Losing hope or keep searching how to overcome impasses with nursing home residents with dementia?

In nursing homes (NH), over 80% of residents with dementia show challenging behavior (e.g. agitation or physical aggression), which is extreme in a minority of cases due to its substantial severity and frequency. It has a great impact on residents and their social environment. Sometimes a certain impasse is reached, preceded by a long trajectory of searching for a solution and in which NH staff feels that they are out of (treatment) options.

In the WAALBED (WAAL-Behavior-in-Dementia)-study these impasses were explored by obtaining experiences and perspectives of NH staff and relatives involved with NH residents with dementia and extreme challenging behavior living on dementia special care units in the Netherlands. The research group, led by Debby Gerritssen from the Department of Primary and Community Care, published their results in BMC Geriatrics, on September 16th.

They performed a qualitative multiple case study with individual interviews and focus group discussions. Interviewees were elderly care physicians, psychologists, care staff members, unit managers and relatives. In dealing with the behavior, some NH staff members did not give up hope and continued with their search for a solution to manage the extreme behavior. Others resigned themselves to the situation. Characteristics and attitudes of stakeholders involved (resident, relative, care staff, treatment staff, NH staff, and NH organization) contributed in experiencing a situation of extreme challenging behavior as an impasse. For example, the resident was unlike the other residents and the behavior was considered highly complex and challenging due to its unpredictability. Care staff had insufficient skills and knowledge and treatment staff missed the whole picture of the situation because they were at bay. In addition, interdisciplinary collaboration and communication was suboptimal; care staff members found it difficult to ask for help and rarely reflected on their own actions and feelings and treatment staff members did not support care staff members properly.

As these important contributing factors are now known, interventions based on knowledge about mono- and interdisciplinary communication and collaboration can be developed to prevent these impasses in the future. Particularly in these complex cases, communicating and collaborating intensively is the key to managing these situations and finding the most optimal approach. Working uniformly and methodically are ways to achieve this.

Publication

Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Persoon A, Koopmans RTCM, Gerritsen DL. Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia. BMC Geriatrics. 2022 Sep 16;22(1):758.