Alzheimer Disease: Sandman PO

Edvardsson D, Winblad B, Sandman PO. · Department of Nursing, Umea University, Sweden. · Lancet Neurol. · Pubmed #18339351 No free full text.

Abstract: When caring for people with severe Alzheimer's disease (AD), the concept of the person being central is increasingly advocated in clinical practice and academia as an approach to deliver high-quality care. The aim of person-centred care, which emanates from phenomological perspectives on AD, is to acknowledge the personhood of people with AD in all aspects of their care. It generally includes the recognition that the personality of the person with AD is increasingly concealed rather than lost; personalisation of the person's care and their environment; offering shared decision-making; interpretation of behaviour from the viewpoint of the person; and prioritising the relationship as much as the care tasks. However, questions remain about how to provide, measure, and explore clinical outcomes of person-centred care. In this Review, we summarise the current knowledge about person-centred care for people with severe AD and highlight the areas in need of further research.

Lövheim H, Sandman PO, Karlsson S, Gustafson Y. · Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. · Int Psychogeriatr. · Pubmed #18416871 No free full text.

Abstract: BACKGROUND: Many people with dementia exhibit some behavioral or psychological symptoms, e.g. aggressive or aberrant motor behavior, depression or hallucinations, at some time during the course of the disorder. The aim of the present study was to describe the probability of the occurrence of these symptoms of dementia in relation to the level of cognitive impairment. METHODS: 3404 people with cognitive impairment were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), subsumed with a rotated factor analysis, and investigated in relation to level of cognitive impairment, measured using the Gottfries cognitive scale. RESULTS: The passiveness factor had an almost linear correlation to the level of cognitive impairment (r2 = 0.237). Non-linear correlations, with highest prevalences in middle-stage cognitive impairment, were found for aggressive behavior (r2 = 0.057), wandering behavior (r2 = 0.065), restless behavior (r2 = 0.143), verbally disruptive/attention-seeking behavior (r2 = 0.099), regressive/inappropriate behavior (r2 = 0.058), hallucinatory symptoms (r2 = 0.021) and depressive symptoms (r2 = 0.029). CONCLUSION: The relations between the behavioral and psychological symptoms of dementia and level of cognitive impairment were non-linear, with higher prevalence rates in the middle stages of dementia, apart from the symptom of passiveness, which increased almost linearly with the severity of cognitive impairment.

Edvardsson D, Sandman PO, Nay R, Karlsson S. · Department of Nursing, Umeå University, Sweden. · Int Psychogeriatr. · Pubmed #18304386 No free full text.

Abstract: BACKGROUND: Clinical experience suggests that the work characteristics of staff in residential care may influence the well-being of residents with dementia. However, few studies have explored those anecdotal experiences. The aim of this study was to investigate associations between work characteristics of nursing staff and prevalence of behavioral symptoms among people with dementia in residential care settings. METHODS: The self-report job strain assessment scale was used to measure staff perceptions of their working environment, and the Multi Dimensional Dementia Assessment Scale to measure the occurrence of behavioral symptoms among residents in 40 residential care units for people with dementia. RESULTS: The findings show that in settings where staff reported high job strain, the prevalence of behavioral symptoms was significantly higher compared to settings where staff reported low job strain. Furthermore, settings characterized by staff having a more positive caring climate had significantly less prevalence of escape, restless and wandering behaviors compared to settings having a less positive caring climate. There was no statistically significant association between staff members' self-reported knowledge in caring for people with dementia and prevalence of behavioral symptoms. CONCLUSIONS: This study provides evidence for the oft-cited clinical experience that the well-being of nursing staff is associated with the well-being of people with dementia in residential care settings.

Lövheim H, Sandman PO, Kallin K, Karlsson S, Gustafson Y. · Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. · Int Psychogeriatr. · Pubmed #16879762 No free full text.

Abstract: BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics. METHODS: A cross-sectional study in all geriatric care units in the county of Västerbotten, Sweden, which included 2017 residents aged 65 years and over with cognitive impairment (mean age was 83.5 years). Data were collected from prescription records and observations made by care staff of BPSD among residents during the preceding week. A multivariate regression model was constructed to find factors independently associated with antipsychotic drug use. RESULTS: Eleven factors were independently associated with the use of antipsychotics. Aggressive, verbally disruptive and wandering behavior, hallucinatory and depressive symptoms, male sex, living in a group dwelling for people with dementia, imposed mental workload, the ability to rise from a chair, activities of daily living (ADL) dependency and lower age all correlated significantly. CONCLUSIONS: Antipsychotic drug treatment of old people with cognitive impairment in geriatric care is common, and determined not only by the patient's symptoms but also by factors related more closely to the caregiver and the caring situation. These findings raise important questions about the indications for drug treatment in relation to the patient's quality of life.

Zingmark K, Sandman PO, Norberg A. · Department of Nursing, Umeå University, Umeå, Sweden. · J Adv Nurs. · Pubmed #11895530 No free full text.

Abstract: AIM: To illuminate the meaning of offering care and a place to live to people with Alzheimer's disease in a special care unit. RATIONALE: There is a need to gain a deeper understanding about so called 'homelike' care settings, and about how to promote experiences of being at home in residents with Alzheimer's disease. The study is part of a long-term study in a special care unit. METHODS: The study comprises phenomenological hermeneutic interpretation of interviews with 10 care providers. RESULTS: The analyses revealed a number of caring aspects such as, for example, 'viewing dignity and striving to preserve a sense of self in the resident', 'encouraging a sense of belonging', 'offering relief' and 'promoting a sense of power and control in the resident', although integrated and reflected in each other. The caring aspects constituted the themes confirmation, familiarity, communion and agency considered as dimensions of the good life. CONCLUSION: To avoid simplification in which, for example, the furniture from a certain decade become the standard for good care, it seems important to focus upon the meaning of the good life. Care that promotes a good life of people with Alzheimer's disease seemed relationship centred.