Table 1 Optimising the circumstances of rehabilitation for people with dementia: CMOcs, consensus statements and outcomes
CMOc | Consensus statements | Outcome | Operationalisation | |
|---|---|---|---|---|
CMOc1 | Context: cognitive impairment may limit the ability of people with dementia to articulate pain Mechanism (resource): staff use non-verbal pain signifiers and/or give blanket pain relief Mechanism (reasoning): people with dementia are not in pain Outcome: capacity to engage with an intervention increases | Tools which assess non-verbal signs of pain should be used | Agreed in round 1 (93%) | • Checklist of Nonverbal Pain Indicators (CNPI) [44, 89] included in assessment document • Pain management included in staff training |
CMOc2 | Context: cognitive impairment may limit the ability of people with dementia to adapt to and cope with new environments Mechanism (resource): intervention assessment and delivery takes place in appropriate, accessible and familiar environments Mechanism (reasoning): people with dementia feel comfortable and less distracted Outcome: anxiety and challenging behaviours are reduced | The intervention should primarily take place in the patient’s home | Agreed in round 1 (86%) | Intervention delivered mainly in patient’s home |
CMOc3 | Context: the role of comorbidities may be underestimated in dementia Mechanism (resource): holistic biopsychosocial assessment is employed Mechanism (reasoning): staff understand the range of factors contributing to falls and are able to treat comorbidities more effectively Outcome: falls risk may be reduced and recovery enhanced in patients with dementia | A continence assessment is required | Agreed in round 1 (79–100%) | All included in assessment document (see Table 2 below) |
An assessment of comorbidities is required | ||||
An osteoporosis risk assessment is required | ||||
A vision assessment is required | ||||
A medication review is required | ||||
An assessment of challenging behaviour is required | ||||
Formal assessments of gait and balance should be carried out by the Timed Up and Go (TUG) test [90] | No consensus after 2 rounds (54% & 62%) | |||
All patients require attendance for a lying and standing blood pressure (BP) |