Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings

Elderly people living in the aged care facilities and suffering from dementia often suffers from depressing psychological symptoms (BPSD) (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012). The clinical manifestations of this condition are aggression, anxiety, aggression, violence, apathy, depression, irritability and rarely hallucinations, disinhibition and euphoria (Backhouse, Killett, Penhale & Gray, 2016)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings.

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The behavioral symptoms that are generally observed are restlessness, agitation and wandering. The patients with BPSD are normally recommended with several pharmacological therapies, including prescription of antipsychotic drugs and antidepressants. The elderly population are presented with multiple comorbidities, thus increasing the chance of adverse drug related conditions (Backhouse, Killett, Penhale & Gray, 2016)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings. This has led to the development of the several complementary therapies and non –pharmacological interventions (NPIs) to treat the behavioral and the psychosocial symptoms in dementia patients. Several non-pharmacological interventions like aromatherapy, art therapy, behavioral therapy, tailored activity, reality orientation and physical exercises have shown promising results in managing the behavioral and the psychosocial symptoms of the BPSD (de Oliveira et al., 2015). The main rationale behind this research is that, in many cases the needs of the dementia patients remain unaddressed that deteriorates their quality of life. Several studies like Livingston et al., (2012), have discussed about the importance of the alternative therapies on the dementia patients. This study aims to focus on the use of NPIs on the individuals residing in the aged care unit and experiencing behavioral and the psychosocial symptoms of dementia.  Additionally, this research proposal will illustrate the effect of the nursing care practices on the organizational factors, managing the care home environment for the elderly people suffering from dementia.

Does non-pharmacological interventions helps in treating behavioral and psychological symptoms of dementia (BPSD) in the elderly residents in the aged care settings?

P- Elderly patients in the aged care setting suffering from symptoms of dementia (BPSD)

I-Non –pharmacological interventions

C- In comparison to the pharmacological interventions

O- Treating BPSD symptoms

The term BPSD can be used as an umbrella term to describe a heterogeneous group of behavioral and psychological symptoms (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012). Psychotropic medicines have modest efficacy, but is associated with several side effects (Brodaty & Arasaratnam, 2012)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings. Antipsychotic medicines had been in use to manage the behavioral and psychological symptoms of dementia (BPSD). There are studies that have suggested the potential risk associated with these medications. Most of the health care professionals are trained in the application of medicines to the BPSD patients, but very few clinicians are informed about the alternative treatments to avoid the delirious side effects (Brodaty & Arasaratnam, 2012).  According to de Oliveira et al., (2015), some of the side effects related to the antipsychotic medications are anticholinergic action, parkinsonian events, cardiac conduction disturbances, cognitive slowing, sedation and reduce bone mineral density. Hence, in such cases it is better to use the non-pharmacological treatments, which have been proven to be a safe alternative treatment. Brodaty & Arasaratnam, (2012) have stated that non-pharmacological interventions like transcranial direct current stimulation can be used in treating aged patients with LBD.  According to Koder, Hunt & Davison, (2014), cognitive behavioral therapy (CBT) has been found to useful for treating anxiety in dementia patients. A randomized control trial has proved that CBT has been found have caused a significant reduction to the anxiety and depression in the dementia patients (Sadek, Hoe & Orrell, 2015). Gitlin, Kales and Lyketsos, (2012), has opined that music therapy are often used to treat anxiety and depression among the dementia patients. It does so by evoking the feelings, memories and sensations. People have been found to be responding to music ever since language has not developed. Music accesses several parts of the brain and soothing music might evoke emotional reaction in the dementia patients, especially those suffering from acute memory loss. It helps the person to connect to the people around them and also encourages social interaction and promotes group activities (Groot et al., 2016). Studies are there that have proven that mild to moderate exercises can be useful for the wellbeing of the patients with dementia (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012).  Currently, in the clinical practice, agitation is normally treated with the help of medicines but the clinical outcomes have been found to be poor (Cooper et al., 2012)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings.  However, there had been uncertainties about how these interventions will be applied in the aged care homes for helping the individuals suffering from the behavioral symptoms. Due to the lack of understanding about the effective application of the interventions, its application in the aged care homes are limited (Brechin, 2013). The literature that has been present is weak in nature due to the absence of any meta-analysis or randomize control trials. Other systematic reviews and the secondary literature that consisted of research of inconsistent literatures with inappropriate sample size and statistically in-significant results, thus, increasing the chance of bias (Ma et al., 2014).

Four ethnographic case studies were intended to be conducted in four care homes. This will be done by doing a postal survey to choose the suitable care homes.  The propose research will employ a qualitative approach that will help to give a better understanding of the problem. This method was chosen, as it will be suitable for examining the complex problems in the real life, setting like aged care homes (Hymes, 2013)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings.

In total, the four case studies will include 384 hours of observation, 37 interviews with 40 staffs with suitable mapping of the psychotropic medication administration. Data collection will be continued until saturation is reached. Observation will be conducted over a period of 5- 6 week period in each of the care homes. There will be one interview with the staff members at time that will be convenient to the staff members. The interview will be recorded and transcribed. The case studies will be reviewed by the Social Care Research ethics Committee before the commencement to the fieldwork. The duration of each of the interview sessions would be for 40-60 minutes, where the participants will be made to sign a consent form containing all the pros and cons of the study.

Postal survey will be conducted to select the care homes for the sampling of the case studies. All the eligible responses of the survey will be analyzed and sorted. The aged care facilities that will be included will most likely to contain patients experiencing the BPSD. This will helps the researcher to get the relevant findings.

The researcher will approach the organization by a letter of permission with a follow-up call after a week later aiming to discuss about the study. The care home staffs working closely with residence experiencing BPSD will be chosen as the potential participants. A purposive sampling method will be used for the study. All the staff members of the organization will be informed about the study by providing with a participant information sheet.

Observation of the participants through direct interaction will be used. The main aim of ethnographic case studies is to get a deep insight in to any individual and the work environment, by a series of interviews and field observations.  In case of interviewing the staff members, semi-structured interview will be taken for interrogating the staffs. Bergh and Ketchen, (2011) have stated that, interview is the most common method of qualitative and ethnographic researches. Interviews helps in exploring the views, beliefs, experiences of each of the participants. The usefulness of the semi -structured interviews lies in the fact that it helps to discover the specific areas of interest and helps the researcher to get an in-depth detail about a specific concept (Silverman, 2016). The main rationale for choosing the semi-structured interview is that it helps to provide an idea about the perception of the informal caregivers about the application of psychotherapies such as cognitive behavioral therapy.  Tape recorders and in some cases, video recording might be used.

Ethical approval is an important part of each clinical trials or researches as it gives authority to the participants to withdraw from the study as per their will.

All the staff members of the study will be informed verbally about the study and will be made to sign a consent form. Consent will be taken from each participants individually. Personal consultants will be identified and contacted for providing advice about those participants who does not have personal capacity to consent. Written consent will be taken from each of the individual members. Ethical approval for the study will be taken from the local ethics committee for the conduction of this study. Privacy and confidentiality should be maintained during the conduction of the interviews. All the interview Data and observations should be recorded electronically and should be maintained by using encrypted passwords for avoiding data loss due to unauthorized entry or theft. Hand written data for the ethnographic study will be maintained properly in closed cabinets Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings.

Data will be typed up, anonymised and then stored securely. A framework approach will be taken for analyzing the extensive quality data set.

After the interviews had been conducted, a transcriptionist will make a transcript of all the recordings. The generated transcript will be tallied thoroughly with the recording. Finally, a statistician will analyze the transcripts. This approach has five phases- “familiarization” that involves immersion in the data for recognizing the key themes. A thematic framework will be used where ideas will be assembled from the research question. “Indexing” that involves the application of the thematic framework to the whole data set and finally “charting” them, which involves summarization of the data under each of the themes with reference to the source data and finally mapping and the interpretation of the data, where the structures and the patterns will be identified and the key concepts will be examined.

The data analysis will break down the collected data in to each of the ethnographic case study and for their future use in the dementia care. Several aspects will be generated from a given framework. This study will be able to show the association between the findings, strategies, behaviors and the theme. The observations will be able to show the actions that are conducted in every day’s life in an aged care facility. The activities that will be observed mainly are – watching of televisions, solving the jigsaw puzzles and other activities of the elderly people that are being done without the help of the caregivers. The aged care will be screened for the activities like aromatherapy, massage, reflexology, nail varnishing, doll therapy and more for the residents experiencing high-risk behaviors (Morrin et al., 2016). Group activities such as exercises, reminiscence, cognitive stimulation, art and craft, music therapy, entertainment and church services has to be considered (de Oliveira et al., 2015)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings. Some of the activities such as gardening or cooking might also be considered as group activities. The residents experiencing psychological and the behavioral symptoms for which NPIs should be recommended as the first line of treatment. The final studies taken place will assist the nursing staffs, as the whole study will be done on a nursing perspective.

This study will help the nurses of the clinical staffs about the various non-pharmacological treatment that can be administered to elderly residents of the aged care. This will help to increase the level of support that the caregivers are providing to the elderly patients. Individual interventions can be considered as the first line of treatment for treating the behavioral and the psychological symptoms (McLaren, LaMantia & Callahan, 2013). Treatments like, multisensory stimulation, music therapy, long massages, might not be identified by the staffs as the major activities for treating patients, but such an ethnographic study can point out the gaps left in the activities (Ueda,  Suzukamo, Sato & Izumi, 2013, McDermott, Crellin, Ridder & Orrell, 2013). The researcher who will conduct the data collection method for the study should have several years of experience of paid care work having experience working with the older people. Such experience will assist the researcher for coping up with the emotional aspects of the work.  This will help in the development of good rapport and trust between the participant and the researcher, which will help in increasing the credibility of the data (Backhouse et al., 2016)Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings.

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Conclusion

In conclusion, it can be said that interventions for the elderly people in the care homes are not enough for meeting the various needs of the dementia patients. Hence, improvement is required for elevating the general wellbeing of the residents in the nursing homes. In future, I intend to run the data analysis part of the training for evaluating the status post the research proposal. This study will be potentially important for those suffering from psychological and the behavioral symptoms as such a study will be helpful in pointing out, which of the interventions are more useful in treating the dementia patients. There lies an evidence gap between the practice and rhetoric in this case that requires to be addressed by the implementation of the activities that are customized intervention especially for the residents. Effect Of Non-Pharmacological Interventions On Elderly Residents In Aged Care Settings