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Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia

Published online by Cambridge University Press:  23 January 2012

Linda J. Garcia ,
Michèle Hébert ,
Jean Kozak ,
Isabelle Sénécal ,
Susan E. Slaughter ,
Faranak Aminzadeh ,
William Dalziel ,
Jocelyn Charles  and
Misha Eliasziw
Linda J. Garcia*
Affiliation:
Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada Élisabeth Bruyère Research Institute, Ottawa, Canada
Michèle Hébert
Affiliation:
Occupational Therapy Program, School of Rehabilitation, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
Jean Kozak
Affiliation:
Department of Family and Community Medicine, Centre for Healthy Aging, Providence Health Care, Vancouver, Canada
Isabelle Sénécal
Affiliation:
Social Sciences and Humanities Research Council of Canada, Ottawa, Canada
Susan E. Slaughter
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Canada
Faranak Aminzadeh
Affiliation:
Élisabeth Bruyère Research Institute, Ottawa, Canada Regional Geriatric Program of Eastern Ontario, Ottawa, Canada
William Dalziel
Affiliation:
Regional Geriatric Program of Eastern Ontario, Ottawa, Canada Department of Medicine, University of Ottawa, Ottawa, Canada
Jocelyn Charles
Affiliation:
Veterans Centre, Sunnybrook Health Sciences Centre, Toronto, Canada Department of Family & Community Medicine, University of Toronto, Toronto, Canada
Misha Eliasziw
Affiliation:
Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
*
Correspondence should be addressed to: Linda J. Garcia, Professor, Interdisciplinary School of Health Sciences Faculty of Health Sciences, University of Ottawa, K1N 6X1, Ottawa, Ontario, Canada. Phone: +1-613-562-5254; Fax: +1-613-562-5632. Email: [email protected].
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Abstract

Background: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.

Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.

Results: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.

Conclusion: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

Keywords

dementialong-term careAlzheimer's disease (AD)
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 5 , May 2012 , pp. 753 - 765
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Alzheimer Knowledge Exchange (2011). Dementia-Friendly Design Considerations: Noise. Toronto: Alzheimer Knowledge Exchange. Available at: http://www.akeresourcecentre.org/files/Design/Noise%20K2P%20Physical%20Design%20V6.pdf.Google Scholar
Alzheimer Society of Canada (2009). Rising Tide: The Impact of Dementia on Canadian Society. Toronto: Alzheimer Society of Canada.Google Scholar
Aminzadeh, F., Dalziel, W. B., Molnar, F. and Garcia, L. J. (2010). Meanings, functions, and experiences of living at home for individuals with dementia at the critical point of relocation. Journal of Gerontological Nursing, 36, 28–35.CrossRefGoogle ScholarPubMed
Andrén, S. and Elmståhl, S. (2008). Effective psychosocial intervention for family caregivers lengthens time elapsed before nursing home placement of individuals with dementia: a five-year follow-up study. International Psychogeriatrics, 20, 1177–1192.CrossRefGoogle ScholarPubMed
Brunelle, J. and Tousignant, M. (1988). Les techniques de prélèvement de perceptions en activité physique. In Brunelle, J., Drouin, D., Godbout, P. and Tousignant, M. (eds.), La Supervision de l'intervention en activité physique (pp. 179–186). Montréal: Gaétan Morin.Google Scholar
Chang, E. et al. (2009). Challenges for professional care of advanced dementia. International Journal of Nursing Practice, 15, 41–47.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia. American Journal of Psychiatry, 9, 361–381.Google ScholarPubMed
Creswell, J. W. (1998). Qualitative Inquiry and Research Design: Choosing among Five Traditions. Thousand Oaks, CA: Sage.Google Scholar
Denzin, N. K. (1989). The Research Act: A Theoretical Introduction to Sociological Methods, 3rd edn. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Ducharme, J. K. and Geldmacher, D. S. (2011). Family quality of life in dementia: a qualitative approach to family-identified care priorities. Quality of life research, 20, 1–5.CrossRefGoogle ScholarPubMed
Duffin, C. (2008). Designing care homes for people with dementia. Nursing Older People, 20, 22–24.CrossRefGoogle ScholarPubMed
Etters, L., Goodall, D. and Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20, 423–428.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Fleming, R. and Purandare, N. (2010). Long-term care for people with dementia: environmental design guidelines. International Psychogeriatrics, 22, 1084–1096.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gaugler, J. E. et al. (2010). The effects on incident and persistent behavioral problems on change in caregiver burden and nursing home admission of persons with dementia. Medical Care, 48, 875–883.CrossRefGoogle ScholarPubMed
Hallberg, I. R., Norberg, A. and Eriksson, S. (1990). A comparison between the care of vocally disruptive patients and that of other residents on psychogeriatric wards. Journal of Advanced Nursing, 15, 410–416.CrossRefGoogle ScholarPubMed
Kverno, K. S., Rabins, P. V., Blass, D. M., Hicks, K. L. and Black, B. S. (2008). Prevalence and treatment of neuropsychiatric symptoms in advanced dementia. Journal of Gerontological Nursing, 34, 8–15.CrossRefGoogle ScholarPubMed
Luppa, M., Luck, T., Weyerer, S., König, H.-H., Brähler, E. and Riedel-Heller, S. G. (2010). Prediction of institutionalization in the elderly: a systematic review. Age and Aging, 39, 31–38.CrossRefGoogle ScholarPubMed
Marquardt, G. and Schmeig, P. (2009). Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. American Journal of Alzheimer's Disease and Other Dementias, 24, 333–340.CrossRefGoogle ScholarPubMed
McMinn, B. and Draper, B. (2005). Vocally disruptive behavior in dementia: development of an evidence based practice guideline. Aging & Mental Health, 9, 16–24.CrossRefGoogle ScholarPubMed
Pavlakovic, R. (2001). Management of behavioral disorders in the facility care setting. Stride, May/July, 21–24.Google Scholar
Reimer, M. A., Slaughter, S., Donaldson, C., Currie, G. and Eliasziw, M. (2004). Special care facility compared to traditional environments for dementia care: a longitudinal study of quality of life. Journal of the American Geriatrics Society, 52, 1085–1092.CrossRefGoogle Scholar
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacolgy Bulletin, 24, 653–659.Google ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). Global Deterioration Scale (GDS). American Journal of Psychiatry, 139, 1136–1139.Google Scholar
Schwarz, B., Chaudhury, H. and Brent Tofle, R. (2004). Effect of design interventions on a dementia care setting. American Journal of Alzheimer's Disease and Other Dementias, 19, 172–176.CrossRefGoogle ScholarPubMed
Slaughter, S., Calkins, M., Eliasziw, M. and Reimer, M. (2006). Measuring physical and social environments in nursing homes for people with middle to late-stage dementia. Journal of the American Geriatrics Society, 54, 1436–1441.CrossRefGoogle ScholarPubMed
Strauss, A. and Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage.Google Scholar
Verbeek, H., van Rossum, E., Zwakhalen, S. M., Kempen, G. I. and Hamers, J. P. (2009). Small, homelike care environments for older people with dementia: a literature review. International Psychogeriatrics, 21, 252–264.CrossRefGoogle ScholarPubMed
WHO (2011). The World Health Report: Executive Summary. Geneva: World Health Organization. Available at: http://www.who.int/whr/1997/media_centre/executive_summary1/en/index14.html.Google Scholar
Zeisel, J., Silverstein, N. M., Hyde, J., Levkoff, S., Lawton, M. P. and Holmes, W. (2003). Environmental correlates to behavioral health outcomes in Alzheimer's special care units. Gerontologist, 43, 697–711.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2010). Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. International Journal of Geriatric Psychiatry, 25, 14–22.CrossRefGoogle ScholarPubMed