Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-26T07:06:59.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany

Published online by Cambridge University Press:  05 February 2009

Bettina Kuske ,
Tobias Luck ,
Stephanie Hanns ,
Herbert Matschinger ,
Matthias C. Angermeyer ,
Johann Behrens  and
Steffi G. Riedel-Heller
Bettina Kuske
Affiliation:
Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit, Leipzig, Germany
Tobias Luck*
Affiliation:
Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit, Leipzig, Germany
Stephanie Hanns
Affiliation:
Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther University of Halle-Wittenberg, Halle/Saale, Germany
Herbert Matschinger
Affiliation:
Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit, Leipzig, Germany
Matthias C. Angermeyer
Affiliation:
Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit, Leipzig, Germany
Johann Behrens
Affiliation:
Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther University of Halle-Wittenberg, Halle/Saale, Germany
Steffi G. Riedel-Heller
Affiliation:
Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit, Leipzig, Germany
*
Correspondence should be addressed to: Tobias Luck, Department of Psychiatry, University of Leipzig, Public Mental Health Research Unit Semmelweisstrasse 10, D-04103 Leipzig, Germany. Phone: +49 341 9724530; Fax: +49 341 9724539. Email: Tobias.Luck@medizin.uni-leipzig.de.
Get access

Abstract

Background: This study examines the effectiveness of a nursing home staff training program designed to improve the interaction between residents with dementia and their caregivers.

Methods: A three-arm cluster-randomized and controlled population of 96 caregivers and 210 residents was used. Caregivers of the intervention group (IG) received a three-month training program in dementia care. Data were gathered at baseline, immediately after the training and at a six-month follow-up-assessment. Short- and long-term effects of the training program were assessed in comparison with another intervention referred to as the relaxation group (RG) and a wait-list control group (CG).

Results: Results indicated significant positive effects of the training program on caregivers' knowledge immediately after the training and on the use of physical restraints at the six-month follow-up. Caregivers' overall competence increased significantly both in the IG and in the RG. No intervention effects were found on caregivers' level of burnout, their health complaints or on the use of sedative drugs. Relaxation training was more successful in the reduction of caregivers' health complaints.

Conclusions: Results of the study indicate both the effectiveness and the limitations of a general training program in dementia care. The complexity of the nursing home setting potentially needs more complex interventions. Ongoing and continued support of the caregivers, as well as changes in organization and environment, are more likely to be helpful in the long-term improvement in the quality of care. Future research should focus on studies of specific interventions, such as the interesting effects of relaxation training on the caregivers' state of health.

Keywords

intervention studylong-term careformal caregiversrelaxation
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 295 - 308
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aylward, S., Stolee, P., Keat, N. and Johncox, V. (2003). Effectiveness of continuing education in long-term care: A literature review. The Gerontologist, 43, 259–271.CrossRefGoogle ScholarPubMed
Beck, C., Ortigara, A., Mercer, S. and Shue, V. (1999). Enabling and empowering certified nursing assistants for quality dementia care. International Journal of Geriatric Psychiatry, 14, 197–211.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Burgio, L. D. et al. (2000). Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. The Gerontologist, 41, 449–460.CrossRefGoogle Scholar
Burgio, L. D., Stevens, A., Burgio, K. L., Roth, D. L., Paul, P. and Gerstle, J. (2002). Teaching and maintaining behaviour management skills in the nursing home. The Gerontologist, 42, 487–496.CrossRefGoogle ScholarPubMed
Büssing, A. and Perrar, K. M. (1992). Die Messung von Burnout. Untersuchung einer deutschen Fassung des Maslach Burnout Inventory (MBI-D). Diagnostica, 38, 328–353.Google Scholar
Büssing, A., Glaser, J. and Höge, T. (2003). Psychische Belastungen und Beanspruchung in der ambulanten und stationären Pflege. (Bericht 69). Munich: Technische Universität, Lehrstuhl für Psychologie.Google Scholar
Capezuti, E., Strumpf, N. E., Evans, L. K., Grisso, J. A. and Maislin, G. (1998). The relationship between physical restraint removal and falls and injuries among nursing home residents. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 53, M47–52.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry, 9, 361–381.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Werner, P., Culpepper, W. J. and Barkley, D. (1997). Evaluation of an inservice training program on dementia and wandering. Journal of Gerontological Nursing, 23, 40–47.CrossRefGoogle ScholarPubMed
Diggle, P., Heagerty, P., Liang, K.-Y. and Zeger, S. L. (2002). Analysis of Longitudinal Data. 2nd edn. Statistical Sciences Series 25. Oxford: Oxford University Press.CrossRefGoogle Scholar
Fitzpatrick, J. M. and Roberts, J. D. (2004). Challenges for care homes: education and training of healthcare assistants. British Journal of Nursing, 13, 1258–1261.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fossey, J. et al. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: a cluster randomised trial. BMJ, 332, 756–761.CrossRefGoogle ScholarPubMed
French, D. D., Campbell, R. R., Spehar, A. M. and Accomando, J. (2007). How well do psychotropic medications match mental health diagnoses? A national view of potential off-label prescribing in VHA nursing homes. Age and Ageing, 36, 107–108.CrossRefGoogle ScholarPubMed
Hagen, B. F. and Sayers, D. (1995). When caring leaves bruises: the effects of staff education on resident aggression. Journal of Gerontological Nursing, 21, 7–16.CrossRefGoogle ScholarPubMed
Haith-Cooper, M. (2000). Problem-based learning within health professional education. What is the role of the lecturer? A review of the literature. Nurse Education Today, 20, 267–272.CrossRefGoogle ScholarPubMed
Heuschmann, P. U. et al. (2005). The reliability of the German version of the Barthel-Index and the development of a postal and telephone version for the application on stroke patients. Fortschritte der Neurologie Psychiatrie, 73, 74–82.CrossRefGoogle ScholarPubMed
Hosia-Randell, H. and Pitkälä, K. (2005). Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs and Aging, 22, 793–800.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Huizing, A. R., Hamers, J., Gulpers, M. and Berger, M. (2006). Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial. BioMedCentral Geriatrics, 6, 17. doi:10.1186/1471-2318-6-17.CrossRefGoogle ScholarPubMed
Kessler, J., Markowitsch, H. J. and Denzler, P. (2000). Mini-Mental-Status-Test (MMST). Göttingen: Beltz Test GMBH.Google Scholar
Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258.CrossRefGoogle ScholarPubMed
Klauer, K. (1993). Denktraining für Jugendliche. Ein Programm zur intellektuellen Förderung. Handanweisung. Göttingen: Hogrefe.Google Scholar
Kuske, B., Hanns, S., Luck, T., Angermeyer, M. C., Behrens, J. and Riedel-Heller, S. G. (2007). Nursing home staff training in dementia care: a systematic review of evaluated programs. International Psychogeriatrics, 19, 818–841.CrossRefGoogle Scholar
Kuss, O. and Watzke, S. (2005). Proper handling of correlated data in rehabilitation research. Rehabilitation (Stuttgart), 44, 367–372.Google ScholarPubMed
Liang, K.-Y. and Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13–22.CrossRefGoogle Scholar
Lintern, T., Woods, B. and Phair, L. (2000). Before and after training: a case study of intervention. Journal of Dementia Care, 8, 15–17.Google Scholar
Magai, C., Cohen, C. I. and Gomberg, D. (2002). Impact of training dementia caregivers in sensitivity to nonverbal emotion signals. International Psychogeriatrics, 14, 25–38.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 56–61.Google ScholarPubMed
Matteson, M. A., Linton, A. D., Cleary, B. L., Barnes, S. J. and Lichtenstein, M. J. (1997). Management of problematic behavioral symptoms associated with dementia: a cognitive developmental approach. Aging Clinical and Experimental Research, 9, 342–355.CrossRefGoogle ScholarPubMed
McCallion, P., Toseland, R. W., Lacey, D. and Banks, S. (1999). Educating nursing assistants to communicate more effectively with nursing home residents with dementia. The Gerontologist, 39, 546–558.CrossRefGoogle ScholarPubMed
Molter-Bock, E., Hasford, J. and Pfundstein, T. (2006). Psychopharmacological drug treatment in Munich nursing homes. Zeitschrift für Gerontologie und Geriatrie, 39, 336–343.CrossRefGoogle ScholarPubMed
Peterson, D., Berg-Weger, M., McGillick, J. and Schwartz, L. (2002). Basic Care I: the effect of dementia-specific training on certified nursing assistants and other staff. American Journal of Alzheimer's Disease and Other Dementias, 17, 154–164.CrossRefGoogle Scholar
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433–441.CrossRefGoogle Scholar
Rosen, J., Mulsant, B. H., Kollar, M., Kastango, K. B., Mazumdar, S. and Fox, D. (2002). Mental health training for nursing home staff using computer-based interactive video: a 6-month randomized trial. Journal of the American Medical Directors Association, 3, 291–296.CrossRefGoogle ScholarPubMed
Ruths, S., Straand, J. and Nygaard, H. A. (2001). Psychotropic drug use in nursing homes: diagnostic indications and variations between institutions. European Journal of Clinical Pharmacology, 57, 523–528.Google ScholarPubMed
Sonntag, A., Matschinger, H., Angermeyer, M. C. and Riedel-Heller, S. G. (2006). Does the context matter? Utilization of sedative drugs in nursing homes: a multilevel analysis. Pharmacopsychiatry, 39, 142–149.CrossRefGoogle ScholarPubMed
Spore, D. L., Smyer, M. A. and Cohn, M. D. (1991). Assessing nursing assistants' knowledge of behavioral approaches to mental health problems. The Gerontologist, 31, 309–317.CrossRefGoogle ScholarPubMed
Tinetti, M. E., Liu, W. L., Marottoli, R. A. and Ginter, S. F. (1991). Mechanical restraint use among residents of skilled nursing facilities: prevalence, patterns, and predictors. JAMA, 265, 468–471.CrossRefGoogle Scholar
Twisk, J. W. R. (2003). Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. Cambridge: Cambridge University Press.Google Scholar
Wells, D. L., Dawson, P., Sidani, S., Craig, D. and Pringle, D. (2000). Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Journal of the American Geriatrics Society, 48, 442–449.Google ScholarPubMed
Weyerer, S. and Schäufele, M. (2004). Die Versorgung dementer Patienten in Deutschland aus epidemiologischer Sicht. Zeitschrift für Gerontopsychologie & -psychiatrie, 17, 41–50.CrossRefGoogle Scholar
Zerssen, D. v. (1976). Die Beschwerden-Liste. Manual. Weinheim: Beltz.Google Scholar
Zimber, A. (2003). Wie gut geht's den psychisch Kranken? Prüfsystem zu,r Lebensqualität, gerontopsychiatrischer Patienten in Pflegeheimen (GEROLF©). Pflegemagazin, 4, 19–23.Google Scholar