Dissertations / Theses: 'Dementia Institutional care'

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Sandman, Per-Olof. "Aspects of institutional care of patients with dementia." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 1986. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100563.

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The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected. The results of the study have been reported in six papers summarized below: I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics. II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance. III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time. IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent. V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer. Based upon the above cited studies, a model for nursing care of demented patients is presented.

S. 1-45: sammanfattning, s. 46-192: 6 uppsatser

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Lin, Che-Ying. "The development of quality indicators for Taiwanese institutional dementia care." Thesis, University of Stirling, 2010. http://hdl.handle.net/1893/2542.

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This study is a mixed-method study that seeks to develop a set of institutional dementia care indicators to evaluate quality of care and inform the improvement of quality of life (QOL) for Taiwanese people with dementia living in care homes. It also uses comparative analysis to compare the different features of policy and its delivery in dementia care between Scotland and Taiwan, a comparison designed to aid the development of dementia care policy, and the establishment of quality indicators for institutional dementia care, in Taiwan. This study employed the person-centred care approach at the micro perspective, and the total quality management (TQM) approach at the macro perspective, in order to inform a seamless care model for people with dementia living in care homes. Data were collected in two stages: comments from experts in dementia care were recorded in an exercise using “Delphi” methodology; subsequently the opinions of service receivers were recorded in a fieldwork exercise. The Delphi exercise (stage one) acted as the pre-test, involving 24 experts in dementia care in Scotland and Taiwan in evaluating the usefulness and applicability of proposed quality indicators for institutional dementia care. Quantitative and qualitative data from the Delphi panel were analyzed. The fieldwork (stage two) collected 237 questionnaires (from 122 residents with dementia and 115 family members) in 14 Taiwanese care homes for people with dementia (including special care units within care homes). The field test data were analyzed using reliability and item analysis, confirmatory factor analysis (CFA), and descriptive and inferential statistics. Initially, 43 proposed quality indicators for institutional dementia care were identified through literature review. However, after two Delphi rounds, only six key dimensions (41 quality indicators) were identified by consensus as the important items for use in measurement of quality of care for people with dementia living in Taiwanese care homes. Through reliability and item analysis, and CFA, this research developed a model which is a three-factor structure (social care, health and personal care, and environment) with 18 quality indicators. The 18 quality indicators have high reliability, validity, and credibility and load onto a second order factor which represents quality of care for people with dementia living in care homes. Further analysis was then conducted to explore how relative ratings on these three factors differed according to measured characteristics of the residents and their family members. In general, only a few strong patterns of difference emerged and multiple linear regression analysis suggested that differences in ratings could not be attributed to influences of socio-economic and socio-demographic differences between respondents. The study concludes that the Delphi method could be used as a methodology for health services research to integrate the opinions of multidisciplinary dementia experts and that CFA is an effective technique to study the empirical factor structure. The findings suggest that the 18 quality indicators could be suitable criteria for people with dementia and their family members to evaluate care quality and select an appropriate care home. The indicators also have important policy implications for the Taiwanese Government and regulations intended to ensure that care homes meet the requirements of service receivers.

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Cook, Ailsa. "Understanding the communication of older people with dementia living in residential care." Thesis, University of Stirling, 2003. http://hdl.handle.net/1893/3301.

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This thesis explores the communication of a group of older people with dementia living in a residential care home and specifically, seeks to understand how living with dementia in a care home influences communication. The study draws broadly on a symbolic interactionist perspective and uses an ethnographic, inclusive, video methodology. In so doing, the study grounds the research in the experiences of the older residents with dementia and explores communication as it is interwoven with social life. The empirical data, on which this thesis is based, were gathered over the course of six months in one residential care home in Central Scotland. Analysis of these data, in conjunction with the theoretical literature informing the study, led to the development of a framework and a set of concepts to understand the communication of the older people with dementia living in residential care. This framework was used to examine the ways in which the older residents' experiences of institutionalisation, ageing, and dementia, generally, and of life in the care setting, specifically, influenced their communication. The findings revealed that the older residents made diverse meanings of their experiences in the home, and mat many of the meanings that they made were threatening to their self-identity, self-determinacy and social relationships. The residents engaged in a range of strategies to respond to the impact of these meanings and to negotiate their life in the care home. The research presented in this thesis has many implications for understanding the experiences of older people with dementia in residential care. In particular, the research highlights the need for a new social understanding of dementia, that examines the experience of dementia in relation to broad structural and cultural processes and that seeks to promote the social inclusion and citizenship of older people with dementia.

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Ellames, Lorraine. "Dementia care training for residential care workers : building residential care workers' own views into a conceptual model." Thesis, University of Sussex, 2018. http://sro.sussex.ac.uk/id/eprint/76639/.

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This thesis is the result of research that investigated the views of residential care workers (RCWs) working with people with dementia about their perceptions of training for their dementia care role with older people. Using a constructivist ontology and an interpretivist epistemology, the research investigates how care workers perceive their training and how they feel it can be applied to their working environment. RCWs were asked what they saw as the specific needs of residents with dementia, what training they had received, how useful they perceived the training to be, and what training they felt was still needed. Previous studies had put forward topics for inclusion into dementia care training, but very little research had asked RCWs themselves about their dementia training needs. Nineteen semi-structured interviews were carried out across three care home organisations during the summer of 2013 in the East of England. Findings from thematic analysis showed that the care workers interviewed had very limited or no dementia training or assessment they could remember, and that training had generally been a negative experience. Dementia care trainers were not considered helpful or knowledgeable enough and RCWs identified that their learning needs had not been taken into consideration. The learning environment was viewed as unsuitable, usually a lounge or a bedroom where it was very cramped and RCWs were pulled out of training when there were limited staff numbers. Many challenges specific to caring with people with dementia were also identified: challenging behaviour, lack of time and resources, poor teamwork and communication and lack of organisational support all inhibited the development of person-centred care and training transfer into practice. A conceptual model of the training and learning cycle is proposed as a way forward for dementia training. This model illustrates the training process from course creation through to satisfactory completion. Learning into practice is measured by care workers' knowledge, confidence, and competence. This assessment is a two-way process between the learner and the mentor to ensure RCWs feel fully supported and recognised. Although this conceptual model has not been tested empirically, such a process is seen as a possible next step.

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Kelly, Fiona. "Well-being and expression of self in dementia : interactions in long-term wards and creative sessions." Thesis, University of Stirling, 2007. http://hdl.handle.net/1893/207.

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This is a multi-method ethnographic study, grounded in symbolic interactionism and social constructionism, which seeks to explore the social worlds of people with dementia in institutional long-term care. Carried out over six months, it uses non-participant observation, Dementia Care Mapping, video-recording, focused conversations and extensive fieldnotes to document types of interactions that fourteen people with dementia received in everyday ward life and during weekly creative sessions facilitated by occupational therapy (OT) staff. Using Kitwood’s (1997) work on person-centred care and Sabat’s (2001) work on selfhood (Selfs 1-3) it identifies their responses to such interactions in terms of their well or ill-being and expressions of Self. The study shows that everyday staff interactions with participants, while sometimes positive, were more often limited in their potential for maintaining or increasing well-being. Sometimes staff interactions were abusive; causing participant ill-being. Participants expressed Selfs 1-3 verbally and visually, although some of these expressions were subtle, fleeting and fragile. During creative sessions, OT staff engaged in sustained positive interactions, raising participant well-being and facilitating Self-expression; a fragile expression of Self could become a robust expression of Self, a past Self could be reclaimed and a desired Self co-constructed. My findings suggest that, in their interactions during creative sessions, OT staff generally recognised and supported Self of participants, raising well-being. However, ward staff did not fully recognise and therefore could not support Self in their interactions with participants, resulting in participant ill-being. This is a crucial finding, which could partially explain the differences in interaction types I observed, and the corresponding differences in participant well-being and Self-expression. This thesis argues for integrating the selfhood and person-centred approaches into an innovative staff-training programme, in order to bring about transformational change in practice. This might encourage care staff to reach out, recognise and respond to aspects of Self as they carry out care; promoting more positive ways of interacting with their patients, increasing patient well-being and fostering staff satisfaction.

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Lövheim, Hugo. "Psychotropic and analgesic drug use among old people : with special focus on people living in institutional geriatric care." Doctoral thesis, Umeå universitet, Institutionen för samhällsmedicin och rehabilitering, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1608.

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Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

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Österholm, Johannes H. "Assessment meetings between care managers and persons living with dementia : Citizenship as practice." Doctoral thesis, Linköpings universitet, NISAL - Nationella institutet för forskning om äldre och åldrande, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-127392.

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This thesis deals with encounters between persons living with dementia and care managers. Dementia often results in progressive care needs that must be met by different social care services. The person’s care needs are assessed in an assessment meeting where the person and their relatives meet with a care manager to negotiate needs and social care services. The assessment is conducted through one or several conversations where the person with dementia meets the care manager; relatives are often present in the meetings. Dementia is a syndrome that involves a cognitive decline and a decreased ability to communicate and interact with others. It may therefore be difficult for a person with dementia to take part in discussions about their care needs and social care services. 15 audio recorded meetings have been studied to explore and understand how persons with dementia use their remaining communicative, cognitive and linguistic resources to invoke, negotiate, and use their rights as citizens in the institutional context where their care needs are assessed. The analysis concerns the organization of talk as a joint activity; the production of social actors in talk-in-interaction; the relation to institutional features of discourse. This dissertation concludes that the practice of citizenship is situation based and varies depending on the participants present. Care managers can facilitate for persons with dementia to overcome communication problems by using different discursive strategies and to make it possible for them to participate or at least be included in the negotiation. Persons with dementia are positioned as less competent than other persons participating in the assessment meeting. This might have an impact on the participation of people with dementia in negotiations regarding their future care. Furthermore, stories told in assessment meetings often position the person as dependent on others, which could undermine the identity and sense of self of the person with dementia.
Den här avhandlingen berör möten mellan personer med demenssjukdom och biståndshandläggare. Demenssjukdomar medför ofta komplexa omsorgsbehov, vilka kan mötas med hjälp av olika stödinsatser. Personens omsorgsbehov bedöms i ett biståndshandläggningssamtal där personen och dennes anhöriga träffar en biståndshandläggare för att förhandla dennes behov och eventuella insatser. Konversation är centralt i dessa möten. Demenssjukdomar medför kognitiva nedsättningar och nedsatt förmåga att kommunicera och interagera med andra. Det kan därför vara svårt för personer med demenssjukdom att deltaga i diskussioner om behov och insatser. 15 ljudinspelade samtal har studerats för att förstå hur personer med demens använder sina kvarvarande kommunikativa, kognitiva och språkliga resurser för att åberopa, förhandla och använda sina rättigheter som medborgare i den institutionella kontext där deras omsorgsbehov bedöms. I samtalet medverkar personen med demens, handläggaren samt ofta någon familjemedlem. Analysen fokuserar på organiseringen av samtal som en gemensam aktivitet; hur sociala aktörer skapas i samtal; hur det institutionella samtalets särdrag påverkar konversationen. Sammanfattningsvis visar denna avhandling på att hur medborgarskap praktiseras är situationsbaserat och varierar beroende på vilka som deltar i mötet. Biståndshandläggare kan underlätta för personer med demenssjukdom att övervinna kommunikativa problem genom att använda olika samtalsstrategier och göra det möjlig för dem att delta eller att åtminstone inkluderas i förhandlingen angående olika stödinsatser. Personer med demenssjukdom positioneras ofta som mindre kompetenta än andra personer som deltar i behovsbedömningssamtal, vilket kan medföra konsekvenser på personens delaktighet i planerandet av framtida insatser. Berättelser i dessa samtal positionerar ofta personen med demenssjukdom som beroende av andra, vilket kan underminera deras identitet och uppfattning av sig själva.

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Pellfolk, Tony. "Physical restraint use and falls in institutional care of old people effects of a restraint minimization program /." Doctoral thesis, Umeå : Umeå universitet, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-31952.

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Erickson-Taube, Christina Marie. "Special care units: Recreational activities for patients with Alzheimer's disease." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2843.

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The purpose of this study was to evaluate the recreational activities provided in special care units located in the Inland Empire. The population that this study sought to assist was patients diagnosed with Alzheimer's disease and living in an Alzheimer's special care unit.

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Unbehaun, David [Verfasser], Volker [Gutachter] Wulf, and Claudia [Gutachter] Müller. "Designing, implementing and evaluating assistive technologies to engage people with dementia and their caregivers : a practice-based approach to explore the potential and impacts of exergames to foster interaction, social participation and well-being in private and institutional care contexts / David Unbehaun ; Gutachter: Volker Wulf, Claudia Müller." Siegen : Universitätsbibliothek der Universität Siegen, 2020. http://d-nb.info/1218783893/34.

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Reep, Jennifer Kebeh. "Family Caregiving beyond Institution Doors." Miami University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=miami1461910478.

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Abbey, Jennifer Ann, and mikewood@deakin edu au. "Death and late-stage dementia in institutions: a cultural analysis." Deakin University. School of Nursing, 1995. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050825.153139.

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The first purpose of this study was to describe the deaths of fifteen nursing home residents with late-stage dementia. The devastating effect of dementia on a person has been called a living death (Woods, 1989). The caring which occurs when someone is going through this process in a nursing home was recorded and analysed. In analysing this act of caring, the second purpose was to look for the origins of the structures and the sources of pressure that shaped the context and therefore helped determine the behaviour of the various groups under observation. These groups were residents and their relatives, the staff of the nursing home and the treating doctors. Before commencing observations and carrying out this study, an understanding needed to be developed of: the condition of dementia as it is perceived by health professionals and presented in the media; the institutions in which the majority of people with dementia end their days; the background and conditions of the staff who nurse in them; the models of care that guide and determine policies; and the conceptions of life and death which underpin relevant laws and moral standpoints. Accordingly, in part 1. chapter 1 the history, causes, pathology and effects of dementing conditions are examined. Relevant medical and lay literature including media influences are examined which pertain to the subject of death and dementia and nursing home care. The history of this institutional care is briefly examined together with the growth of the discipline of gerontological nursing. Chapter 2 discusses some of the effects of this history on present day care and the concept of emotional work being carried out within the present day aged care public policy regulations. The moral arguments surrounding illness and dying in Australian society today are briefly discussed. Chapter 3 describes the conceptual framework for the study, the ethnographic method that has been employed and an outline of critical theory as the basis for analysis. The chapter concludes by recounting the practical steps taken to arrange the field work, secure the consent of participants, record data and gather documents, and outlines the ethical considerations given to the undertaking of the study. Chapter 4 describes the context in which the study took place and the first tentative exploration of the culture from an etic perspective. Part 2 describes the death trajectories observed and raises some questions about alternative strategies that may have been considered within a different paradigm of caring. In chapter 5 the death trajectories of each of the fifteen residents in the study are described, each written with a particular emphasis to illustrate aspects of the culture of care that emerged through thematic analysis. Observations, comments and feelings from staff and family are wound in and around these case studies. Chapter 6 looks more closely at the impact of policy and institutional pressure on the milieu in which these deaths took place. Part 3 draws conclusions from the observations and makes suggestions for emancipatory change as viewed from the author's standpoint of critical ethnographic analysis. In the final chapter an argument is presented for policy change that leads a movement towards palliative care practices for people with late-stage dementia. Approaches to implementation of palliative care will need to take account of any expression by the resident such as an advanced directive, indicating a preferred approach to treatment in the period prior to death; a need for a better understanding of such issues as the significance of body breakdown, the manifestations of pain and electrolyte imbalances; the surrounding ethical complexities and shift in public opinion, and perhaps, most of ail, the culture of the institutions in which this dying will take place. A definition of late-stage dementia which might be used in determining patterns of care is set out. A discussion about changes in practice which relate lo communication with treating doctors, the administering of antibiotics, the relief of pain, the mobilisation of residents and the provision of food and water takes place in light of the evidence found. The discussion of these issues is raised in the form of debate. Each aspect needs more rigorous analysis and information so that evidence-based practice, rather than care which is value-laden and emotional, can be used when treatment decisions are made for people with late-stage dementia.

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Lee, Hyunsook. "Comparative study of carers of older people with dementia in Scotland and Korea." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/9796.

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This study aims to explore Scottish and Korean carers‘ attitudes towards the diagnosis of dementia in their relative, family care, community care and to residential care in Scotland and Korea respectively, also under examination was the origin of different carers‘ attitudes between Scotland and Korea. The dominant argument between previous Western and Eastern comparative studies on attitudes, has been that culture made the difference. In other words, the cultural factor was recognised as a main determinant of attitudes towards a diagnosis of dementia, towards social services at home and residential care in Asian societies, including Korea. This thesis starts with the question: Does culture really explain the phenomenon of Asian people‘s attitudes towards dementia? Indeed the tradition of filial piety has been changing and now seems to be rather weak in modern Asian society. In particular, contemporary Korea is modernised and westernised, as a result, many older people live apart from their adult children and their nuclear families. This study asserts that Confucianism is a much less significant factor than differences in social policy. In other words, this thesis focuses not on Confucianism, but on the impact of institutions on carers‘ attitudes towards dementia. Finally, this thesis explores this argument through the following research question: What are the origins of different carers‘ attitudes between Scotland and Korea? In order to develop this argument, this thesis has carried out interviews with 14 Scottish carers and 28 Korean carers; and adopted a qualitative approach that would yield a rich exploration and deeper understanding of the different attitudes between carers in Scotland and Korea. Based on this data, this thesis examines carers‘ attitudes towards the diagnosis of dementia (chapter 3), family care (chapter 4), community care (chapter 5), and residential care (chapter 6). Each chapter analyses similarities and differences in attitudes in Scotland and Korea from the point of view of culture or the social welfare system. To conclude, these findings explain that the origin of carers‘ attitudes in this study is based on social policy rather than culture. In other words, the Korean carers‘ attitudes and behaviours towards diagnosis and long-term care services are rooted in the residual welfare system rather than Confucianism. Likewise, this study found that Confucianism has a less significant influence than social policy on carers‘ attitudes towards the utilisation of health care, community care and residential care. Unlike previous studies on East Asia, that argue for a cultural explanation, this study of Korean carers demonstrates that the residual welfare system is more persuasive than the cultural approach derived from Confucianism . This study contributes to the comparative study of Scotland and Korea as well as being a qualitative study in Korea. In addition, it will provide a new perspective on attitudes towards studies on East Asia. Moreover, the study will suggest political implications through the exploration of the carers‘ attitudes towards dementia diagnosis, social services at home and residential care. It also can provide lessons on dementia and dementia care from different experiences in Scotland and Korea.

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Wu, Ya-Ca, and 吳雅琴. "Tackling Dementia – Complications and Involvement between Institutional Care Workers and Patients." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/36236163969831883562.

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碩士
國立東華大學
族群關係與文化學系
100
Taiwan has become an aging society. Its population of senior citizens in 2010 was approximately 2.48 million, in which around 100,000 were Dementia patients. Although most of the patients are taken care of by their families, the rest are looked after by long-term care institutions due to the lack of family care. How do long-term institutional care workers get along with those senior Dementia patients? How do they look after two types of patients, those with Dementia and those with disabilities, at the same time within a mixed-care environment? How do they respond to and adjust themselves while relating to and being confronted by problematic behaviors of senior Dementia patients 8 to 12 hours a day? Departing from a field study lasting for over three years plus qualitative interviews with seven care workers, this research aims to probe into the complications and involvement – physically and mentally – of long-term institutional care workers while taking care of senior Dementia patients. As far as the interaction between care workers and senior Dementia patients is concerned, in addition to the pain and pressure resulted from taking care of senior Dementia patients, this research finds that the abovementioned interaction is also affected by the complications as well as involvement of such interaction, the structure/pattern of mixed care, and the expectations from both care institutions and patients’ families. The research also finds that the abovementioned interaction, as a matter of fact, includes that among social levels even within the authority. Since most of the domestic researches on care workers are quantitative, this research chooses a qualitative track, i.e. field study, to show the real-life interaction between care workers and senior Dementia patients at long-term care institutions. Apart from presenting the laughter and tears of long-term institutional care workers in the lines of duty, this research also probes into the possibility of affecting the abovementioned interaction via government policies and institutional management.

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Chuang, Yu-Sheng, and 莊宇勝. "The Cost Effectiveness Analysis for Taiwan Institutional Care Models in Dementia." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/45537276590983572159.

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碩士
國立臺灣大學
醫療機構管理研究所
95
Background Same as many developed countries, the population construction of Taiwan shows an aging societal trend. As the life expectancy becomes longer, we should pay attention to the threats of elder diseases such as chronic diseases. Dementia is a kind of elder diseases. As the elders’ age, the prevalence and severity will keep rising; patients lack the abilities of caring themselves, and caregivers often experience mental or physical burdens. When the family and society cannot find the solution to these problems, the demands of dementia institutional care will sure rise. Nowadays, most of the non-governmental circles practices the “Specialized type” and “Segmented type” institutional care models, but less of the “Mixed type” institutional care models. There are still no relative studies and conclusions found in institutional care models in dementia with both better effectiveness and costs of caring. Method and Objectives This study is a prospective study. Applying the methods of purposive sampling and opened-questionnaire to collect north, central and south of Taiwan, 3 models and 19 institutions’ cross-sectional cost data were collected. Dementia residents’ retrospective effectiveness data were collected by chart reviewed. In addition to comparing the average per resident/month care costs of three models, multiple regression was also applied to control residents’ basic characters and degrees of cognitive function and ADL, to predict residents’ changes of scores after one year. Then, the count rate of residents effectiveness changed of these three models were compared, and cost-effectiveness analysis was applied to find out the best Taiwan institutional care models in dementia. Results “Specialized type” model is the highest in each resident’s per month care costs in average, “Mixed type” model is the next highest, and the “Segmented type” is the lowest; but there is no statistically significant difference among the three models. No matter what residents’ cognitive function or ADL are, all changes of scores presents the situation of retrogressing in average after one year, and there is statistically significant difference in all models. Comparing the residents’ functional degenerated scores among three different models and to arrange the average degenerated MMSE scores from the lowest to the highest are “Specialized type”, “Mixed type” and “Segmented type” models; to arrange the average degenerated Barthel Index scores from the lowest to the highest are “Mixed type”, “Segmented type” and “Specialized type” models. But there is only statistically significant difference in the average degenerated Barthel Index scores that in “Specialized type” model is higher than in “Mixed type” model. Comparing the predicted residents’ functional degrees one year later, the rate of residents whose degrees of cognitive function gained and kept, the “Specialized type” is the highest, and the “Mixed type” is the lowest; the rate of residents whose degrees of ADL gained and kept that “Segmented type” model is the highest, and the “Specialized type” model is lowest. But this phenomenon is relative to that there are more residents with better ADL in “Specialized type” model, the degenerated scores are also relatively higher because of the natural courses of disease degenerated one year later. In the results of cost-effectiveness analysis, no matter it is on cognitive function or ADL, “Segmented type” model takes the advantage in the cost-effectiveness; through the sensitivity analysis, we find that no matter how manpower costs which takes the largest part of total costs increase or decrease, the results does not change, therefore, the results of this study are stable. Conclusions According to the results of cost-effectiveness analysis, “Segmented type” is the better institutional care model in dementia for Taiwan. But when residents’ cognitive functions are mild and moderate, their problematic behaviors might disturb others. Those who lived into the “Segmented type” or “Mixed type” care models were not appropriate; “Specialized type” institutional care model still have its necessity in existing. Perhaps the costs and effectiveness analytic outcomes in the study are inadequate because of insufficiency of data collection. However, it still should be enough for relative government sections’ reference in distributing resources, and helping long-term care industries and non-governmental circles’ operators to manage themselves appropriately.

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Chan, Li-Chuan, and 詹麗娟. "Cost Analysis for Institutional Care for Seniors Suffering from Dementia – An Activity-Based Costing." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/5xxd4c.

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碩士
東吳大學
會計學系
101
The senior population (aged 65 years or older) of Taiwan is increasing from the 2,486,000 people in 2010 to 7,844,000 in 2060; while the proportion of total population rises from 10.7% to 45.6%. Dementia, a common disease in senior population, suffers about 170,000 seniors in Taiwan. It expects the number may be 800,000 in 2060. The care for dementia becomes a considerably heavy burden on the families and society. Dementia is a progressive brain degeneration disease that causes people to lose the ability to identify people, thing, place, and objects while their routine activity functions will gradually decline due to the damage of the cognitive function. Their mortal in average 8 to 10 years but can only last 15 years in some special cases. Those patients are highly depend on their family member. Those heavy dependence have their family member exhausted. The institutional care mold can only solve those social problems.. The data from Ministry of Interior Affairs show that as of the end of 2011, there are 6,545 beds for fostering institutions, 44,794 care beds, and 4,750 chronic care beds. However, the lack of statistics on dementia care beds indicates a significant deficiency in care provided to patients of dementia. The main reason could lie on the fact that the fees charged for dementia care is relatively higher and the government does not provide proper subsidy or measures. This study is to explore the true care costs for seniors suffering from dementia,. The study conducts in-depth interview with the senior personnel working at the case institutions in addition to conduct on-site observations. The study applies operation-based costs system to analyze the various caring operations, followed by applying the various operating labor hour of questionnaires to analyze the calculate the maximum costs for institutional care for seniors suffering dementia as NT84,070 and the minimum value as NT40,032. The study intends to applies the results as reference to the Government’s “Long-Term Care 10 Year Plan” for seniors suffering from dementia and the care benefits standards, providing the long0term care industries with operating costs management and pricing reference to care for seniors suffering from dementia. Keywords: Seniors suffering dementia, Activity-Based Costing, Institutional Care

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17

Huang, Ching-Chun, and 黃敬淳. "The Effect of Patient with Dementia on Quality of Home and Institutional Health Care." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/62327296407274677943.

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碩士
國立陽明大學
衛生福利研究所
104
Background: Patients with dementia in the early stage of disease still have self-care ability, but they become totally disable and have aggressive behavior in the later period, making it more difficult to take care of them. Several Studies found that there are differences on quality of care between people with and without dementia. However, in Taiwan there has not been a national population-based study identifying whether the quality of care is different between people with and without dementia in home and institutional care. Objectives: To explore the effect of dementia on quality of care in home and institutional health care. Methods: The study adopted a retrospective cohort study design, data were derived from the National Health Insurance Research Database, and the subjects were elders who use National Health Insurance Home Health Care at the first time during 2008-2012. Patients were divided into two groups－dementia and non-dementia group by using propensity score with sex, age and comobidity to match subject in each care site. Each case was monitored from the patient’ s entry day until the respiratory tract infection, urinary tract infection, pressure ulcer, fracture and hip fracture occurred or to the end of one year follow-up. Stepwise Cox proportional- hazards regression was used to analyze the outcome, after controlling demographic, disease and institutional characteristics. Results: In home health care, dementia group have higher respiratory tract infection risk(AHR=1.11)and pressure ulcer risk(AHR=1.43)than non-dementia group, however there were no difference in urinary tract infection, fracture and hip fracture between two groups during one year after they use services. Conclusions: Dementia patients have higher risks in respiratory tract infection and pressure ulcer than people without dementia in home health care site. Medical institutions should keep going continuous education courses and monitoring the quality of care in institutional setting and enhance the caring skill of informal caregiver. Formal caregiver should strengthen the skill of dementia care, pass the long-term care information to patients who need it, and teach informal caregiver the skill of caring dementia patients.

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Lin, Huey-Jane, and 林惠珍. "Factors Affecting Caregivers of Person with Dementia to Use Institutional Long-Term Care Services." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/73603961425612941371.

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碩士
南華大學
企業管理學系非營利事業管理碩士班
103
Based on Andersen’s behavior model of health service use, this study aims to investigate factors affecting caregivers of person with dementia who are now staying in nursing homes and long-term care institutions to choose institutional long-term care services, and to explore the relationships among predisposing factors, enabling factors, need factors and the utilization of institutional long-term care services. 　　This study uses a cross-sectional survey with structured questionnaire. The sample includes 113 residents in one long-term care institution in Yunlin County and two nursing homes in Tainan City. 　　The major findings of this study are as following: (1) Both predisposing factors and need factors are more important predictors for using institutional long-term care services. (2) The analyses of multiple logistic regressions controlling other variables indicate that predisposing factors such as age and education level of elders with dementia, education level and care responsibility recognition of caregivers; enabling factors such as the perception of quality of institutional care services; need factors such as physical disability and emotion-behavior disturbance of elders with dementia and care and emotion loading and economic burden of caregivers are the most important predictors of institutional care service utilization. (3)However, the caregivers of institutional residents with dementia received few assistance from formal community care services when they cared elders with dementia at home. 　　Based on these findings, this study suggests that the government should develop various community care resources to support the disabled elders and their caregivers to mitigate their living burdens. More information, guidance and community resources regarding dementia care should be provided to assist elders with dementia staying at home for a longer time that the purpose of aging in place can be achieved.

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Du, Toit S. "Well-being and person-centred care of people with dementia cared for in institutional settings in South Africa." 2011. http://hdl.handle.net/10454/6825.

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Wu, Hui-Chuan, and 吳慧絹. "The Related Factors of Oral Hygiene Care Behaviors in Institutional Nursing Assistants with Dementia Residents." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/86889453488326499927.

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碩士
國立臺北護理健康大學
長期照護研究所
99
As the consequence of an aging society, dementia has become an issue highly concerned by health institutes all over the world. Patients suffering from dementia gradually lose their cognitive functions, and this even causes negative impact on their ability to take care of their own health. A frequently seen problem is that of the patients’ oral hygiene, which, if failed to maintain, can not only cause health problems related to the mouth, but may even expose the patient to systematic infections, which can be deadly . While the body and cognitive function impairment seen in institute dementia residents remains a common phenomenon, nursing assistants are usually required to help perform the oral hygiene tasks. Nevertheless, it seems that the proficiency and training of institute nursing assistants in oral hygiene care remain insufficient, which is worsen by heavy tasks, time pressure or rejection by residents – bite from residents in such cases may also hinder the willingness of nursing assistants in performing oral care, consequently causes potential threat to the oral hygiene of the dementia residents. In 2003, WHO has already called attention to oral health issues, whereas the Department of Health (DOH) also echoed by issuing “Oral Health Act” and “Oral Health for People with Disabilities Five-Year Plan” in 2005 and 2008 respectively; in which DOH called for strengthened oral health care to senior citizens and the disabled as well as better oral hygiene proficiency of the nursing assistants; the urgent need of dementia residents’ oral health care is hence highlighted. Therefore, this research aims to probe the current situation how oral health care is performed by institute nursing assistants for dementia residents, while also analyzing other related factors and behaviors. A cross-sectional study is applied for the study purposes. Data collection is done through a questionnaire survey which aims at native nursing assistants taking care of dementia residents in five long-term caring institutes in the north district equipped with special dementia care, and 109 effective samples in total are acquired. The research questionnaire include: the scale of knowledge of oral hygiene, oral hygiene attitude scale, oral hygiene behavior scale, dementia behavior problem scale and so on. The study results show that nursing behaviors which institutional nursing assistants perform to maintain dementia residents’ oral hygiene tends to medium-good level (Mean = 61.63; SD = 8.33), whereas oral hygiene nursing knowledge remains good (Mean = 8; SD = 1.6), and oral hygiene nursing attitude tends to medium-high level (Mean = 30.53; SD = 4.26). Among factors which influence oral hygiene behaviors, the more positively nursing assistants will perform if the less troubled they are by dementia residents’ behavior, the more sufficient time they spend on performing oral nursing care, and the more positive oral nursing attitude they maintain. In addition, the predictors for oral hygiene care behaviors model of institute nursing assistants are: the attitude of oral hygiene care and the degree of the troubled behaviors caused by dementia resident. From the result of this research, the following suggestions can be made: while reaction methods to dementia resident behavior can be further strengthened in the in-service education of nursing assistants in the future, positive attitude of nursing assistants can also be reinforced through different work experience sharing. Moreover, knowledge to environment setup prior to oral hygiene care should be enhanced. Nursing assistants should be reminded to help dementia residents to the washroom. It is recommend that while executing oral nursing care, nursing assistants can play the same theme music and perform neck-shoulder massage for dementia residents, which may help to reduce problem behaviors by stabilizing the emotion of dementia residents, hence to promote the higher quality of oral hygiene care.

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Rahm, Hallberg Ingalill. "Vocally disruptive behaviour in severely demented patients in relation to institutional care provided." Doctoral thesis, 1990. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100550.

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Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.

S. 1-48: sammanfattning, s. 49-164: 6 uppsatser

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Chang, Chingwei, and 張清為. "Investigation of the long-term institutional care requirements of patients with dementia and their families by qualitative and quantitative analysis." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/11806282234629459454.

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博士
國立政治大學
資訊管理研究所
96
Over the past decade, the number of long-term care (LTC) residents has increased, and many have accepted treatments such as medication, rehabilitation and occupational therapy. This study employs both qualitative and quantitative techniques in order to discuss senile dementia patient care in long-term care institutions, and we use a supply and demand viewpoint to explore what services are really necessary for the patient and their family. In qualitative method, the main purpose of this stage is to use the ethnographic decision tree model to understand and explore the decision criteria of the subject. Our study found that the degree of dementia of the patient always affects the decisions made by family members – in fact, this is the most important of all criteria elicited from the interviews with family members. There are also ethical constraints, care burden, norm of filial obligation, patient need professional medical care and institutional environment, etc. which mentioned by families. We linked together the decision criteria considered most important in accounting for the decision-making sequence of family members to be the ethnographic decision tree model which predictive power is 92%. In quantitative stage, our study discussed the effectiveness of occupational therapy when given to dementia patients of different contexts. The results of this stage showed that patients of a good condition in the first stage present a more positive attitude towards participation in the occupational therapy designed by the institution; therefore, they have a greater chance of their condition improving or remaining the same. However, patients of an average condition have a more passive attitude towards taking part in any therapy; therefore, they have a greater chance of their condition deteriorating, because of their violent tendencies and their resistance to care, the task of caring for these patients is more difficult than caring for patients in the other groups. Above all, we suggest that families adopt the therapies no matter in homecare or institutionalization, as early as possible in order to improve the likelihood of being able to control the patient’s condition. It is understandable that accepting more therapies and interaction in the early stage of dementia, having higher chance to go well, however, by waiting until then they also miss the best opportunity to attempt to improve the patient’s condition, it is really not the good way we suggest to be.

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Šuláková, Dagmar. "Etapy sociální práce s klientem s Alzheimrovou nemocí." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-358140.

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In this thesis, "Stages of social work with clients with Alzheimer's disease", I focused on the analysis of the most effective stages of social work. I found out that most respondents prefer a domestic informal care, corresponding to the stages of provided social work and unconditional acceptance of the patient. The sick person requires a sensitive holistic approach, accepting his individuality and ensuring dignity in all stages of the disease. The thesis was structured on the theoretical part, based on the findings of scientific literature dealing with the symptomatology and processes of Alzheimer's disease, characterized by basic treatment and care approaches. The theoretical part is followed by an own joint investigation, divided in a qualitative and a quantitative approach. The qualitative approach is based on a detailed case study which uses the methods of observation and interviews. Anonymous questionnaires were used for the quantitative method. The obtained data were summarized and analyzed. Due to the lack of data I concluded that the considered results can be obtained as irrelevant.

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Robertson, S., C. Cooper, J. Hoe, Kathryn Lord, P. Rapaport, L. Marston, S. Cousins, C. G. Lyketsos, and G. Livingston. "Comparing proxy rated quality of life of people living with dementia in care homes." 2018. http://hdl.handle.net/10454/18153.

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Yes
Background. Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. Methods. We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. Results. Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family’s (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as ‘Poor’ (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents’ QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. Conclusion. Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently
This research was supported by the UK Economic and Social Research Council and the National Institute of Health Research Grant number NIHR/ESRC (S.R., P.R, L.M., G.L., C.C., S.C., ES/L 001780/1); the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (SR, PP, GL); the UCLH NIHR Biomedical Research Centre (GL, CC); and the Johns Hopkins Alzheimer’s Disease Research Center (C.L., P50AG005146, PI: Albert).

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Mestre, Alexandra de Brito Lacerda Cristiano e. "O acolhimento em lar de pessoas idosas com demência e a prestação de cuidados." Master's thesis, 2016. http://hdl.handle.net/10437/7354.

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Orientação : Isabel Vieira
O envelhecimento populacional é uma questão em destaque; comprovam-no as estatísticas e o elevado número de publicações nesta área. Do aumento generalizado do número de Pessoas Idosas institucionalizados emerge a necessidade de conhecer e compreender melhor o acolhimento da pessoa idosa com demência no Lar ASAS. O presente estudo explora, assim, o que é o envelhecimento e velhice; a demência – doença mental; a Prestação de Cuidados e os Cuidadores, e o acolhimento social, segundo a opinião das pessoas idosas residentes. O objetivo primordial desta investigação é analisar O Acolhimento em Lar de Pessoas Idosas com Demência e a Prestação de Cuidados, a partir da observação, da experiencia das ajudantes de ação direta e da opinião das pessoas idosas residentes. A investigação desenvolveu um estudo de caso, exploratório, numa instituição de Lisboa; aplicaram-se questionários a 10 utentes da instituição e 6 entrevistas semi-diretivas às ajudantes de ação direta da ASAS – Associação para Serviços de Apoio Social. A Metodologia seguida foi a qualitativa, numa abordagem compreensiva para a identificação das práticas de cuidados quotidianos. Os resultados apresentam que os utentes, no geral, encontram-se satisfeitos com a prestação de cuidados a que estão sujeitos e mostram, igualmente, que a relação com as ajudantes de ação direta é estruturante para a sua segurança e conforto. Na opinião das AAD como cuidadoras, estas mostram-se satisfeitas com o serviço prestado ás pessoas idosas, mas dizem que necessitam de mais conhecimentos sobre a especificidade e particularidades das pessoas com demência, a fim de sentirem uma maior segurança no seu desempenho e prestarem serviços de melhor qualidade.
Population aging is an issue highlighted; show on statistics and the large number of publications in this area. The general increase in the number of institutionalized elderly emerges the need to know and better understand the care of the elderly with dementia in the Home WINGS. This study explores Thus, what is aging and old age; dementia - mental illness; the care and the provision of direct action helpers, and social care, in the opinion of the elderly residents. The primary objective of this research is to analyze the Home in Home for Elderly People with Dementia and Care Services, from observation, experience of direct action aids and the opinion of the elderly residents. Research has developed a case study, exploratory, a Lisbon institution; They were applied questionnaires to 10 users of the institution and 6 semi-directive interviews with direct action Adjutant ASAS - Association for Social Support Services. The methodology followed was the qualitative, a comprehensive approach to the identification of daily care practices. The results show that users in general are satisfied with the care to which they are subject and shows also that the relationship with the direct action helpers is structuring for your safety and comfort. In the opinion of the AAD as caregivers, these prove to be satisfied with the service provided to the elderly, but they say they need more knowledge about the specific nature and characteristics of people with dementia in order to feel safer in their performance and provide services best quality.

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TSOU, JUI-YU, and 鄒瑞玉. "Research on Therapy and Care of Dementia Patients :A Case Study of Two Elderly Care Institutions,Taoyuan City." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/c457an.

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碩士
元智大學
社會暨政策科學學系
107
This research concerns dementia patient treatment and care, focusing on veteran elderlies with similar living conditions and cultural backgrounds registered at a residential institution specializing in Dementia caregiving service and a Day care center, both in Taoyuan City. This study is qualitative, using literature analysis, actual participatory observation and in-depth interviews as methods to understand the impact that medical treatment and lifecare service have on the disease process of dementia patients and identify the suitability of occupational therapy intervention in the patients' everyday lives. Recently, as the national population aged, the number of dementia patients also rose, which have caused considerable difficulty for families in giving care to their members and also financial stress. In order to allow dementia patients to receive proper medical attention and adequate lifecare service, the Administrative Yuan launched a "10-Year Long-Term Care Plan 2.0", including dementia patients into targeted populations as a response to a range of caregiving issues related to dementia (Ministry of Health and Welfare 2016). This study found that dementia patients can receive occupational therapy through non-medicated means to improve the patents' degenerative limbs, and also applies to other patients with different diseases. There are however uncertain factors, such as dementia patients' willingness to participate and their physical conditions. The learning care type such as non-medicated therapy sessions can extend cognitive functions. When dementia patients receive proper medical care and lifecare, their quality of life improves, and the duration of long-term care is dramatically reduced and lowers the intensity of human labor and social cost.

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27

Åström, Sture. "Attitudes, empathy and burnout among staff in geriatric and psychogeriatric care." Doctoral thesis, 1990. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-103814.

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This study concerned assessments of attitudes towards demented patients among students and nursing staff as well as attitudes towards active euthanasia, wish to transfer to other jobs, ability of empathy and experience of burnout among nursing staff. The study aimed also to relate experience of burnout to attitudes towards demented patients, ability of empathy and experience of work with demented patients. The study was performed by use of questionnaires, scales measuring attitudes towards demented patients, experience of burnout and ability of empathy. Tape-recorded interviews were also included aiming to explore the staffs experience at work. The results showed that a majority of the students and staff held positive attitudes towards demented patients. A small proportion intended to work solely with demented patients. Staff working in psychogeriatric care and somatic long-term care held more positive attitudes than staff working in acute medical care. Proportions of staff with positive attitudes varied depending on age, duration of employment, education and place of work. A larger proportion of staff in geriatric care than in acute care reported a wish to transfer to another job. LPN’s in nursing homes to the largest proportion stated this wish to transfer. A majority of both students and staff expressed negative attitudes towards active euthanasia to severely demented patients in the finale stage of life. However, most favourable attitudes towards active euthanasia were found among students with shorter health care education and among nurse's aides and LPN’s. The staffs empathy was judged as moderately high and there were no differences found in relation to sex, staff category or place of work. Experience of burnout /tedium varied with the place of work and category of staff. Largest proportions at risk to develop burnout were found among those working in somatic long-term care and psychogeriatric care. RN’s showed lower burnout scores than nurse's aides and LPN’s. Experience of burnout was correlated to attitudes towards demented patients, indicating that the lower burnout score the staff have the more positive are the attitudes. Burnout was also related to the staffs ability of empathy i.e. the lower degree of burnout the higher is the empathie ability. Regression analysis showed that "Experience of feed-back at work” and "Time spent at present place of work" were the most important factors for the staffs experience of burnout.

Diss. (sammanfattning) Umeå : Umeå universitet, 1990, härtill 7 uppsatser.

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LIN, CHUN-LONG, and 林俊龍. "STUDY ON BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA AT LONG-TERM CARE INSTITUTION'S NURSING MANAGEMENT." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/26066482016709650431.

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碩士
明新科技大學
服務事業管理研究所碩士班
104
This paper aims to investigate nursing stuff at long-term care institutions for behavioral and psychological symptoms of dementia "BPSD" We collected solution about this dilemma and developed Standard Operating Procedures "SOP". We hoped to .improve quality at BPSD at long-term care instutition. Research methodology: we adopt qualitative research method, and collect raw data by semi-structured interview mode with Nursing Heads working long-term care institution .It was " Formal Interview " architecture and "Empirical Data". We followed directs and outlines by designing questions. Before performing study, we consult five dementia specialist for reliability and validity with research meeting. We collected and analyzed raw data. Finally, we organized copying strategy and practical solution about BPSD. Conclusions and recommendations: more than 25% elderly suffered from BPSD at long-term care institution. We summarized articles and empirical data and found 6 more popular type of BPSD. They were "wandering behavior"、"repetitive phenomena"、"hoarding behavior"、"delusion of theft"、"delusion of persecutory" and "inappropriate eating behavior"。"Anxiety"、"knowledge about BPSD management", "time-limit" and "family and social support" were four main fields of caregiver stress at long-term care institution. We found that nursing stuff including multiple copying strategies for BPSD such as "stuff education"、"family communication"、"emotional support"、"medical consultation"and"environmental improvement". Intergrated care was necessary. We found that "attention shift"、"hand over to the next shift"、"medical assessment" were ecessary practical solution . We recommend to use SOP and reduced caregiver stress.

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TSAI, CHIA-WEN, and 蔡嘉紋. "The Effect of Using Life Story Drawing on Dementia Elderly in Long-Term Care Institution." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/656aey.

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碩士
長庚科技大學
高齡暨健康照護管理系(所)
107
As ageing population grows rapidly, the number of people with dementia rise. The prevalence of dementia in Taiwan is about 8%, with an increase of every 5 years of age over 65 years, the prevalence rate doubles. Live review, one of the reminiscence therapies, becomes popular to treat patients with mild and severe dementia. It is a structural guidance for participants to record their past life events and experiences. Through the help of the therapist, the participants evaluate their life stories to promote self-life value and self-affirmation as well as to achieve their self-consolidation as their final stage of life. This is a quasi-experimental research design. The participants were dementia elderly recruited from long-term care institutions registered at the New Taipei City. After consent form was obtained, patients were divided into control group and experimental group. The experimental group received painting life stories intervention As a result, 29 participants were in experimental group and 16 people in the control group. Both groups were mostly female (55.2% and 62.5%, respectively). The average age was 78.2 years old and 80.3 years old. The painting group accepted 8 consecutive weeks of painting life story activities, and the control group did not conduct any intervention activities. MMSE and Cornell's Wisdom Depression Scale for the Elderly were administered for three times which included pre-test, the 8th week after the intervention, and the 12th week. A statistical software package spss18.0 was used to analyze the data including the mean, standard deviation, percentage, t-test and generalized estimation equation (GEE) to explore the cognitive and depression improvement of the elderly with mental health. The results of the study showed that the dementia elderly in the line institutions were mostly moderately demented and depressed. After 8 weeks of intervention, the experimental group had significant effects on cognitive and depression improvement. After 12 weeks, the experimental group still showed significant improvement both in cognition and depression. The findings suggest that the painting of life stories can be promoted in the institutions of the dementia elderly to slow down the cognitive degeneration as well as to improve their depression.

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30

Jírová, Monika. "Problematika institucionální péče o seniory s Alzheimerovou chorobou." Master's thesis, 2013. http://www.nusl.cz/ntk/nusl-320794.

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Thesis entitled "The issue of institutional care for the elderly with Alzheimer's disease" includes information about different types of dementia, charts the current situation in the Czech Republic and in the world, characterized fundamental questions of social policy and presents some methods of non-pharmacological treatment. The research analyzes the conditions of life of seniors with Alzheimer's disease who live in different types of institutions. It also focuses on family members. For compact view on the topic contribute opinions of experts from relevant institutions. Aim of this study is to describe and compare the system of care in individual and institutional facilities using statistical information to point to the timeliness issue.

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31

Yin, Yao Shwu, and 姚淑吟. "The Effects of Fall Prevention Course on Dementia Seniors’ Depression and Balance Function in a Long－Term Care Institution." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/vqaf25.

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碩士
美和科技大學
社會工作系碩士班
105
This research focuses on the effort to the functions of balance and depression of the elder dementia patients from the “fall prevention training course ” in the long-term care institution. Pre –post test is taken to be as the method from quasi experimental design in this research. Through 16 times of the course training during 8 weeks, 17 elder dementia patients in a long-term care institution from Southern Taiwan were studied by the result of before / after measurement and tracking test from Cornell Scale for Depression in Dementia(CSDD) and Tinetti gait. According to the research result, the obvious improvement and progress can be found from CSDD in emotional signs and behavioral disorder and as well as Tinetti gait and balance test. In conclusion of the research, fall prevention training course is effective and worth to be promoted. This research can be the reference for the persons who are working on anti-falls training course designing. As the suggestion for further strictness and validity to the relative researches, the application of control group and the experimental group could be the supplementary to the comparison and the tracking test. Moreover, the fall prevention training course shall be widely promoted to the purpose of keeping the life condition for the elder dementia patients in the organizations.

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32

Shih, Li-Hung, and 施麗紅. "The Difficult Agents: The Model of Care Collaboration between the Caregivers of the Elderly with Dementia and the Social Workers in the Long-Term Care Institutions." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/5ry526.

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博士
東海大學
社會工作學系
101
The Difficult Agents: The Model of Care Collaboration between the Caregivers of the Elderly with Dementia and the Social Workers in the Long-Term Care Institutions Abstract After the elderly suffer from dementia, they must be cared. At last, they may be located in institutions. The process is a reason that the care collaboration between chief domestic caregivers and institutional social workers. It is beneficial to the elderly with dementia, the caregivers, institutions and the staff through collaboration between the two parties. The study aims to find out the relevant viewpoints upon happenings and progress of dual collaborative relationships from the perspectives of senile dementia caregivers and institutional social workers. Thus, the conceptual model of dual collaborative relationships is formulated so as to facilitate intervention in pragmatic encounters within social work. The qualitative research approach of Grounded Theory is adopted in this study. The 24-hour care institutions which serve senile dementia sufferers in Taiwan have been reached. There are 17 major caregivers and 11 social workers recommended by institutions of different geographical areas. After data analysis has been carried out through the 28 subjects, a chronological framework is incorporated, including senile dementia sufferers’ pre-check-in at institutions, check-in process, and post-check-in of them. Eventually, the core concept explaining a collaborative relationship between the caregivers and the social workers is detected, “the process of mutual empathic co-dependence”. It means that: “In an attempt to take care of the elderly sufferers comprehensively, the two parties develop a series of communication and coordination. The caregivers have to empathize with inevitable limitations encountered by institutional staff regarding giving care. The caregivers should partially devote themselves to caring the elderly. On the other hand, the social workers ought to be able to empathize with the caregivers’ concern towards the elderly, approving their roles of being experiential experts. Then, the social workers would be able to calmly view the caregivers’ demand, to proceed with care coordination. At last, even if the opinions of caregivers are not wholly comprehended, the endeavors made to senile dementia sufferers by institutions could be appraised”. With reference to the core concept, there are certain conceptual variables from three aspects, provided that three of them are interrelated as a result. There are several characteristics regarding senile dementia sufferers, including hometowns of the elderly, religious belief, diagnosis of dementia types, disabilitied levels causing various giving care difficulties, any migration experience in the past, etc.)；(For the chief caregivers, the characteristics include gender, occupations, religious belief, the caregivers’ initial knowledge about dementia, relationships between the caregivers and the elderly (parent-child relationships/couples), consensus about check-in at care-giving institutions among family members, the caregivers’ trust/empathy towards specific institutions, the caregivers’ original realization of filial piety, etc.) ；Last but not least, for social workers, the characteristics include employment types (professional/part-time), perspectives upon the demented elderly, empathy for chief caregivers, consistency of giving care among staff and chief caregivers, special features of affiliated organizations (organizational scales, policies of multi-services tactics, governmental constitutions, service tendencies, etc.), etc. These characteristics are highly correlational between both sides regarding development of care collaborative relationships.) Above all, the three hierarchical conceptual variables could be distinguished. They are made use of for priority change in pragmatic encounters within social work in future. An important concept which repeatedly occurs throughout the study process is highlighted by the researcher, i.e. the caregivers’ cognition about dementia, difficulties of looking after the senile dementia sufferers. By means of the concept, the collaborative models between the caregivers and the institutional social workers intersect to contribute to classifications. Two variables intersect so that four quadrants evolve. They are namely “wholly supportive type”, “involved coordinative type”, “wrestling pursuit type”, and “destiny-following type”. The former two types are relatively more appropriate for this study in respect of the collaborative core concept of empathic co-dependence. In terms of prospective social work encounters, change of caregivers’ cognition about dementia can promote change of cooperation and communication forms between caregivers and social workers. As a result, the latter two quadrants are altered into the previous two with collaboration. Lastly, according to the elderly’s pre-check-in, check-in process, post-check-in, chief caregivers/family members, social workers and institutions, possibilities of fostering establishment regarding collaborative relationships of empathic co-dependence between chief caregivers and institutional social workers by the government, relevant suggestions are given in this study. Keywords：the Elderly with Dementia, The Caregivers, the Social Workers in the Long-Term Care Institutions, the Model of Care Collaboration, the Process of Empathic Co-Dependence

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Huang, Yi-Chen, and 黃翊宸. "A Survey on the Composition of Unit care Environment and Environmental Quality Status for the Dementia Elderly - By the Case Study of the Southern institution." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/3zhn73.

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碩士
國立雲林科技大學
建築與室內設計系
103
Because people with dementia remain long-term memory, so people with dementia in a familiar living space can best support their normalization of life, creating a family-like environment as the basic principles of care for Alzheimer's sufferers. In retrospect international empirical literature related to the development of dementia care and noted have tended to living unit concept of a case by case, take a small scale like "home" atmosphere of life in dementia care unit is the ideal features to inmate enjoy family life and routine mode, so the service provided by the organization as an object is changed to an individual object. This study aims to (1) survey of Taiwanese unit care environment, in order to understand Taiwan people with dementia care unit environment status. (2) explore the environment issue unit care and the environment quality of life of Taiwan, as a reference to improve the environment of care for people with dementia. Research Methods The literature review, research prevalence survey, observation recording method, index check method. Selection elderly care facilities have dementia care unit Mode 2, the status of the environment for environmental analysis, as well as the quality of the living environment assessment analysis. Research :( A) The unit will focus on environmental care unit into a region, in order to leave the Prevention of Alzheimer's sufferers. (B) Care environment in the cell, so that people with dementia can live in family activities. (C) Nostalgia nostalgic space situation and nostalgia facility setting, interact with people with dementia. (D) Set OT space for individual partitions. (E) Construction of sensory stimulation when environmental element, should be taken to avoid animal pattern. (F) Set the instruction marks should be used with dementia easily recognizable elements, and on the need for continuity in the wall or floor. (G) Spatial arrangement unit affects the interaction between people with dementia, and public space can have diverse leisure activities. (H) External window of reality-oriented facilities, should pay attention to it because of the sun and glare of sunshine. (I) Wandering space setting will lead to different units generated between interactive. (J) Units have set service management facility, will lead to the environment "in public, semi-public, semi-private and private hierarchy of" no clear distinction.

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34

Huang，Chia-Ying and 黃家盈. "The Knowledge, Attitude, Self-efficacy of the Nurse in Long Term Care Institution Regarding the Management of Behavioural and Psychological Symptoms of Dementia(BPSD) and Their Relationship." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/3eu358.

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碩士
弘光科技大學
護理研究所
107
The prevalence rate of dementia in nursing institutions is 65.70%, with more than 25% being Behavioral and Psychological Symptoms of Dementia (BPSD), of which symptoms include: wandering, repetitive phenomena, compulsive hoarding, delusion, aggressive acts and so on. Long-term care receives a wide range of patients, as a result, employees are often perplexed as to how to care and interact with patients of BPSD. This study aims at understanding the knowledge, attitude, self-efficacy and related factors of long-term nursing personnel in dealing with dementia patients with abnormal behavior and psychology.The current study is as cross-sectional design study, which conducts individual survey through structured questionnaire, taking nursing personnel in long-term nursing institutions in Taichung as population, CVI:0.92, and selecting samples by Stratified Proportional Sampling. A total of 102 questionnaires are sent out, with 96 questionnaires actually collected, demonstrating a recovery rate of 94.11%.The results show that most nursing personnel in long-term nursing institutions are aged between 30~39 years old, with their nursing seniority being more than five years. Most of them have the experience of contacting dementia patients with abnormal behavior and psychology, having received relevant education and training. The average correct ratio in regards to the nursing knowledge of dementia patients with abnormal behavior and psychology accounts is 89%. They remain neutral about caring for dementia patients with abnormal behavior and psychology. The average score of self-efficacy of nursing personnel caring for dementia patients with abnormal behavior and psychology is slightly lower. There are significantly correlations between the knowledge, attitude as well as the number of cases handled with self-efficacy of caring for dementia patients with abnormal behavior and psychology, reaching statistical significance. The results of this study can serve as a reference for the in-service education of nursing personnel in the long-term nursing institutions to promote their efficiency of caring for dementia patients with abnormal behavior and psychology.

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