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Table 3 Identification of stressors, life imbalance, decisions and crisis outcomes

From: Reviewing the definition of crisis in dementia care

Perspective

Stressors/predictors of crisis

Crisis recommendations

Person with dementia

Diagnoses [25, 26]

1. Counselling [25]

 

Inability to live on their own [7, 27–31]

1. Lives with family or friends [29, 30]

2. Assisted living [29]

3. Institutionalization [29, 32]

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]

 

Comorbid conditions [27, 28, 31, 33, 35]

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]

 

Malnutrition [27, 28, 31, 35]

1. General practitioner management [28]

2. Geriatric home hospitalizations/Hospitalization[31, 35]

 

Falls [27, 28, 32, 36]

1. General practitioner management [28, 33]

2. Hospitalization [31, 35, 36]

3. Institutionalization [32, 36]

4. Improved information to caregiver [27, 28, 33, 34]

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]

1. General practitioner management [22, 28],

2. Careful management of drug therapy [27, 31, 38]

3. Improved information to caregiver [28, 33, 34]

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]

8. Acute hospitalization [31, 35]

9. Structured follow up after hospitalization [33]

10. Institutionalization [29, 32, 34]

 

Newly institutionalized [10, 26]

1. Therapeutic interaction with nurse to promote orientation and psychosocial function [10]

Caregiver

Lack of knowledge [28, 31]

1.General practitioner provides information [21, 28, 31, 34]

2. Carer Support [12, 13, 17, 22]

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]

1. Introduce care plans [7, 17, 38]

2. Carer support by community services, nurse [41], professionals, family members to come up with coping strategies [13, 38]

3. Home care [28, 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]

 

Caregiver exhaustion [12, 13, 19, 21, 28, 29, 31, 34, 40]

1. Advance care planning [7, 17, 29]

2. Care plans [17, 21, 38, 39]

3. Carer support by community services, professionals, family members [13, 19, 22, 31, 32, 34, 38]

4. Case management [7, 13, 30, 32, 38, 39]

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]

8. Therapy [13, 19, 21]

9. Day care [38]

10. Temporary respite/temporary admission to nursing home [38, 40, 42, 43]

11. Hospitalization [31]

12. Institutionalization [19, 21, 34]

 

Caregiver Illness [13, 19, 22, 28, 29, 31, 34, 37]

1. Advance planning [17, 29]

2. General practitioner management [22, 28, 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]

7. Emergency institutionalization [19, 29, 34]

8. Forward planning in cases where the caregiver is old and frail [29]

 

Death of caregiver [26, 28, 29, 31]

1. Forward planning in cases where the caregiver is frail [29]

2. General practitioner management [28, 31]

3. Emergency institutionalization [29]

 

Person with dementia institutionalization [7, 17, 26]

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]

10. Assessment interventions [23, 24]

11. Increased staff interaction with patients [10, 23, 24]

12. Increased family intervention [23, 24]

13. Nurse assistant creates structured program for persons with dementia [24]

14. Staff should have compassion for persons with dementia [24]