11 October 2022
Article from October 2022 edition of INPractice
The Rosemary Bryant AO Research Centre (RBRC) explains why it is excited about its latest project, one which could revolutionise dementia care in residential facilities.
The RBRC worked with Eldercare to test the feasibility of an evidence-based clinical pathway for the prevention and management of behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities.
The “staggering” results in the change of behaviours has prompted Eldercare to plan to extend the new clinical pathway throughout its sites and for other Residential Aged Care Centre to explore opportunities to trial.
Never has the need for effective clinical care been more pressing. According to Dementia Australia, 30 per cent of people aged over 85 have dementia, the second leading cause of deaths for Australians behind coronary heart disease.
The Royal Commission into Aged Care Quality and Safety’s Final Report found that half the people living in nursing homes have dementia, yet “we are deeply concerned that so many aged care providers do not seem to have the skills and capacity required to care adequately for people living with dementia”.
New data this year revealed one in five aged care residents is being given antipsychotic medication - mind-altering drugs that the Royal Commission called inappropriate.
The Commission said “many of these medications were being used as chemical restraint’’.
In some facilities three quarters of residents have been given antipsychotic drugs.
As RBRC Director Professor Marion Eckert notes, dementia isn’t going away anytime soon. On the contrary, cases are set to soar.
Research from the University of Canberra’s National Centre for Social and Economic Modelling (NATSEM) has found that cases of Alzheimer’s disease are estimated to nearly double in Australia by 2041 and cost the national economy $26.6 billion annually.
That equates to a whopping $442 billion over the next 20 years. The number of people with Alzheimer’s-related dementia is expected to surge by more than 70 per cent, placing a huge strain on an already over-stretched aged care sector.
Professor Eckert’s seven-tiered model of management for BPSD categorises changes in behaviour that can arise in some people living with dementia based on risk to self or others.
This model indicates up to 90 per cent of people with dementia will experience some form of BPSD and the prevalence of mild to severe BPSD is approximately 61 per cent.
BPSD can include aggression, apathy, anxiety, agitation, psychotic symptoms, depression, disinhibited behaviours and vocally disruptive behaviour.
Not only is the resident’s quality of life negatively impacted, BPSD can significantly negatively affect family members, as well as a carer’s ability to care effectively, contributing to stress, burnout and ultimately staff leaving the sector.
The new model of care is based on focusing on the needs of people living with dementia rather than their behaviour, as is usually the case.
“That was one of the resounding impacts that came out of the research, was that carers changed their whole mindset around focusing on what the residents were needing,’’ Professor Eckert said.
“Trying to understand what it actually was that they needed rather than focusing on the fact that they are agitated and pacing up and down. That came out quite clearly from what we had done with the pathway that we have developed.
And so, they (Eldercare Trowbridge House in Payneham) started to change their whole way of caring for people within the facility.
“One of the exciting opportunities that came from the research, that as a result of that change they went from trying to manage people with antipsychotic therapy every day to it becoming more of an exception rather than a standard rule.
“And so they virtually reduced the antipsychotic medication down to zero.
The results were astounding.’’
The new model entails person-centred care responsive to the values, preferences and needs of the resident.
In mild to moderate cases of dementia behavioural management interventions can be tailored to the person’s preferences, skills and abilities.
Interventions can be:
- Reminiscence-based, drawing on the resident’s life histories and lived experiences
- Massage and touch, which had significant reduction in BPSD
- Recreation therapy: Activities the resident enjoys
- Environmental interventions: Appropriate modifications to physical and sensory environments
For high-risk residents interventions to prevent harm can include referral to acute or specialist services and/or the swift introduction of non-pharmacological or highly monitored pharmacological approaches to risk mitigation.
“The results in the change of behaviour due to this approach to care and managing behaviour were staggering,’’ said Joanne Wagner, site operations manager for Eldercare Trowbridge House.
“Our focus shifted to focusing on residents’ needs rather than the behaviour and engagement with our multidisciplinary team resulted in our Allied Health team adopting a pathway for them to apply and monitor as well.
“The focus, support and research expertise provided by the Rosemary Bryant Research Centre resulted in a change of clinical care at our site.
“We now plan to look at standardising this care and providing education to new staff with the aim to extend across our other sites.
“This research has significant impact on the lives of people in our care, their families and the staff.
“This research has empowered nurses through evidence to inform and change practice to support the delivery of quality care.’’
The Rosemary Bryant AO Research Centre is the product of a partnership between the University of South Australia and the ANMF (SA Branch) and its adjunct service, the Rosemary Bryant Foundation.
The Centre was established and funded by the ANMF (SA Branch) to strengthen and empower the role of nursing and midwifery through the development of a research-driven, evidence-based platform of health care.
The Centre, based at UniSA, and the Foundation, based at the ANMF (SA Branch), are named after Rosemary Bryant AO, Australia’s first Commonwealth Chief Nurse and Midwifery Officer, Emerita Director of Nursing at the RAH and honorary Iife member of the ANMF (SA Branch).
“The Rosemary Bryant AO Research Centre is really proud of this research,’’ Professor Eckert said.
“We’ve started out looking at the evidence and then we’ve had an opportunity to put it into practice, what we learnt from the evidence, and then have a real tangible benefit we’ve seen with the residents and the nurses and personal care workers and also the family members and Allied Health team.
“So it’s creating a holistic approach and benefit for those people that are living with dementia.
“We really need to have robust practices which are based on evidence to be able to provide that holistic care management strategies. And to do that, we’ve now developed a tool that we’ve applied and tested and we know it can make a difference, so for us it’s really about the scalability of it and we’re very fortunate to be able to continue to do the research with funding from the Nurses Memorial Foundation to expand across two different facilities, our next step.
“On the back of the Aged Care Royal Commission, we really need to take this seriously,’’ Professor Eckert said. “Almost 500,000 Australians are living with dementia and it’s not a problem that’s decreasing. We know that 80 per cent of those people will experience challenges, medical and psychiatric issues. This is something that’s not going away.
“It’s not necessarily a modern phenomenon but certainly we are now seeing an ageing population.
We are seeing people living a lot longer and therefore having chronic diseases and conditions.
“It’s not a new problem but now that we are seeing an older population, we’re seeing it’s more prevalent, just by the nature of the fact we are living longer.
“Unfortunately, we also have other challenges with other types of dementia that we do see in younger people, which is on the increase. There are other casual factors with that as well. Early onset dementia, that can be related to a lot of different things, that could be related to challenges in terms of head traumas, alcohol consumption, smoking, and vascular circulation. We’re seeing an increase now in the number of people over the age of 50 with dementia.
“The Rosemary Bryant AO Research Centre is super excited about this research,’’ Professor Eckert said.
“If we can potentially implement something that has a genuine change to behaviour then that’s going to be a lot more satisfying, not just for the resident but also the nurse and the carer and also the family member.
“This is something that came out in our review, in our feedback, was that satisfaction of the nurse delivering care was a lot higher because they didn’t feel like people were medicated on antipsychotic medication all day, it lifted that whole approach to management and care for people.
“Nurses come to work every day to do a good job. To be able to have that satisfaction of knowing that the care they delivered is improving the quality of life for people, it’s a lot better than feeling like you’re not necessarily improving the quality
of life.’’
Click here to read the October 2022 edition of INPractice.