Dementia Care Competence Among Care Professionals and Reduced Challenging Behavior of Home-Dwelling Persons with Dementia: A Pre- and Post-Intervention Data Analysis

Article type: Research Article

Authors: Nakanishi, Miharu^{a; *} | Hirooka, Kayo^b | Imai, Yasuaki^c | Inoue, Shintaro^d | Yukari, Yukio^e | Katayama, Chie^f | Miyamoto, Yuki^g | Shindo, Yumi^h | Ueno, Hidekiⁱ | Toya, Junichiro^f | Takano, Yosuke^j | Nishida, Atsushi^{b; *}

Affiliations: [a] Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan | [b] Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan | [c] Suzuran Inc., Setagaya-ku, Tokyo, Japan | [d] Kokoronohiroba Ltd., Ome-shi, Tokyo, Japan | [e] Zaitaku-Sogo-Shien-center Fukuro, Adachi-ku, Tokyo, Japan | [f] Sakura-shinmachi Urban Clinic, Setagaya-ku, Tokyo, Japan | [g] Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan | [h] Bureau of Strategic Planning, National Center for Geriatrics and Gerontology, Obu-shi, Aichi, Japan | [i] Welfare and Medical Intelligence, Chiba University Hospital, Chuo-ku, Chiba-shi, Chiba, Japan | [j] Mental Home Clinic Setagaya, Setagaya-ku, Tokyo, Japan

Correspondence: [*] Correspondence to: Ms. Miharu Nakanishi, RN, PhD, Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan. Tel./Fax: +81 3 6834 2292; E-mail: mnakanishi-tky@umin.ac.jp., and Mr. Atsushi Nishida, PSW, PhD, Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagayaku, Tokyo 1568506, Japan. Tel./Fax: +81 3 6834 2296; E-mail: nishida-at@igakuken.or.jp.

Abstract: Background:We developed a psychosocial dementia care program to help care managers and professional caregivers manage challenging behavior in home-dwelling persons with dementia in Japan. The program consists of a web-based tool for ongoing monitoring and assessment for challenging behavior, and multi-agency discussion meetings. Results of a cluster-randomized controlled trial indicate a reduction in challenging behavior through this program. Objectives:The present study aimed to identify a key component of the developed program that is associated with a reduction in challenging behavior. Methods:We used consecutive data of the intervention and examined the association between challenging behavior in home-dwelling persons with dementia, professionals’ competence, and the frequency of revision of action plans. Challenging behavior was assessed using the total score of the Neuropsychiatric Inventory. A baseline and follow-up questionnaire was completed by care professionals using a Japanese version of the Sense of Competence in Dementia Care Staff scale. Results:A total of 86 care professionals completed a 6-month intervention with 219 persons with dementia. The 86 care professionals significantly improved in their dementia care competence. Challenging behavior was significantly reduced among the 219 persons with dementia at follow-up regardless of the level of professionals’ competence or the frequency of revision of action plans. Less pain was significantly related to the lower levels of challenging behavior. Conclusion:The ongoing multi-agency discussion meetings, with a focus on challenging behavior, may have been the key component in the psychosocial dementia care program. Pain management should be emphasized in action plans for challenging behavior.

Keywords: Challenging behavior, dementia, home-dwelling, palliative care, professional competence

DOI: 10.3233/JAD-171077

Journal: Journal of Alzheimer's Disease, vol. 64, no. 2, pp. 515-523, 2018