[Better assessment, better care: Quetci, a questionnaire for assessing cognitive disorders in nursing practice]. / Mieux évaluer, mieux soigner : le Quetci, un questionnaire d'évaluation des troubles cognitifs IDE.

Cognitive disorders can have significant repercussions on the quality of care and daily life for patients. We have developed a new tool specifically designed for nursing practice to identify these problems in patients with brain tumors. The Cognitive Impairment Assessment Questionnaire for nursing practice is an objective, quick and easy-to-administer tool that is readily accepted by patients.

Resident and Staff Mealtime Actions and Energy Intake of Long-Term Care Residents With Cognitive Impairment: Analysis of the Making the Most of Mealtimes Study.

Long-term care (LTC) residents with cognitive impairment (CI) are at increased risk of malnutrition, often explained by mealtime actions (e.g., resident eating challenges, staff actions with eating assistance). The purpose of the current study was to examine the association between mealtime actions and energy intake of LTC residents with CI. Participants with CI (N = 353) from 32 LTC in four provinces were included. Mealtime actions were assessed using the Relational Behavioural Scale, Edinburgh Feeding Evaluation in Dementia (Ed-FED), nine additional eating challenges, and the Mealtime Relational Care Checklist. Several eating challenges (e.g., refusal to eat, turning head away) were associated with poor energy intake. Adjusting for age and sex, partial eating assistance and total Ed-FED score were associated with poor intake, whereas dysphagia risk and often receiving assistance were associated with better intake. Interventions to support eating independence and address residents' eating challenges in LTC are needed to improve their intakes. [Journal of Gerontological Nursing, 45(8), 32-42.].

Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: A mixed-methods systematic review.

BACKGROUND: The fundamental importance of establishing an interpersonal care relationship for quality nursing care has been highlighted. However specific elements of the interpersonal care relationship of importance to older patients in the hospital have not been identified. OBJECTIVES: The aim of this review was to explore and synthesise research findings regarding the elements of the interpersonal care relationship concept from the perspectives of older patients. DESIGN: A systematic mixed-methods review. DATA SOURCES: An extensive search was conducted up until October 2018 for articles without any publication date time limit in PubMed, Web of Science, Cochrane Database of Systematic Reviews and CINAHL. REVIEW METHODS: Primary studies were included if they concerned patients aged 65 years or older and their perspectives on the elements of the interpersonal care relationship with nurses. Inclusion was limited to patients without cognitive impairment who were admitted to an acute hospital setting. The methodological quality of each study was assessed using the Critical Appraisal Skills Programme for qualitative studies, the Quality Assessment Tool for Quantitative Studies and the Mixed-Methods Appraisal Tool. Thematic analysis was used to structure the results of the included studies. RESULTS: Of the 7596 studies found, 24 were included in this review. Twenty articles had a qualitative, three a quantitative and one a mixed methods design. Older patients consider dignity and respect as core values that need to be met in the interpersonal care relationship. Five core elements of the interpersonal care relationship were identified to meet these core values: elements related to caring behaviour and attitude, person-centred care, patient participation, communication and situational aspects. These core elements were structured according to three categories, identified in the literature, that determine the quality of the interpersonal care relationship: nurse-, older-patient-related elements and situational aspects. CONCLUSIONS: The elements identified in this review can guide efforts to define the interpersonal care relationship between older patients and nurses. Nurses should be supported and motivated by education and practice to adapt their behaviour, attitudes and communication to meet older patients' expectations. Hospital management can also encourage nurses to communicate well. Investment in the current organisation of care is needed to improve nurses' work overload and presence. Further research is needed to clarify the underlying processes influencing the experience of the interpersonal care relationship from the perspectives of older patients, nurses, informal caregivers and hospital management.

Evaluation of Pain in the Cognitively Impaired Patient in the Emergency Department.

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse, and to assist with the translation of research into practice. For each column, a topic and a research study are selected. The stage is set with a case presentation. The research article is then reviewed and critiqued, and the findings are discussed in relation to the case presented. In the current column, we examine the findings of A. from their article titled "An Iceberg Phenomenon in Dementia: Pain."

The use of involuntary treatment among older adults with cognitive impairment receiving nursing care at home: A cross-sectional study.

BACKGROUND: Respect for inherent dignity and individual autonomy is a basic principle in health care. However, several studies indicate that care-dependent older adults with a cognitive impairment, receiving nursing care at home, are at risk of care without their consent, referred to as 'involuntary treatment'. This includes the application of physical restraints (e.g. measures to prevent leaving bed or chair), psychotropic drugs (e.g. antidepressants, sedatives) and non-consensual care (e.g. forced hygiene, hiding medication). Research about involuntary treatment is scarce and only recently first studies have been conducted. OBJECTIVE: To investigate 1) the prevalence of involuntary treatment, 2) associated factors and 3) who requests and applies their use among older adults with cognitive impairment receiving nursing care at home. DESIGN: Cross- sectional study. SETTING: Homes of older adults receiving nursing care from district nurses in the eastern part of Belgium. PARTICIPANTS: Data were collected from 1194 randomly selected older adults with cognitive impairments receiving nursing care at home (mean age 83; 67% female). METHOD: District nurses completed an online questionnaire for each selected older adult in their caseload. Involuntary treatment was measured using a questionnaire identifying use of physical restraints, psychotropic medication and non-consensual care. In addition who requests involuntary treatment and who applies it was examined. Older adults sociodemographic characteristics, diagnosis of dementia, activities of daily living (ADL), cognitive status and informal caregiver burden were assessed. RESULTS: Involuntary treatment was used in 52% (95%; CI 49-55) of the total sample. Non-consensual care was most often used (73%; 95% CI 70-77), followed by psychotropic drugs (43%; 95% CI 39-47) and physical restraints (38%; 95% CI 35-42). The use of involuntary treatment was associated with dependency for activities of daily life (OR 1.50; 95% CI 1.33-1.69), cognitive impairment (1.39; 95% CI 1.25-1.55), informal caregiver burden (OR 1.05; 95% CI 1.01-1.10) and aging (OR 0.97; 95% CI 0.95-0.99). Informal caregivers (71%), followed by general practitioners (47%) most frequently requested the use of involuntary treatment, and nurses (81%) mostly applied it. CONCLUSION: In Belgium, involuntary treatment is often used in older adults with a cognitive impairment receiving nursing care at home. The implication of this study for clinical practice is that it confirms the need to develop an approach to prevent and reduce it. Further research is needed to plan and develop such an approach, in order to prevent and reduce the use of involuntary treatment.

Quality of acute care for persons with cognitive impairment and their families: A scoping review.

BACKGROUND: An increasing number of older persons with cognitive impairment use inpatient services for co-occurring acute illness. Research has demonstrated that persons with cognitive impairment face more adverse health outcomes during hospitalization than their age counterparts without cognitive impairment. As hospitals tend to be ill equipped to meet the complex care needs of this population, various initiatives underscore the need to better utilize existing evidence to improve quality of care. OBJECTIVES: To map the extent of knowledge about quality of acute care in inpatient settings, and to synthesize knowledge on strategies to improve quality care for persons with cognitive impairment and their families. DESIGN: A scoping review using Arksey and O'Malley's methodological framework. DATA SOURCES: CINAHL and Medline were searched and reference lists of pertinent articles screened to identify publications regarding acute care for persons with cognitive impairment. REVIEW METHODS: Two reviewers independently screened and identified publications based on eligibility criteria. Publications were included if they targeted acute care issues relating to persons with cognitive impairment 65 years or older, their family members, or health professionals caring for them, and were published after 2000 in English or German. Publications were read and data were extracted using a predefined template. Thematic analysis was conducted by two reviewers. RESULTS: Of the 1445 identified publications, 66 were included. Quality of acute inpatient services pertained to structural (such as staff capacity and knowledge) and process dimensions (such as forming a caring relationship, assessing and intervening). Strategies identified to improve care quality included interventions at the point of care, such as specific tools and specialist roles to improve patient outcomes, as well as educational and training interventions to enable staff to care for this patient group. CONCLUSIONS: There is a discrepancy between clearly defined best practice for persons with cognitive impairment utilising inpatient services, and the quality of care actually experienced by patients, family members, and staff. Research reveals a sobering picture of inadequate care and manifold challenges encountered by this patient group, family members and staff alike. Promising strategies to improve care quality target health professionals' knowledge and capacity to work with this group and include specific tools and models of care, such as specialist roles and units. Organisation-wide efforts to ensure quality care for this patient group are needed, as is further research to determine which implementation and intervention strategies achieve the most beneficial outcomes for all involved.

Perceived burden among spouse, adult child, and parent caregivers.

AIMS: To identify what factors are associated with the caregiver burden of spouse caregivers, adult child caregivers, and parent caregivers. BACKGROUND: Caregivers often feel stressed and perceive caregiving as a burden. The caregiver burden has been little studied from the perspective of the personal relationship between caregiver and care recipient. DESIGN: Cross-sectional study. METHODS: A random sample of 4,000 caregivers in Finland was drawn in 2014 and those who remained either spouse, adult child, or parent caregivers at data collection were included in the analysis (N = 1,062). Data collection included recipients' characteristics. Caregivers' perceived burden was measured using the Caregivers of Older People in Europe index. General linear models were used to explain perceived caregiver burden. RESULTS: Care recipients' low level of cognitive function was associated with greater perceived burden. Higher quality of support was associated with lower perceived burden among female and male spouse caregivers, daughter caregivers, and mother caregivers. Low cognitive function explained 3-6% and high quality of support 2-5% of the total variation in the burden explained by the models, which ranged between 45-55%. CONCLUSION: Because cognitive challenges of care recipient are associated with greater perceived burden and high quality of support with lower burden among most of the caregiver groups, high-quality tailored nursing interventions will be needed especially for the caregivers of the most frail care recipients.

One to one specialling and sitters in acute care hospitals: A scoping review.

BACKGROUND: One to one specialling is a type of care which is provided to ensure the safety of patients who may be suffering from cognitive impairment, exhibit challenging behaviour, or may be at risk of falls or of causing harm to themselves or others. Care such as this, often referred to as 'specialling' or 'sitting' is common practice in most hospitals around the world, but there is a lack of evidence regarding its cost effectiveness and the quality of care provided. AIM: The aim of this scoping review was to explore the breadth and scope of literature on one to one specialling, sitters and similar types of care in acute secondary care settings, in order to identify the challenges and concerns relating to the quality of care (process and outcomes) and cost effectiveness emerging from the literature, and determine the implications of this for policy, practice and future research. DESIGN: This review was based on scoping review methodology following a five stage scoping review process. A keyword search was conducted in the following databases: MEDLINE, Scopus, CINAHL Plus, Web of Science, ProQuest Social Science, and ProQuest Nursing and Allied Health. The time limit placed on the search was January 2000 to April 2016. Inclusion and exclusion criteria were applied. The Mixed Methods Appraisal Tool was used to assess the quality of primary research articles. FINDINGS: Forty-four articles were included in the review. We found a lack of clarity in the terms used to describe one to one specialling and variability in what this type of care entails, who provides the care and the needs of patients requiring this type of care. High costs of specialling are often seen as a concern, but there was a lack of economic evaluations considering the full cost of specialling and balancing these against the benefits. Some of the articles proposed alternatives to one to one specialling or the use of sitters, but only some of these were evaluated. CONCLUSION: There is wide variation in what specialling and one to one care entails, which can in turn lead to the provision of poor quality care. A reduction in this variation and improved quality care might be achieved through the development of guidelines, training and standardized decision-making tools. Further research on the impact of one to one specialling on patient outcomes and cost would be beneficial, as well as robust evaluations of the alternatives to specialling.

[The analogon, a caregiving resource in geriatric psychiatry]. / L'analogon, une ressource soignante en psychogériatrie.

Few caregivers know what analogons are, yet they use them on occasion, intuitively, for the benefit of their patients. An analogon, an identifying object, enables patients with cognitive disorders to 'decipher' their environment and find meaning in it. Caregivers sometimes use analogons without being aware of the theory behind them.

Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study.

BACKGROUND: Older patients suffering from a combination of psychiatric disorders and physical illnesses and/or dementia are called Double Care Demanding patients (DCDs). Special wards for DCDs within Dutch nursing homes (NHs) and mental health care institutions (MHCIs) offer a unique opportunity to obtain insight into the characteristics and needs of this challenging population. METHODS: This observational cross-sectional study collected data from 163 DCDs admitted to either a NH or a MHCI providing specialized care for DCDs. Similarities and differences between both DCD groups are described. RESULTS: Neuropsychiatric symptoms were highly prevalent in all DCDs but significantly more in MHCI-DCDs. Cognitive disorders were far more present in NH-DCDs, while MHCI-DCDs often suffered from multiple psychiatric disorders. The severity of comorbidities and care dependency were equally high among all DCDs. NH-DCDs expressed more satisfaction in overall quality of life. CONCLUSIONS: The institutionalized elderly DCD population is very heterogeneous. Specific care arrangements are necessary because the severity of a patient's physical illness and the level of functional impairment seem to be equally important as the patient's behavioural, psychiatric and social problems. Further research should assess the adequacy of the setting assignment and the professional skills needed to provide adequate care for elderly DCDs.

Variance in caregiver burden predicted by patient behaviors versus neuropsychological profile.

Informal caregivers provide the majority of care to persons with dementia; efforts to support caregivers' well-being are increasingly important in the context of limited formal healthcare supports. Informal caregiving is commonly associated with caregiver burden and burden may depend upon patient characteristics including neuropsychological profile, dementia severity, and dementia etiology. This study investigated predictors of caregiver burden in a sample of 213 Memory Clinic patients diagnosed with dementia and whose caregivers provided collateral information. Caregiver burden was similar irrespective of dementia etiology. Beyond the expected predictive value of dementia severity on caregiver burden, patient behavioral symptoms, functional dependence, and caregiver psychological distress were predictive of caregiver burden. In contrast, care-recipient neuropsychological performance did not predict burden. These findings suggest that beyond severity of dementia, specific behavioral disturbances predict caregiver burden which may have implications for programming and intervention aimed at supporting and sustaining caregivers in their role.

[The reconstruction of meaning in dementia]. / La reconstruction de la signification dans la démence.

Dementia brings about progressive cognitive deterioration, combining memory problems, language difficulties and thought disorders. While there is currently no treatment for the organic disorders causing the dementia, help can be given to patients to slow down the regressive processes. Psychological mediations exist to support patients in their efforts to make sense of their environment.

Estimulação em idosos institucionalizados: efeitos da prática de atividades cognitivas / Estimulación en ancianos institucionalizados: efectos de las prácticas de actividades cognitivo / Stimulation in institutionalized elderly people: effects of cognitive activity practice

Objective: To evaluate cognitive aspects in institutionalized elderly people before and after realization of cognitive stimulation activities. Method: It is a semi-experimental and quantitative study. It was performed in a Long Term Care Institutions for the Elderly (ILPI) located in Natal, Rio Grande do Norte with the elderly who reached the minimum score in the survey instrument Mini Mental State Examination. They were only 26% of the residents. Results: After stimulation activities it was observed that the elderly were able to maintain or to increase the score for the various aspects evaluated. It was confirmed by statistical analysis using the Wilcoxon test a significant difference between the groups before and after, given by p-value = 0.027. Conclusion: It was identified that the realization of cognitive stimulation activities gets responses that contribute to the increase of the Mini Mental State Examination score.

Objetivo: Avaliar aspectos cognitivos em idosos institucionalizados antes e após a realização de atividades de estimulação cognitiva. Métodos: Trata-se de estudo quase experimental, contemplando uma abordagem quantitativa. Foi realizado em uma instituição de longa permanência na cidade do Natal/RN com os idosos que atingiram o ponto de corte no instrumento de pesquisa Mini Exame do Estado Mental, que somam apenas 26% do total de residentes. Resultados: Após as atividades de estimulação percebeu-se que os idosos conseguiram manter ou aumentar a pontuação dos diversos aspectos avaliados. Foi comprovado pela análise estatística, utilizando o teste de Wilcoxon, que há diferença significativa entre os grupos antes e depois, dado pelo p-valor = 0,027. Conclusão: Identificou-se que com a realização de atividades de estimulação cognitiva foram obtidas respostas que contribuíram para o aumento do escore do Mini Exame do estado mental.

Objetivo: Evaluar los aspectos cognitivos en los ancianos institucionalizados antes y después de realizar actividades de estimulación cognitiva. Método: Se realizó un estudio cuasi-experimental, contemplando un enfoque cuantitativo. Se llevó a cabo en una institución de larga estancia en la ciudad de Natal/RN con las personas mayores que alcanzaron el punto de corte en el instrumento de la encuesta Mini Examen del Estado Mental, que representan sólo el 26 % de todos los residentes. Resultados: Después de actividades de estimulación se dieron cuenta de que los ancianos eran capaces de mantener o aumentar la puntuación de los diferentes aspectos evaluados. Se confirmó por análisis estadístico, usando la prueba de Wilcoxon, una diferencia significativa entre los grupos antes y después, dado por p-valor = 0,027. Conclusión: Se identificó que con la realización de actividades de estimulación cognitiva fueron las respuestas que han contribuido al aumento en la puntuación Mini Examen del Estado Mental.

Migración internacional de retiro. Procesos de autocuidado grupales entre inmigrantes británicos jubilados / International migration retirement. Self-care group processes among british immigrants retirees

Objetivo: Identificar prácticas autogestionarias grupales de atención a la dependencia, entre extranjeros británicos residentes en la Región de Murcia. Metodología: Diseño de investigación de carácter cualitativo con enfoque metodológico etnográfico. Población: inmigrantes británicos jubilados residentes en Mazarrón (Murcia). Las estrategias para recoger datos fueron las entrevistas en profundidad y la observación no participante. Resultados principales: Emergieron cinco categorías 'Prácticas de autocuidado en red', 'Los amigos y la familia', 'Sociabilidad y espacios identitarios', 'Percepción del sistema sanitario en España' y 'Expectativas de futuro y planificación de cuidados al final de la vida'. Conclusión principal: El análisis de las prácticas de autocuidado de los inmigrantes jubilados británicos nos muestra un colectivo que gestiona, en parte, la dependencia a través de 'sistemas de cuidado colaborativos' y que contrasta con el escaso asociacionismo de la tercera edad en España

Objective: Identify group self-managed dependence care practices between British immigrants residents in Region de Murcia. Methods: Qualitative research with ethnographic methodological approach. Population: retired British immigrants resident in Mazarrón (Murcia). Strategies for collecting data were in-depth interviews and nonparticipant observation. Results: The data is structured into 5 categories 'Practice selfcare network', 'Friends and Family', 'Sociability and identity spaces', 'Perception of the health system in Spain' and 'Expectations of future care planning at the end of life'. Conclusions: The analysis of self-care practices of immigrant British retirees, shows us a group that manages, partly, dependence through 'collaborative care systems' which contrasts with the poor elderly associations in Spain

Migrant caregiving for family members with mild cognitive impairment: an ethnographic study.

BACKGROUND: Migrant families caring for family members with mild cognitive impairment (MCI) face considerable socioeconomic burden and isolation. AIM: To examine the cultural needs, beliefs and health seeking behaviours of migrant Turkish family member caregivers. DESIGN: An ethnographic approach was used employing in depth interviews. METHODS: Turkish caregivers residing in Melbourne, Australia were purposively sampled. Ten participants undertook face-to-face interviews in Turkish and English, followed by coding, transcription and thematic analysis. RESULTS: Common themes were: (i) characteristics of MCI; (ii) care complicates our lives; (iii) beneficial coping strategies; (iv) adherence to cultural beliefs; (v) an uncertain future; (vi) interfacing with community health providers: need to understand Turkish culture (vii) need for long-term support. Migrant caregivers voiced undergoing considerable stress exacerbated by their cultural obligations. CONCLUSIONS: Establishing ethnically appropriate community support groups and advocating for a health workforce tier of representative migrant health care workers is recommended as a new role for community nurses.