Yes / Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho‐educational intervention for care assistants caring for people with dementia in aged‐care facilities. A process evaluation was carried out alongside a pretest/post‐test controlled study conducted in aged‐care facilities. Seven focus‐group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi‐structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged‐care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. / Foundation for Science and Technology (FCT). Grant Number: SFRH/BD/72460/2010 and RIPD/CIF/109464/2009

Yes / This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest–posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents. / Foundation for Science and Technology

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20085号 / 社医博第76号 / 新制||社医||9(附属図書館) / 33201 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 福原 俊一, 教授 佐藤 俊哉, 教授 古川 壽亮 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Yes / This study assessed the effects of a person-centred care based psycho-educational intervention on direct care workers' communicative behaviours with people with dementia living in aged care facilities. An experimental study with a pre-posttest control group design was conducted in four aged care facilities. Two experimental facilities received an eight-weekly psycho-educational intervention aiming to develop workers’ knowledge about dementia, person-centred care competences and tools for stress management; control facilities received an education-only, with no support to deal with stress. A total of 332 morning care sessions, involving fifty-six direct care workers (female, mean age 44.72±9.02), were video-recorded before and two weeks after the intervention The frequency and duration of a list of verbal and non-verbal communicative behaviours were analysed. Within the experimental group there was a positive change from pre to post-test on the frequency of all workers’ communicative behaviours. Significant treatment effects in favour of the experimental group were obtained for the frequency of inform (p<0.01, ƞ2partial=0.09) and laugh (p<0.01, ƞ2 partial=0.18). Differences between groups emerged mainly in relation to non-verbal communicative behaviours. The findings suggest that a person-centred care based psycho-educational intervention can positively affect the direct care workers’ communicative behaviours with residents with dementia. Further research is required to determine the extent of the benefits of this approach. / Foundation for Science and Technology

Yes / This study aimed to assess the effects of a psycho-educational intervention, designed to improve direct care workers’ stress, burnout and job satisfaction and person-centered communicative behavior with people with dementia. A pretest-posttest control group design was conducted in four aged-care facilities. Two experimental facilities received a psycho-educational intervention; two control facilities received an education-only. Data were gathered from fifty three care workers at baseline, immediately and six months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers’ burnout and a significant improvement in several communicative behaviors (e.g., involvement). Stress levels deteriorated at six months and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management as this might be associated with a reduction of their levels of exhaustion and improved communicative behaviors. / Foundation for Science and Technology

<p>The purpose of this study was to examine and describe how politicians and directors of care define and experience quality in aged care facilities. Further on we wanted to compare on which fundamental principles the participants base their opinion about quality and how they work with quality. To reach our aim we conducted five interviews with politicians and directors of care. The results show that it is hard to determine quality in an unambiguous and objective way. Quality in aged care appears to be about relations and encounters amongst people. The participants in our study agree that experiences are subjective and depending on individual expectations.</p><p>There are fundamental principles shared by both politicians and directors of care regarding safety and respect of human integrity. Directors of care point out the difficulties in having multiple perspectives to consider, residents and their relatives have other expectations on what services should be provided than the directors of care understand to be their assignment from the local government. It appears to be a gap between political goals and reality. The future will bring changes, regarding both needs and expectations. The participants see a challenge in developing aged care and meeting new generations of elderly.</p>

The purpose of this study was to examine and describe how politicians and directors of care define and experience quality in aged care facilities. Further on we wanted to compare on which fundamental principles the participants base their opinion about quality and how they work with quality. To reach our aim we conducted five interviews with politicians and directors of care. The results show that it is hard to determine quality in an unambiguous and objective way. Quality in aged care appears to be about relations and encounters amongst people. The participants in our study agree that experiences are subjective and depending on individual expectations. There are fundamental principles shared by both politicians and directors of care regarding safety and respect of human integrity. Directors of care point out the difficulties in having multiple perspectives to consider, residents and their relatives have other expectations on what services should be provided than the directors of care understand to be their assignment from the local government. It appears to be a gap between political goals and reality. The future will bring changes, regarding both needs and expectations. The participants see a challenge in developing aged care and meeting new generations of elderly.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.

Rapid increases in population ageing and the associated rise in the prevalence of dementia have created many challenges for the care of older people with dementia. As the majority of people now living in residential aged care facilities (RACFs) now have dementia, the need to maximise the quality of life for this group is increasingly recognised. While such issues have attracted research and policy attention in recent years, the evidence base for practice in dementia care is still underdeveloped. The need for more effective therapeutic interventions to improve the quality of life for older people with dementia is recognised, particularly those living in RACFs. The use of pets is one example of recent attempts to help create a more home-like environment and dog therapy is available in many facilities. Well designed research to demonstrate whether it actually has a positive impact on residents’ quality of life is lacking. This study is the first reported randomised controlled trial investigating dog therapy for people with dementia. Fifty-five older people with mild to moderate dementia living in three residential aged care facilities in the Greater Brisbane area participated in this study. The goal was to identify whether dog therapy accrued any benefits to residents’ well being and compare the benefits, if any, with human-only therapy intervention. The main hypothesis was that dog contact delivered in a small group recreational therapy format would have a beneficial effect on the well being of participants. It was additionally hypothesised that prior and current positive relationships with dogs would be related to improved outcomes of dog therapy and support a human-animal bond explanation of relationship development with the therapy dog(s). Participants were randomly assigned into two groups within each facility: The dog therapy group and a human-only therapy group. Session plans were structured according to a recreational therapy format. Three therapy dogs were used (a miniature Poodle, a Staffordshire Terrier and a German Shepherd Dog) with one dog present at any dog therapy session A before-and-after design was used with concealment of participants at allocation. Mixed methods were used including a panel of seven validated psychometric instruments, an observational measure and a series of four novel questionnaires, dogs for older groups with Alzheimer’s (DOGA), developed de novo specifically to investigate the effects of dog therapy on participants within this study. Measures of mood, quality of life, health and psychosocial functioning, collectively referred to as well-being, detected benefits accruing to dog therapy participants compared with human-only therapy that approached significance (p = .056) with a large effect size (partial eta squared 16.6%). A different measure of mood and apathy showed similar improvement for participants of both therapy types trialed with analyses of a smaller dataset (n = 36) revealing an overall highly significant result (p=.008) and large effect size (partial eta squared = 25.6%) for all participants. To explore the perceptions of care staff to the dog therapy intervention, a self-complete semi-structured questionnaire was completed by a sample of 21 from two of the study facilities. Content analysis revealed that staff overwhelmingly supported dog therapy with a total of 84 comments about benefits and 22 about risks. Responses were categorised and then linked into emergent themes: a temporal dimension, sense of self and increased opportunities for self expression. The opportunity provided by the therapy dog for accessible caring physical contact for participants was identified as important. General recreational therapy goals such as improved mood, reminiscence and increased levels of conversation were reported by staff to continue beyond interventions. The observed risks were: confusion over dog ownership, subsequent worry about losing the dog after sessions, jealousy over the therapy dog and one participant did not enjoy the small group format. Participants described their experiences of contact with the therapy dog as “like” above “attached”. Personal preference explanations are therefore supported, rather than “attachment”, to explain outcomes for participants. This suggests the psychosocial approach has greater relevance here than human-animal bond explanations. Effects of previous dog attachment on outcomes were inconclusive but there was some evidence that participants’ relationship with the therapy dog(s) influenced outcomes, though the nature of that relationship has not been clarified. Recommendations from the study findings are that dog therapy be conducted for people with mild to moderate levels of dementia in groups of 3-11 for a duration of around 10 weeks with sessions for 30 minutes held once or twice weekly and according to a standard format. Opportunities for participants to touch, hug and interact directly with the therapy dog should be maximised without compromising dog welfare. The findings suggest that respect for the personhood of participants is important to the success of the therapy types trialled, which further supports psychosocial therapies involving contact with people or live animals for use with people with dementia over those that minimise or exclude it.