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Aspects of institutional care of patients with dementia
Umeå University, Faculty of Medicine, Department of Nursing.
1986 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 1986. , 45 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 181
Keyword [en]
Dementia, institutional care, ADL, constipation, conversation, dietary intake, morning, care, relocation
National Category
Nursing Geriatrics Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:umu:diva-100563ISBN: 91-7174-270-0 (print)OAI: oai:DiVA.org:umu-100563DiVA: diva2:793386
Public defence
1986-12-19, Hörsal A, Samhällsvetarhuset, Umeå universitet, Umeå, 09:00
Supervisors
Projects
digitalisering@umu
Note

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

Available from: 2015-03-09 Created: 2015-03-04 Last updated: 2015-04-10Bibliographically approved
List of papers
1. Long-term care of the elderly: A descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden
Open this publication in new window or tab >>Long-term care of the elderly: A descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden
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1988 (English)In: Comprehensive gerontology. Section A, Clinical and laboratory sciences, ISSN 0902-0071, Vol. 2, no 3, 120-32 p.Article in journal (Refereed) Published
Abstract [en]

Probands (n = 3607) living in long-term care institutions in the county of Västerbotten were assessed to estimate whether the prevalence of dementia in different types of institutions had changed since a similar survey was made 7 years before. The probands' motoric functions, vision, hearing, speech, prevalence of behavioral disturbances and psychiatric symptoms, work load and use of psychoactive drugs were also investigated with special emphasis on the differences between the demented and the non-demented. About 40% were demented. This proportion of demented patients had increased in somatic long-stay clinics, nursing homes and homes for the aged since 1975. Further, the mean age of the probands and their length of stay had increased in these institutions. Demented probands were more impaired with regard to motor functions, speech, vision, hearing, ADL-functions, behavioral and psychiatric symptoms, and they also imposed a higher work load on the staff than the non-demented. Demented probands were also prescribed psychoactive drugs, i.e. neuroleptics but not minor tranquilizers or antidepressants, more often than the non-demented in accordance with the increased prevalence of behavioral disturbances and psychiatric symptoms.

National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-36387 (URN)3148369 (PubMedID)
Available from: 2010-09-29 Created: 2010-09-29 Last updated: 2016-02-01
2. Morning care of patients with Alzheimer-type dementia: A theoretical model based on direct observations
Open this publication in new window or tab >>Morning care of patients with Alzheimer-type dementia: A theoretical model based on direct observations
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1986 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 11, no 4, 369-378 p.Article in journal (Refereed) Published
Abstract [en]

Five hospitalized patients in different stages of Alzheimer-type dementia were monitored by unstructured, direct observations during morning care. Orem's model of nursing as a compensation for the patient's lack of self-care capabilities was used as a frame of reference for an analysis of the behaviours of patients and nurses 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 was able to manage morning care independently, but there was a wide variation in their highest level of performance.

Place, publisher, year, edition, pages
John Wiley & Sons, 1986
Keyword
Alzheimer's Disease, Alzheimer's Disease -- Nursing, Models, Theoretical, Self Care -- Evaluation, Middle Age, Aged, Inpatients, Male, Female, Human
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-100742 (URN)10.1111/j.1365-2648.1986.tb01263.x (DOI)3638311 (PubMedID)
Available from: 2015-03-09 Created: 2015-03-09 Last updated: 2017-12-04
3. Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia
Open this publication in new window or tab >>Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia
1988 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 13, no 5, 571-578 p.Article in journal (Refereed) Published
Abstract [en]

Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that when the patients ate without the participation of staff, the two least demented patients became 'caregivers' in the group and helped the three most demented patients to eat. When two mental nurses joined the group, the patients dropped their roles as helpers. The conversation in the group could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all comprehensible utterances concerned food and eating and almost all conversation concerned the present.

Place, publisher, year, edition, pages
John Wiley & Sons, 1988
Keyword
Alzheimer-type dementia, verbal communication, eating behavior
National Category
Nursing Psychiatry
Identifiers
urn:nbn:se:umu:diva-36388 (URN)10.1111/j.1365-2648.1988.tb01450.x (DOI)3225360 (PubMedID)
Available from: 2010-09-29 Created: 2010-09-29 Last updated: 2017-12-12
4. Treatment of constipation with high-bran bread in long-term care of severly demented elderly patients
Open this publication in new window or tab >>Treatment of constipation with high-bran bread in long-term care of severly demented elderly patients
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1983 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 31, no 5, 289-293 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 1983
National Category
Nutrition and Dietetics Geriatrics
Identifiers
urn:nbn:se:umu:diva-13671 (URN)
Available from: 2007-05-14 Created: 2007-05-14 Last updated: 2017-12-14
5. Nutritional status and dietary intake in institutionalised patients with Alzheimer's disease and multifarct dementia
Open this publication in new window or tab >>Nutritional status and dietary intake in institutionalised patients with Alzheimer's disease and multifarct dementia
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1987 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 35, 31-38 p.Article in journal (Refereed) Published
Abstract [en]

Nutritional status, dietary intake, weight change, and mortality were studied in a sample of severely demented, institutionalized patients. Dietary intake was registered during five days in two periods, five weeks apart. A weighing method was used. Nutritional status was assessed by anthropometric measurements (weight for height index, triceps skinfold thickness, arm muscle circumference) and determination of circulating proteins (albumin, transferrin, and prealbumin). Energy and/or protein malnutrition was found in 50% of the patients. The mean dietary intake was sufficient according to energy (2059 kcal/day), proteins, vitamins, and minerals. A comparison of patients with or without malnutrition showed no differences in dietary intake, diagnoses, age, length of hospital stay, or duration of illness. However, malnourished patients had had four times as many infectious periods treated by antibiotics as patients with no malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. There was no correlation between loss of weight, length of hospital stay, or duration of illness.

Keyword
Alzheimer's disease, multifarct dementia, dietary intake
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-13673 (URN)3098821 (PubMedID)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14

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