A federal survey deficiency citation is needed for resident-to-resident aggression in U.S. nursing homes

Resident-to-resident aggression (RRA) in nursing homes is a prevalent and concerning public health problem. A rapid growth in the number of research studies has led to advancements in understanding and awareness of these incidents. However, no state survey deficiency citation (F-Tag) currently exists to capture RRA in a structured way in the Centers for Medicare & Medicaid Services’ (CMS) nursing homes F-Tags Coding System. This omission represents a major barrier to State Survey Agencies, CMS, consumers, and care advocacy organizations’ efforts to keep vulnerable and frail residents safe and free from psychological harm. The commentary makes the case for development and implementation of a new RRA-specific F-Tag by identifying 20 problem areas and the ways in which this F-Tag could address them. The new F-Tags Coding System (part of the new Federal Nursing Home regulations) represents a rare and time-sensitive opportunity to bridge this major gap in practice, research, and policy.     

Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers

The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost.     

Armed and Aging: Dementia and Firearms Do Not Mix !

ABSTRACT

The possibility that persons with dementia possess firearms is cause for concern, but only a limited number of research studies have been conducted on such a topic, usually in the form of case reports. Reducing the occurrence of the firearm-related violence requires effectively identifying dangerous individuals and keeping firearms out of their hands. The health care professionals, i.e. the social workers and the physicians, need to work together and to produce a suitable evaluation of patients with dementia to prevent firearm-related injuries and serious and irreparable damage to persons.     

A Preliminary Qualitative Analysis on the Feasibility of Using Gaming Technology in Caregiver Assessment

This exploratory qualitative study examined the feasibility of utilizing gaming technology that will ultimately assess task performance and stress among caregivers of dementia patients. The long-term goal is to use this unobtrusive application (app) to detect caregiver burnout for the purposes of early intervention. This preliminary study examined participant interface with a specific gaming technology called CAST (Caregiver Assessment Using Serious Gaming Technology). Ten dementia caregivers participated. Participants attended a demonstration and then interacted with a preliminary version of the CAST tablet application. Social work researchers interviewed participants using open-ended questions to gauge interest, technology skill level, and comfort with the app. Participants expressed interest and identified potential ways to further develop the system in order to increase ease of use, decrease time commitment, and improve suitability for daily use. The provided feedback will be used to refine the user interface of the application, which will then be used to monitor caregivers’ stress in future development.     

Conserving Habitus: Home,Couplehood and Dementia

ABSTRACT

Compared to research on home in circumstances of aging, place and care, our knowledge about home in relation to couplehood is limited despite increases in the percentage of married and cohabiting older people in the UK. Specifically, our understanding of the experience and meaning of home for couples where one partner has dementia remains under-explored. This article presents a scoping review of published empirical literature to examine older couples’ experiences of home in dementia. The literature identified and reviewed through searching academic databases and Google Scholar is interdisciplinary and a thematic analysis suggests interactions of couplehood, home and dementia. To discuss these interactions, we use Bourdieu’s framework of field, capital, practice and habitus. We observe that habitus may gradually alter and fracture. But, in locating and supporting the performance of (adapted) everyday relationships and domestic practices, home has a distinct role in contributing to conserving habitus and in turn continuity of relationships and home. The gradual fracturing of habitus with the progression of dementia however also suggests that the continuity of relationships and home remain contingent, but this needs further investigation. It is an element of home futures that cannot remain invisible.     

Consumer‐directed care for older Australians: Are resources identified on the Web adequate to support decisions about home‐based care packages?

Consumer‐directed care (CDC) was introduced as part of aged care policy reforms in Australia in 2012. CDC aims to promote choice and control for people with complex needs who need home care and supports. While more choices may bring benefits, information and resources are needed by people to navigate new and complex care‐related decisions. In 2017, we identified the resources available to support consumers of the new CDC Home Care Packages (HCP) program via an Internet search. Forty‐six resources were analysed to assess the adequacy of information to inform care choices. General information was most frequently found, but information to guide specific choices, such as choosing or changing service providers, was limited. Accessibility of information was limited for non‐English speakers and for people with low literacy or reduced capacity for decision making. No training opportunities were identified, and only one non‐partisan organisation offered support for decision making. Overall, the information and supports analysed were not adequate to assist older people to make choices to ensure consumer direction of care. There is an urgent need to improve the quality and accessibility of information and provide training and support for choice, particularly for those with limited decision‐making capacity, such as those living with dementia.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

Which Neuropsychiatric Disorder Is More Associated With Divorce?

The social disruption experienced by people with neuropsychiatric disorders may be pervasive and manifest in divorce. It has been estimated that 90% of marriages involving a partner with bipolar disorder culminate in divorce. To verify this information we studied the results of the 2004 National Nursing Home Survey. We found that the percentage of divorced residents was 7%. However, “lonesome” status (widowed, divorced, separated, never married, and single) was prevailing in 79% of residents. The rates of divorce were highest among bipolar, paranoid, and schizophrenic residents (18%, 12%, and 12%, respectively). Lonesome status was also highest among bipolar, paranoid, and schizophrenic residents (85%, 84%, and 83%, respectively). Never married status was highest among those with schizophrenia, obsessive-compulsive residents, and bipolar patients (12%, 12%, and 11%, respectively). We conclude that shizophrenic and bipolar patients are very likely to never get married or to end up divorced.     

Design Characteristics of Sensory Gardens in Norwegian Nursing Homes: A Cross-Sectional E-Mail Survey

ABSTRACT

Sensory gardens are increasingly popular in Norwegian nursing homes. This study examined the design characteristics of Norwegian sensory gardens using a cross-sectional web survey design addressing nursing home leaders (n = 121). The findings revealed that Norwegian sensory gardens were generally compliant with recommended design guidelines involving sensory experiences, stable walkways, landmarks, accessibility, visibility from indoors, seating features, and prosthetic supports. There is, however, a potential for further improvements concerning walkways with rails, access to alarm systems, clear signposts to toilets from the outdoors, lighting in the evenings, greenhouses, increased awareness of edible and nontoxic plants, and maintenance of the gardens.     

Dementia Caregiving in the Context of Late‐Life Remarriage: Support Networks,Relationship Quality,and Well‐being

Caregiving research has not accounted for increasingly diverse and complex marital and family histories of older Americans. The authors examined social relations and care‐specific positive and negative support networks among late‐life remarried wife dementia caregivers (N = 61) to determine associations among network structure, relationship quality with and support received from network members, and global assessments of family and stepfamily disagreement on caregiver well‐being. Own family and friends predominated in the social relations and positive networks. Although over half (54%) of respondents included a stepfamily member in their positive networks, stepchildren comprised the largest group (35%) in the negative networks. Larger negative networks and actively negative interactions were related to greater caregiver burden, and more global disagreement with stepfamily was associated with greater depression and burden. The findings illustrate the complex nature of support and the value of targeted examinations of caregiving support dynamics among late‐life remarried older adults and stepfamilies facing health demands.