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My scientific publications Mina vetenskapliga publikationer: Abstracts Sammanfattning på engelska |
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Göteborg University 1998-11-23. Hans Ragneskog, Göteborg University , Department of Clinical Neuroscience, Göteborg University College of Caring Sciences, Department of Nursing and Center for Caring Science, Örebro. Abstract
Nursing home patients with dementia were video taped in three previous studies. Sixty sequences of nine patients, exhibiting agitated behaviors, were examined to identify the most probable antecedents to agitation. Probable reasons were interpreted and applied to the Progressively Lowered Stress Threshold (PLST) model, which suggests that agitation is stress-related. Analysis suggests that agitation often serves as a form of communication. Two underlying reasons seemed to be that the patient had loss of control over the situation and deficient autonomy. The most common causes for expressed agitation were interpreted as discomfort, a wish to be served immediately, conflict between patients or with nursing staff, reactions to environmental noises or sound, and invasion of personal space. It is recommended that nursing staff promote autonomy and independency for this group of patients whenever possible. By evaluating probable reasons for expressed agitation, the nursing staff can take steps to prevent or alleviate agitation.
Many patients with dementia symptoms display forms of agitation such as the repeating of words, restlessness and aggression. These forms of behaviour may inflict strain on the co-patients and the caregivers. In this study, 17 experienced formal caregivers from nursing homes and collective residential units were interviewed about their experiences of agitated patients with dementia and strategies to improve their care. The questions were open except some specific questions about sound, music, and opinions about pharmacological treatment. A calm atmosphere and a slow pace emerged as important strategies to control agitation. Fixed routines could develop this. Mixing of lucid and agitated dementia patients appeared as a major problem, because some lucid patients became angry when patients with dementia displayed agitation. Irritability in one patient could trigger agitation in other patients but was possible to stop at an early stage. Several responders had successfully used music to calm down individual agitated patients. Music seemed to be an underestimated nursing intervention to control agitation in daily life, but uncontrolled sound could cause agitation in the patients and stress in the nursing staff.
The influences of dinner music on food intake and symptoms common in dementia such as depressed mood, irritability and restlessness was studied. The study was carried out on a nursing home ward in Sweden. Soothing music was played as dinner music for two weeks, Swedish tunes from the 1920s and 1930s for two weeks and pop music for two weeks. Before these periods was one week without music; a two-week control period ended the intervention. The effects of the intervention were assessed by psychological ratings and by weighing of the helpings. During all three music periods the patients ate more in total. The difference was significant for the dessert. The staff were supposed to be influenced by the music, as they served the patients more food, both main course and dessert, when music was played. The patients were less irritated, anxious and depressed during the music periods. The result of the study suggests that dinner music, particularly soothing music, can reduce irritability, fear-panic and depressed mood and get demented patients on a nursing home ward to eat more.
In the present open study, the long-term safety, tolerability and efficacy of citalopram in the treatment of elderly people with emotional disturbances were studied. One hundred and twenty-three, elderly patients with symptoms of depression-anxiety were included. Most of the patients (76%) were demented. Fifty-two patients completed a 12-month treatment. Irritability, depressed mood, anxiety, restlessness and fear-panic were significantly reduced. The severity of illness from baseline to month nine was rated as significantly improved. The side-effects were infrequent and mostly mild.
At a nursing home ward for demented patients, selections of dinner music were played during three periods of two weeks. At the end of the study was a control period. The reactions of five patients to three different types of music were registered by video observations. This study shows that the patients were affected by music, particularly soothing music. When music was played for example it was found that one of the study's restless patients became unusually calm while another fed herself more than usual. The patients spent more time with dinner when music was played. Dinner music made the patients eat more calmly. Music as a nursing tool is an intervention which is simple to realize and worth trying. A tentative conclusion of this study is that music can beneficially affect restless and agitated demented patients.
This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients´ disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention. |
AGITATION IN DEMENTIA, Music and Pharmacological Interventions in the Care of Individuals with Dementia.
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