A study protocol to investigate the management of depression and challenging behaviors associated with dementia in aged care settings

BMC Geriatrics

Daniel W O’Connor²  Kathryn von Treuer¹  Gery Karantzas¹  Tanya E Davison²  David Mellor¹  Marita P McCabe¹ 

[1] School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, Victoria, Australia;School of Psychology and Psychiatry, Monash University, Melbourne, Australia

关键词: Staff training;    Organizational barriers;    Aged care;    Depression;    Challenging behaviors;   

Others  :  856821
DOI  :  10.1186/1471-2318-13-95

 received in 2013-07-02, accepted in 2013-09-13,  发布年份 2013

【 摘 要 】

Background

The high occurrence and under-treatment of clinical depression and behavioral and psychological symptoms of dementia (BPSD) within aged care settings is concerning, yet training programs aimed at improving the detection and management of these problems have generally been ineffective. This article presents a study protocol to evaluate a training intervention for facility managers/registered nurses working in aged care facilities that focuses on organisational processes and culture as well as knowledge, skills and self-efficacy.

Methods

A Randomised Control Trial (RCT) will be implemented across 18 aged care facilities (divided into three conditions). Participants will be senior registered nurses and personal care attendants employed in the aged care facility. The first condition will receive the training program (Staff as Change Agents – Enhancing and Sustaining Mental Health in Aged Care), the second condition will receive the training program and clinical support, and the third condition will receive no intervention.

Results

Pre-, post-, 6-month and 12-month follow-up measures of staff and residents will be used to demonstrate how upskilling clinical leaders using our transformational training approach, as well as the use of a structured screening, referral and monitoring protocol, can address the mental health needs of older people in residential care.

Conclusions

The expected outcome of this study is the validation of an evidence-based training program to improve the management of depression and BPSD among older people in residential care settings by establishing routine practices related to mental health. This relatively brief but highly focussed training package will be readily rolled out to a larger number of residential care facilities at a relatively low cost.

Trial registration

Australia and New Zealand Clinical Trials Register (ANZCTR): The Universal Trial Number (UTN) is U1111-1141-0109.

【 授权许可】

   
2013 McCabe et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Seitz D, Purandare N, Conn D: Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. Int Psychogeriatr 2010, 22:1025-1039.
• [2]McSweeney K, O’Connor DW: Depression among newly admitted Australian nursing home residents. Int Psychogeriatr 2008, 20:724-737.
• [3]Alexopoulos GS, Buckwalter K, Olin J, Martinez R, Wainscott C, Krishnan KRR: Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry 2002, 52:543-558.
• [4]McCabe MP, Davison TE, George K: Effectiveness of staff training programs for behavioral problems among older people with dementia. Aging Ment Health 2007, 11:505-519.
• [5]Davison TE, Hudgson C, McCabe MP, George K, Buchanan G: An individualized psychosocial approach for “treatment resistant” behavioral symptoms of dementia among aged care residents. Int Psychogeriatr 2007, 19:859-873.
• [6]Wood SA, Cummings JL, Barclay T, Hsu MA, Allahyar M, Schnelle JF: Assessing the impact of neuropsychiatric symptoms on distress in professional caregivers. Aging Ment Health 1999, 3:241-245.
• [7]Davison TE, McCabe MP, Mellor D, Karantzas G, George K: Knowledge of late-life depression: an empirical investigation of aged care staff. Aging Ment Health 2009, 13:577-586.
• [8]Doyle C, Ward S: Education and training in residential dementia care in Australia: needs, provision and directions. Aust N Z J Public Health 1998, 22:589-597.
• [9]Brühl KG, Luijendijk HJ, Muller MT: Nurses’ and nursing assistants’ recognition of depression in elderly who depend on long-term care. J Am Med Dir Assoc 2007, 8:441-445.
• [10]McCabe MP, Davison T, Mellor D, George K: Knowledge and skills of professional carers working with older people with depression. Aging Ment Health 2008, 12:228-235.
• [11]Bass BM, Riggio RE: Transformational leadership. New York: Lawrence Erlbaum Associates Inc; 2006.
• [12]Lowe KB, Kroeck KG, Sivasubramaniam N: Effectiveness correlates of transformational transactional leadership: A meta-analytic review of the MLQ literature. Leadership Q 1996, 7:385-425.
• [13]Winbold A, Nay R, Fetherstonhaugh D: Taking a TEAM (Translating Evidence into Aged Care Methods) approach to practice change. Melbourne: Elsevier; 2009:442-455. [Older people: Issues and innovations in care]
• [14]Alexopoulos GS, Abrams RC, Young RC, Shamoian CA: Cornell Scale for Depression in Dementia. Biol Psychiatry 1988, 23:271-284.
• [15]Davison TE, Karantzas G, Mellor D, McCabe MP, Mrkic D: Staff-focused interventions to increase referrals for depression in aged care facilities: A cluster randomized controlled trial. Aging Ment Health 2013, 17:449-455.
• [16]Thyer G: Dare to be different: transformational leadership may hold the key to reducing the nursing shortage. J Nurs Manag 2003, 11:73-79.
• [17]McCabe MP, Davison T, Mellor D, George K, Moore K, Ski C: Depression among older people with cognitive impairment: prevalence and detection. Int J Geriatr Psychiatry 2006, 21:633-644.
• [18]Koys DJ, DeCotiis TA: Inductive measures of psychological climate. Human Relations 1991, 44:265-285.
• [19]Rempel JK, Holmes JG, Zanna MP: Trust in close relationships. J Pers Soc Psychol 1985, 49:95-112.
• [20]Holt DT, Armenakis AA, Field HS, Harris SG: Readiness for organisational change: the systematic development of a scale. J Appl Behav Sc 2007, 43:232-255.
• [21]Cohen-Mansfield J, Werner P, Culpepper WJ, Barkley D: Evaluation of an inservice training program on dementia and wandering. J Gerontol Nurs 1997, 23:40-47.
• [22]Cohen J: Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum; 1988.