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- Pellfolk, Tony, 1976-
(författare)
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Physical restraint use and falls in institutional care of old people : effects of a restraint minimization program
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use. The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care. The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education. The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007. During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls. A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant. In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls.
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| 2. |
- Pellfolk, Tony, 1976-, et al.
(författare)
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Effects of a restraint minimization program on staff knowledge, attitudes, and practice : a cluster randomized trial
- 2010
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Ingår i: Journal of The American Geriatrics Society. - United Kindom : Wiley Interscience. - 0002-8614 .- 1532-5415. ; 58:1, s. 62-69
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints. DESIGN: Cluster-randomized controlled trial with nursing units as the basis for randomization. SETTING: Forty group dwelling units for people with dementia. PARTICIPANTS: At baseline, there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group. At the 6-month follow-up, there were 156 staff and 185 residents (36 newly admitted) in the intervention group and 133 staff and 165 residents (26 newly admitted) in the control group. INTERVENTION: A 6-month education program for all nursing staff. MEASUREMENTS: Staff knowledge and attitudes and physical restraint use were measured before and after the education program. RESULTS: In the intervention group, staff knowledge about and attitudes toward restraint use changed, and the overall use of physical restraints decreased. A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline, whereas it was significantly lower in the intervention group at follow-up. Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group. There was no significant change in the number of falls or use of psychoactive medication. CONCLUSION: The results indicate that staff education can increase knowledge, change attitudes, and reduce the use of physical restraints without any change in the incidence of falls or use of psychoactive drugs.
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| 3. |
- Lövheim, Hugo, 1981-, et al.
(författare)
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One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care : changes between 1982 and 2000
- 2010
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Ingår i: International psychogeriatrics. - : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 22:7, s. 1154-1160
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dementia and depression are common in advanced age, and often co-exist. There are indications of a decreased prevalence of depressive symptoms among old people in recent years, supposedly because of the manifold increase in antidepressant treatment. Whether the prevalence of depressive symptoms has decreased among people in different stages of dementia disorders has not yet been investigated.Methods: A comparison was undertaken of two cross-sectional studies, conducted in 1982 and 2000, comprising 6864 participants living in geriatric care units in the county of Västerbotten, Sweden. Depressive symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and the cognitive score was measured with Gottfries' cognitive scale. Drug data were obtained from prescription records.Results: There was a significant decrease in depressive symptom score between 1982 and 2000 in all cognitive function groups except for the group with moderate cognitive impairment. Antidepressant drug use increased in all cognitive function groups.Conclusion: The prevalence of depressive symptoms decreased between 1982 and 2000, in all levels of cognitive impairment except moderate cognitive impairment. This might possibly be explained by the depressive symptoms having different etiologies in different stages of a dementia disorder, which in turn might not be equally susceptible to antidepressant treatment.
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| 4. |
- Gustafsson, Maria, et al.
(författare)
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Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units
- 2013
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Ingår i: BMC pharmacology & toxicology. - : Springer Science and Business Media LLC. - 2050-6511. ; 14, s. 10-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Antipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden.METHODS: This study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records.RESULTS: This study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance.After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics.CONCLUSION: The prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.
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| 5. |
- Lindelöf, Nina, et al.
(författare)
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Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living
- 2012
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Ingår i: Physiotherapy Theory and Practice. - London : Informa Healthcare. - 0959-3985 .- 1532-5040. ; 28:4, s. 307-316
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.
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| 6. |
- Lövheim, Hugo, et al.
(författare)
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Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007.
- 2011
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Ingår i: International psychogeriatrics. - : Cambridge Journals. - 1041-6102 .- 1741-203X. ; 23:10, s. 1616-1622
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Tidskriftsartikel (refereegranskat)abstract
- Background: Behavioral and psychological symptoms, such as verbal or physical aggression, aberrant motor behaviors, psychotic symptoms, anxiety, depressive symptoms and apathy are common among people with dementia. The aim of the present study was to compare the one-week prevalence of behavioral and psychological symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 2000 and 2007. Methods: A comparison was made between two cross-sectional samples, collected in 2000 and 2007, comprising 4054 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to assess cognitive impairment and behavioral and psychological symptoms. The use of psychotropic drugs was recorded. Results: Between 2000 and 2007, 15 out of 39 behavioral or psychological symptoms had become less common and no symptoms had become more common, after controlling for demographic changes. Four out of six behaviors within the cluster of aggressive behaviors had declined in prevalence. Patients prescribed anti-dementia drugs increased from 5.1% to 18.0% and antidepressant drug use increased from 43.2% to 49.1%, while anxiolytic, hypnotic, sedative and antipsychotic drug use remained largely unchanged. Conclusion: The prevalence of many behavioral symptoms had declined from 2000 to 2007, and among these changes, the decline in aggressive behaviors probably has the greatest clinical impact.
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