriatrics, 16, 2, 141–58.Google Scholar
Harden, R. N., Weinland, S. R., Remble, T. A., Houle, T. T., Colio, S., Steedman, S. and Kee, W. G. 2005. Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians. Journal of Pain, 6, 6, 364–71.Google Scholar
Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, M. and Phillips, C. D. 1995. Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination. Journals of Gerontology: Medical Sciences, 50A, 2, M128–33.Google Scholar
Hojat, M., Gonnella, J. S., Nasca, T. J., Mangione, S., Veloksi, J. J. and Magee, M. 2002. The Jefferson Scale of Physician Empathy: further psychometric data and differences by gender and specialty at item level. Academic Medicine, 77, 10, S58–60.CrossRefGoogle ScholarPubMed
Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J. M., Gonnella, J. S., Erdmann, J. B., Veloski, J. and Magee, M. 2001. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educational and Psychological Measurement, 61, 2, 349–65.Google Scholar
Hox, J. J. 2010. Multilevel Analysis. Techniques and Applications. Second edition, Routledge, New York.Google Scholar
Hunter, P. and Hadjistavropoulos, T. 2011. The Personhood in Dementia Questionnaire. Unpublished manuscript, University of Regina, Regina, Canada.Google Scholar
Hunter, P. V., Hadjistavropoulos, T., Smythe, W. E., Malloy, D. C., Kaasalainen, S. and Williams, J. 2013. The Personhood in Dementia Questionnaire (PDQ): establishing an association between beliefs about personhood and health providers’ approaches to person-centred care. Journal of Aging Studies, 27, 3, 276–87.CrossRefGoogle ScholarPubMed
Johnson, R. B. and Onwuegbuzie, A. J. 2004. Mixed methods research: a research paradigm whose time has come. Educational Researcher, 33, 7, 14–26.CrossRefGoogle Scholar
Kaasalainen, S., Coker, E., Dolovich, L., Papaioannou, A., Hadjistavropoulos, T., Emili, A. and Ploeg, J. 2007. Pain management decision-making among long-term care physicians and nurses. Western Journal of Nursing Research, 29, 5, 561–80.Google Scholar
Kasper, J. D., Black, B. S., Shore, A. D. and Rabins, P. V. 2009. Evaluation of the validity and reliability of the Alzheimer's Disease-related Quality of Life assessment instrument. Alzheimer's Disease and Associated Disorders, 23, 3, 275–84.Google Scholar
Keady, J. and Jones, L. 2010. Investigating the causes of behaviours that challenge people with dementia. Nursing Older People, 22, 9, 25–9.Google Scholar
Kitwood, T. 1993. Person and process in dementia. International Journal of Geriatric Psychiatry, 8, 7, 541–5.CrossRefGoogle Scholar
Kline, T. 2005. Psychological Testing: A Practical Approach to Design and Evaluation. Sage, Thousand Oaks, California.Google Scholar
Kong, E. H. 2005. Agitation in dementia: concept clarification. Journal of Advanced Nursing, 52, 5, 526–36.CrossRefGoogle ScholarPubMed
Koren, M. J. 2010. Person-centered care for nursing home residents: the culture-change movement. Health Affairs, 29, 2, 312–7.Google Scholar
Li, J. and Porock, D. 2014. Resident outcomes of person-centered care in long-term care: a narrative review of interventional research. International Journal of Nursing Studies, 51, 10, 1395–415.Google Scholar
Maas, C. J. M. and Hox, J. J. 2004. Robustness issues in multilevel regression analysis. Statistica Neerlandica, 58, 2, 127–37.Google Scholar
Malloy, D. and Hadjistavropoulos, T. 2004. The problem of pain management among persons with dementia and the ontology of relationships. Nursing Philosophy, 5, 2, 147–59.CrossRefGoogle ScholarPubMed
McKeown, J., Clarke, A., Ingleton, C., Ryan, T. and Repper, J. 2010. The use of life story work with people with dementia to enhance person-centred care. International Journal of Older People Nursing, 5, 2, 148–58.CrossRefGoogle ScholarPubMed
McKeown, J., Ryan, T., Clarke, A. and Ingleton, C. 2013. ‘You have to be mindful of whose story it is’: the challenges of undertaking life story work with people with dementia and their family carers. Dementia: International Journal of Social Research and Practice, 14, 2, 238–56.CrossRefGoogle ScholarPubMed
Mengshoel, A. M. 2012. Mixed methods research: so far easier said than done? Manual Therapy, 17, 4, 373–5.Google Scholar
Mitty, E. and Flores, S. 2007. Assisted living nursing practice: the language of dementia: theories and interventions. Geriatric Nursing, 28, 5, 283–8.Google Scholar
Moos, A. and Björn, A. 2006. Use of the life story in the institutional care of people with dementia: a review of intervention studies. Ageing & Society, 26, 3, 431–54.Google Scholar
Morris, J. N., Fries, B. E., Mehr, D. R., Hawes, C., Philips, C., Mor, V. and Lipsitz, L. 1994. MDS Cognitive Performance Scale. Journals of Gerontology: Medical Sciences, 49, 4, M174–82.CrossRefGoogle ScholarPubMed
Murfield, J., Cooke, M., Moyle, W., Shum, D. and Harrison, S. 2011. Conducting randomized controlled trials with older people with dementia in long-term care: challenges and lessons learnt. International Journal of Nursing Practice, 17, 1, 52–9.CrossRefGoogle ScholarPubMed
Ostlund, U., Kidd, L., Wengström, Y. and Rowa-Dewar, N. 2011. Combining qualitative and quantitative research within mixed method research designs: a methodological review. International Journal of Nursing Studies, 48, 3, 369–83.CrossRefGoogle ScholarPubMed
Paquay, L., De Lepeleire, J., Schoenmakers, B., Ylieff, M., Fontaine, O. and Buntinx, F. 2007. Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents. International Journal of Geriatric Psychiatry, 22, 4, 286–93.CrossRefGoogle ScholarPubMed
Perlman, C. M. and Hirdes, J. P. 2008. The Aggressive Behaviour Scale: a new scale to measure aggression based on the Minimum Data Set. Journal of the American Geriatric Society, 56, 12, 2298–303.CrossRefGoogle Scholar
Reisberg, B., Bornstein, J., Salob, S. P., Ferris, S. H., Franssen, E. and Gerogotas, A. 1987. Behavioural symptoms in Alzheimer's disease: phenomenology and treatment. Journal of Clinical Psychiatry, 48, supplement, 9–15.Google Scholar
Rosemond, C. A., Hanson, L. C., Ennett, S. T., Schenck, A. P. and Weiner, B. J. 2012. Implementing person-centered care in nursing homes. Health Care Management Reviews, 37, 3, 257–66.Google Scholar
Schulz, K. F., Altman, D. G. and Moher, D. 2010. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8, 1, 18.CrossRefGoogle ScholarPubMed
Seitz, D., Purandare, N. and Conn, D. 2010. Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 7, 1025–39.Google Scholar
Semla, T. P., Beizer, J. L. and Higbee, M. D. 2011. Lexi-Comps Geriatric Dosage Handbook. Baker & Taylor Company, Charlotte, North Carolina.Google Scholar
Subramaniam, P., Woods, B. and Whitaker, C. 2014. Life review and life story books for people with mild to moderate dementia: a randomised controlled trial. Aging & Mental Health, 18, 3, 363–75.Google Scholar
Tilden, V. P., Thompson, S. A., Gajewski, B. J., Buescher, C. M. and Bott, M. J. 2013. Sampling challenges in nursing home research. Journal of the American Medical Directors Association, 14, 1, 25–8.Google Scholar
Tuckett, A. G. 2005. Applying thematic analysis theory to practice: a researcher's experience. Contemporary Nurse, 19, 1/2, 75–87.Google Scholar
Whall, A. L., Colling, K. B., Kolanowski, A., Kim, H. J., Hong, G.-R. S., DeCicco, B., Ronis, D. L., Richards, K. C., Algase, D. and Beck, C. 2008. Factors associated with aggressive behaviour among nursing home residents with dementia. The Gerontologist, 48, 6, 721–31.Google Scholar
White, D. L., Newton-Curtis, L. and Lyons, K. S. 2008. Development and initial testing of a measure of person-directed care. The Gerontologist, 48, Supplement 1, 114–23.CrossRefGoogle ScholarPubMed
Zeller, A., Hahn, S., Needham, I., Kok, G., Dassen, T. and Halfens, R. J. G. 2009. Aggressive behaviour of nursing home residents toward caregivers: a systematic literature review. Geriatric Nursing, 30, 3, 174–87.CrossRefGoogle ScholarPubMed