Perspective | Stressors/predictors of crisis | Crisis recommendations |
---|---|---|
Person with dementia | 1. Counselling [25] | |
 | ||
2. Assisted living [29] | ||
4. General practitioner assessment [28] | ||
5. Improved information to caregiver and person with dementia on activities of daily living [27, 28, 33, 34] | ||
6. Improved information to general practitioner about dementia [27] | ||
 | 1. General practitioner management to detect specific conditions earlier [28, 33] | |
2. Improved information to health care professionals about dementia [27, 33] | ||
3. Improved information to caregivers [27] | ||
4. Acute hospitalization/Geriatric home hospitalization [31, 33, 35] | ||
5. Structured follow up after hospitalisation [33] | ||
6. Institutionalization [34] | ||
 | 1. General practitioner management [28] | |
 | ||
5. Improved information to General practitioner about dementia [27] | ||
6. Fall prevention program in assisted living facilities [36] | ||
 | Behavioural and psychological symptoms of dementia [7, 27, 28, 31, 32, 37] | |
4. Improved information to General practitioner about dementia [27] | ||
5. Case management/care consultant [39] | ||
6. Acute bed assessment of the person with dementia in hospital or psychiatric hospital [37] | ||
7. Geriatric home hospitalization [35] | ||
9. Structured follow up after hospitalization [33] | ||
 | 1. Therapeutic interaction with nurse to promote orientation and psychosocial function [10] | |
Caregiver | 1.General practitioner provides information [21, 28, 31, 34] | |
3. Care packages [38] | ||
 | Miscommunication with general practitioner [34] | 1. Clearer communication with the caregiver [34] |
2. Caregiver must be open about caregiving situation [34] | ||
3. Case management/nurse involvement to assess home situation [34] | ||
 | Lack of time for personal or social activities due to increased caring [12, 13, 17] | 1. Temporary respite/temporary admission to nursing home [38, 40] |
2. Carer support by community services, professionals, family members [21, 38] | ||
3. Home care [38] | ||
4. Day care[38] | ||
 | Emotional toll of increased dementia severity [26, 28, 34, 41] | |
2. Carer support by community services, nurse [41], professionals, family members to come up with coping strategies [13, 38] | ||
4. Day care [38] | ||
5. Temporary respite/temporary admission to nursing home [28, 38, 40, 41] | ||
6. Institutionalization [34] | ||
 | Escalating costs due to dementia severity [38] | 1. Customized care plans [38] |
2. Public private partnerships of care offering low cost support services [38] | ||
 | ||
3. Carer support by community services, professionals, family members [13, 19, 22, 31, 32, 34, 38] | ||
5. Social services for patient and caregiver [12, 13, 31, 34] | ||
6. Home care [38] | ||
7. General practitioner management of comorbid conditions, caregiving situation, structured follow up after hospitalization [21, 28, 31, 34] | ||
9. Day care [38] | ||
10. Temporary respite/temporary admission to nursing home [38, 40, 42, 43] | ||
11. Hospitalization [31] | ||
 | ||
3. Community Care Support [22] | ||
4. Extra day care [38] | ||
5. Temporary respite/temporary admission to nursing home, hospital or psychiatric hospital [37, 38, 40] | ||
6. Acute bed assessment of the person with dementia in hospital or psychiatric hospital [37] | ||
8. Forward planning in cases where the caregiver is old and frail [29] | ||
 | 1. Forward planning in cases where the caregiver is frail [29] | |
3. Emergency institutionalization [29] | ||
 | 1. Increased preparation for the caregiver [17] | |
 | Death of person with dementia [26] | 1. Counselling [26] |
Nursing home perspective | Signalling events: physiological, mechanical, psychological, social, or environmental change that affect client status [23, 24] | 1. Predict and prevent crisis through identification of signalling events [23, 24] |
2. Train nursing home staff to identify and appreciate the importance of immediate and gradual changes in behaviour [23, 24] | ||
3. Develop documentation to track signalling events and treatment, | ||
4. Establish proper procedures for crisis intervention [23, 24] | ||
5. Educate staff to become attuned to subtle changes in the behaviour of persons with dementia who have trouble communicating [23, 24] | ||
6. Identify clients that complain repeatedly as an unmet need may have been overlooked [23, 24] | ||
7. Identify other signalling events and maintain a file for future reference [23, 24] | ||
8. Protection of the person with dementia, other residents and staff [24] | ||
9. Diversion and environment management [24] | ||
13. Nurse assistant creates structured program for persons with dementia [24] | ||
14. Staff should have compassion for persons with dementia [24] |