Is drug treatment for dementia followed up in primary care? A Swedish study of dementia clinics and referring primary care centres.

PURPOSE: It is largely unknown how the medical treatment of patients diagnosed with dementia is followed up in primary care. Therefore, we studied patient medical records from two dementia clinics and from the referring primary care centres. METHODS: A retrospective study of 241 patients was conducted from April to October 2011 in north west Stockholm, Sweden. Over half (51.5%) of the patients had Alzheimer's disease (AD), the remainder had mixed AD/vascular dementia (VaD). Eighty-four medical reports from primary care (35% of the study group) were analysed at follow-up 18 months after diagnosis. RESULTS: All four dementia drugs available on the Swedish market (three cholinesterase inhibitors [donepezil, rivastigmine and galantamine] and memantine) were prescribed at the two dementia clinics. The most commonly used dementia drug was galantamine. There were differences between the two dementia clinics in preference and combination of drugs and of treatment given to male and female patients. At follow-up, 84% were still on dementia medication. Drug use was followed up by the general practitioners (GPs) in two-thirds of the cases. Eighteen per cent of the GPs' medical records made no reference to the patient's dementia or treatment even though dementia drugs were included in the list of medications prescribed. CONCLUSIONS: The results indicate that the Swedish guidelines for treatment of cognitive symptoms in AD are being followed in primary care. However, documentation of follow-up of drug treatment was sometimes insufficient, which calls for development of guidelines for complete medical records and medication lists.

Care providers' perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia.

BACKGROUND: The oral caregiving in nursing homes for persons with dementia often becomes complicated due to the patients' lack of compliance, which in turn can result in giving oral care a low priority in daily care. Furthermore, directives for responsibilities are unclear. OBJECTIVE: The aim of this article was to describe care providers' perception of and reasoning for the oral care for nursing home residents with dementia and to describe registered nurses' reasoning in relation to their responsibility for monitoring oral care interventions within the regular caregiving routines for nursing home residents with dementia. METHODS: Two sub-studies were carried out; focus group discussions with nine care providers and interviews with four nurses. All participants were staff in nursing home units specialized in dementia. RESULTS: The focus group discussion revealed three themes: Art of caregiving, Barriers and Treatment strategies. Themes related to the nurses' statements about oral hygiene within caregiving were Care, Responsibility for care and Information. CONCLUSION: Three main findings from the study are discussed: Unclear responsibilities of different staff members related to daily oral care for the nursing home patients; a lack of guidelines and routines for oral hygiene and a lack of guidelines for sharing information between the different professional groups.

Competence development of registered nurses in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Skilled and specialist registered nurses (RNs) are central to evolving elderly care. The past decades' organisational and structural changes have altered RNs' roles and work situations in municipal elderly care in Sweden. This calls for appropriate educational preparation. However, a substantial proportion of RNs in municipal elderly care lack adequate specialist competence. AIM: The focus of this study was to describe RNs' perceptions of needs and possibilities for competence development in municipal elderly care and compare the perceptions of RNs' who work solely in dementia care (DC) with those who work in general elder care (GC) where older persons have diverse diagnoses. DESIGN: A non-experimental, descriptive and comparative design was used. SETTINGS: Sixty special housing with subunits in a large city in the middle of Sweden. PARTICIPANTS: Participating RNs were a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC and 118 (55.4%) in GC. METHOD: A structured questionnaire that was specifically designed for this study and focused on needs and possibilities for competence development in nursing. RESULTS: The RNs were on average not lacking or were hardly lacking knowledge in examined domains. However, RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs requested a better organisation for competence development, especially in GC. The majority of RNs had no supervision. The use of RNs' competence was high, although they used their highest competence about half of the working hours. The employers' financial contribution to RNs' continuing education was poor. CONCLUSION: A better organisation and greater possibilities for RNs' competence development is needed. The employers need to make a greater contribution financially to RNs' continuing education. It is essential to provide RNs with supervision.

Violence in municipal care of older people in Sweden as perceived by registered nurses.

AIMS: The main aim was to describe registered nurses' perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses' perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses. BACKGROUND: Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence. DESIGN: A non-experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty-five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care. METHOD: A questionnaire. Results. Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit. CONCLUSION: Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs. RELEVANCE TO CLINICAL PRACTICE: Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a 'zero tolerance' attitude.

Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Organizational changes have occurred in municipal elderly care in Sweden during the past decades. The 'Adel' reform transferred responsibility for the care of older persons from the county councils to the municipalities. Furthermore, the specialisation in dementia care divided elderly care into two groups: dementia and general care. This change has had a significant impact on the work situation of registered nurses (RNs). AIM: The main focus was to describe RNs' work situation and their characteristics in municipal elderly care. Another aim was to compare RNs working solely in dementia care with those working in general care of older persons with diverse diagnoses. DESIGN: A non-experimental, descriptive design with a survey research approach was used. SETTINGS: Sixty special housing units with underlying units including those offering daytime activities in a large city in the middle of Sweden. PARTICIPANTS: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in dementia care, and 118 (55.4%) in general care. METHOD: A questionnaire survey. RESULTS: The results indicated high levels of time pressure in both groups. Greater knowledge and greater emotional and conflicting demands were found in dementia care. The majority perceived a greater opportunity to plan and perform daily work tasks than to influence the work situation in a wider context. Support at work was perceived as generally high from management and fellow workers and higher in dementia care. CONCLUSION: It is important to decrease RNs' time pressure and increase their influence on decisions made at work.

Registered nurses' education and their views on competence development in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Recent changes of municipal elderly care in Sweden have resulted in that persons 65 years and older, previously nursed in hospital facilities, are now being cared for in the municipality. This change has had a significant impact on the work situation of registered nurses (RNs) and calls for appropriate educational preparation to enable RNs to undertake their new roles effectively. AIM: The main focus was to describe RNs' education and their view of competence development in municipal elderly care. Another aim was to compare RNs working solely in dementia care (DC) with those working in general elder care (GC) of older persons with diverse diagnoses. DESIGN: A non-experimental, descriptive design with a survey research approach was used. SETTINGS: Sixty special housing with subunits including those offering daytime activities in a large city in the middle of Sweden. PARTICIPANTS: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in DC, and 118 (55.4%) in GC. METHOD: A questionnaire survey. RESULTS: The findings showed that RNs possessed a broad range of competence. The majority lacked a bachelor's degree in nursing. Few had adequate specialist competence. RNs' in DC wanted to invest more in competence development whereas RNs in GC were more motivated to attain greater authority in the making of important decisions and to seek another position. CONCLUSION: An important future prospect is to develop the competence of RNs in elderly care. In order to ensure high quality and security in elderly care, it is also essential to increase the number of RNs with specialist competence.