Faculty of Health
Supporting Aged Care Nursing Staff to Manage Behavioural and Psychological Symptoms of Dementia: iSeeBehaviour.
Dr Lisa Clinnick – ACU/Ballarat Health Services Professor Britt Klein - FedUni
Associate Professor Andrew Stranieri - FedUni Dr Richard Dazeley - FedUni
Professor Suzanne McLaren - FedUni Dr Venki Balasubramanian - FedUni
Faculty of Health 25%-50%
Rate of NH residents on psychotropic
medication (1988)
47.7%
rate of Sydney NH residents receiving psychotropic medication
(2006)
UK 2009
Dementia Framework submission –
“estimated that we are treating 180,000 people with dementia with antipsychotic
medication across the country per year. Of these, up
to 36,000 will derive some benefit from the treatment”
60%
of residents receive one psychotropic medication
37%
receive two 11%
receive three or more.
(1988)
20%
The number of residents receiving psychotropic medications who did not have
a diagnosis (1994)
2003 Helsinki study
79.9% of residents prescribed psychotropic
medications
Faculty of Health
Background
• Behavioural and psychological symptoms of dementia (BPSD), are common in aged care residential
facilities.
• Studies report that psychologically-based interventions can be used successfully to manage BPSD
• identifying and knowing how to apply the most appropriate behavioural management strategy requires training or expertise.
Psychotropic medications use
• Side effects of all benzodiazepines include excessive sedation,
• psychomotor slowing,
• cognitive impairment,
• morning “hang-over” effect,
• ataxia and
• falls
• the overall side effect profile of both typical
and atypical antipsychotics is vast..
Faculty of Health
Project Aims:
• to identify an appropriate approach toward the provision of tools that could be helpful to nurses when making assessments and choosing BPSD
intervention strategies when attending to a resident in a short time frame.
• be practically deployed
• encourage a decision maker to exercise discretion
• Developed NBA – Nurses Behavioural Assistant
innovative and sophisticated psychologically-based mobile application and web-based system.
Analytics Support Decisions
• analytics keeps track of how often a specific
intervention (for each individual BPSD type, per patient) is successful or not.
• Nurses are shown these success scores when they opt to implement a behavioural intervention.
Faculty of Health
Project Design-
• program was implemented at an aged care facility located in regional Victoria, Australia
• provided with an outline of the research at two staff training days.
• brainstorming session
• DKAT completed
Initial Feedback
• Size
• Common BPSD identified
• common interventions identified
• Time
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Resident Assessments
• Selection
• Assessments –
• Saint Louis University Mental Status Examination (SLUMS).
• Hospital Anxiety and Depression
Scale (HADS).
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Trial Results
• Staff feedback
• It was easy to use.
• It was hard to classify resident by room number vs name.
• No inclusion of staff member directed behaviours, this doesn’t fit into a category.
• Possibility of using the app at home to log incidents after work using a pass code.
• Also, the possibility of including a timeline of incidents per residents.
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Findings
• behaviours have not coincided with what has been placed into the resident logs.
• Residents are being provided with medication as the first response in a number of incidents.
• Nursing staff may not have classified these as problem behaviours.
Faculty of Health
Limitations
• Nursing staff were enthusiastic about the system concept, however as they have extensive training already they did no use it.
• Small facility was used in this trial
• Small sample of residents for a limited time period.
• A whole facility approach would have overcome some of the limitations
Faculty of Health
Phase 2 - iSeeBehaviour
• Further development using grant funds.
• Enhanced graphics and analytical power.
• Easier use for staff.
• Simpler and more engaging platform.
• Supported with evidence based best practice strategies.
• Nurse Self Care Mindfulness, meditation and stress management strategies for staff to use on themselves.
Faculty of Health
Faculty of Health
Faculty of Health
Future
• Conducting RCT of updated iSeeBehaviour platform.
• Enormous support and enthusiasm from Melbourne based health services and national aged care
providers.
• Expect interest to grow further once evaluation has been conducted.
