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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, 2731] 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]