Qualitative research provides valuable insight into important areas of concern. For example, dementia patients with behavioral problems have been reported to have a significant negative effect on the morale of professional caregivers. McKenzie and colleagues sought to examine whether this was also true for unlicensed caregivers, a demographic that provides most of the care for dementia patients in assisted living facilities. They report that dementia-related behaviors do have a significant negative impact on the perceived care experience for unlicensed caregivers, with depressive symptoms have the greatest impact. The authors suggest that increasing the amount of dementia care training could help improve the morale of unlicensed caregivers.
Unlicensed Caregiver Experience in Dementia Care
Dementia Care
Nearly 5.4 million people in the United States suffer from Alzheimer's disease, the most common form of dementia (Chodosh et al., 2012, p. 85). The health care burden this places on nursing homes, assisted living facilities, and hospices is significant, especially since some dementia sufferers exhibit disruptive and sometimes dangerous behaviors. These behaviors include verbal and physical aggression, wandering, restlessness, insomnia, irritability, and repetitive vocalizations (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 96). Nearly 1 million Americans currently reside in assisted living facilities and an estimated 45 to 67% suffer from dementia. Of these, 34 to 56% exhibit behavioral problems.
The impact of dementia care on professional caregivers is therefore significant, especially when dealing with patients with more advanced forms of the disease. Early studies suggest that dementia care training can have a positive impact on both the patient's health and the care experience of professional caregivers (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 96-97), but the bulk of the care burden in these facilities falls on the shoulders of unlicensed staff. With a resident to staff ratio of 14 to 1 in assisted living facilities, a lack of dementia care training for unlicensed caregivers (ULC) is predicted to contribute significantly to poor morale, high turnover, and reduced care quality.
Towards the goal of improving dementia care in assisted living facilities, McKenzie and colleagues (2012) investigated the reactions of ULC to dementia patients exhibiting behavioral problems. This qualitative experimental approach collected data concerning the perceived care experience of ULCs and the frequency of behavioral problems exhibited by residents with dementia.
Methods
The data was collected from 12 assisted living facilities and based on 87 ULC-patient pairings. Only dementia patients with a formal diagnosis and exhibiting behavioral problems that caused problems for caregivers were included in the study. Informed consent was provided by a family member. Perceived care experience data was collected using a questionnaire that required about 40 minutes to complete. An interviewer was present and the interview occurred during regular working hours.
Patient behavioral data was collected using the Revised Memory and Behavior Problems Checklist (RMBPC), which was filled out by the caregiver at least twice a week. This instrument records both observed dementia-related behaviors and the reaction of the staff members.
Results
The majority of ULC subjects was female, non-white, and did not speak English at home (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 98). Of these, 37% reported receiving no formal dementia care training at their current job and the median hours of training overall was just 2 hours. The residents with dementia were on average 87 years old, 86% female, and 92% Caucasian. The average Mini-Mental State Exam score was 15.3 (std. dev. = 5.03), which suggests that most patients suffered from moderate cognitive impairment.
Memory problems were the most common dementia-related symptom encountered by ULCs (91%) and included forgetting what day it was or asking the same question repeatedly. Depressive symptoms were the second most common (77%) and anxiety and sadness were the primary ones observed. Disruptive behaviors were the least common (60%) and included arguing, irritability, and insomnia.
The dementia-related behaviors that triggered the strongest reactions in ULCs were threats of self-harm, mentioning death, and expressing feelings of low self-worth. Moderate reactions were elicited by threats to harm others and engaging in behaviors that were potentially dangerous. The least upsetting behaviors were memory problems and not finishing things.
A significant positive correlation was found between the number of dementia-related behaviors and how upset an ULC would become (r = 0.73, p < 0.01), with depression-related behaviors triggering the strongest negative reactions (r = 0.64, p < 0.01).
Discussion
The primary finding of this study is that dementia-related behaviors in an assisted living setting have a significant impact on the experiences of ULCs. In essence, the more frequent the behaviors are encountered the more negative the caregiver will perceive their experience, with behaviors related to depression triggering the biggest reactions.
The authors of this study selected a specific question to answer and provided the theoretical context for why this question is important enough to spend research dollars on (Ragin, Nagel, and White, 2004, p. 3-4). The experimental approach was outlined clearly, methods for data collection not controversial, and data analysis straightforward. As designed, this study could be easily replicated by others.
You’re 80% through this paper. Sign up to read the full paper.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.