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Bakgrund: Demens är en utbredd sjukdom som påverkar kognitiva funktioner och kan ge beteendemässiga och psykiska symtom (BPSD). Omvårdnadsbehovet ökar i takt med att sjukdomen utvecklas. Tidigare forskning har visat att musik kan vara användbar vid sjukdom för att minska stress, oro och skapa lugn. Syfte: Syftet var att beskriva effekten av musik på kognitiva funktioner hos personer med demens samt BPSD. Vidare var syftet att beskriva de ingående studiernas genomförande av interventionen. Metod: Litteraturstudie med beskrivande design, baserad på 15 kvantitativa vetenskapliga artiklar vilka söktes i databaserna Cinahl och PubMed.   Huvudresultat: En positiv effekt av musikinterventioner på kognitiva funktioner som kommunikation, relation och minnesförmåga hos personer med demens påvisades. Musikens effekt på BPSD varierade, men positiv effekt visades på depressions symtom, aggressivitet, oro samt andra beteendemässiga och psykiska symtom. Dock var inte resultaten entydiga. De positiva effekterna var mestadels omedelbara och som högst direkt efter genomförd intervention. På lång sikt påverkades kognitiva funktioner och BPSD vagt av musik. Hälften av de inkluderade studierna genomfördes med musikterapi i grupp och hälften individuellt. Majoriteten hade kontrollgrupper som mottog standard vård, men även andra aktiviteter förekom. I hälften av studierna användes deltagarnas favoritmusik och i flera fall var deltagarna aktiva genom rörelse och med hjälp av instrument.  Slutsats: Resultatet av föreliggande studie beskriver att musik kan främja kognitiva funktioner samt förbättrar BPSD hos personer med demens. Musik som aktivitet kan därför anses lämpligt att använda som en alternativ behandlingsmetod och som en del i omvårdnaden. / Background: Dementia is a widely spread disease that affects cognitive functions and can cause behavioral and psychological symptoms (BPSD). The need of nursing increases as the disease progresses. Previous research has shown that music can be useful during illness to reduce stress, anxiety and create calm. Aim: The purpose was to describe what effect music has on cognitive functions in people with dementia and BPSD. Furthermore, the aim was to describe the included studies implementation of the intervention. Method: Literature review with descriptive design based on 15 quantitative scientific articles, available in the databases Cinahl and PubMed. Main result: Music interventions was found to have positive effect on cognitive functions for people with dementia, particularly in ability to communicate, create relationships and in the ability to remember. Music's effect on BPSD varied, but positive effect was shown on depressive symptoms, aggression, anxiety and other behavioral and psychological symptoms. However, the results were not conclusive. The positive effects were mostly immediate and highest the time immediately after the intervention. In the long term the impact of music intervention was vaguely on cognitive function and BPSD. Half of the included studies were conducted with music therapy in group and half were performed individually. The majority of the control group received standard care, but also other activities were held. In half of the studies the participants' favorite music were used and in several cases the participants were active through movement and with the help of instruments. Conclusion: The results of the present study describe that music interventions can promote cognitive functions and improves BPSD in people with dementia. Music as an activity can therefore be considered appropriate to use as an alternative therapy and as part of the care.

Bakgrund: Demenssjukdom blir allt vanligare och risken att drabbas ökar i takt med stigande ålder. Beteendemässiga och psykiska symtom vid demenssjukdom (BPSD) förekommer ibland till följd av demenssjukdomen. BPSD delas in i fyra huvudgrupper där hyperaktivitet innebär vandring, upprepat frågande, muntligt störande beteende samt agitation och aggressivitet, som är något av det svåraste och mest utmanande att bemöta för omgivningen. Syfte: Syftet var att sammanställa omvårdnadsinterventioner vid hyperaktivitet i samband med demenssjukdom. Metod: Metoden var en systematisk litteraturöversikt enligt SBUs riktlinjer. De kvantitativa studierna analyserades med stöd i processen för manifest innehållsanalys enligt Graneheim & Lundman (2003). Resultat: I resultatet framkom två övergripande typer av omvårdnadsinterventioner: Generella omvårdnadsinterventioner med tre grupper: Musik minskar agitation och aggressivitet, Närhet till hundar kan stabilisera agitation och aggressivitet, och Ljusterapi för bättre dygnsrytm minskar agitation. Individuellt anpassade omvårdnadsinterventioner med två grupper: Interventioner utifrån patientens intressen minskar beteendeproblem och Individualiserad Montessori intervention minskar agitation. Resultatet indikerade att generella omvårdnadsinterventioner hade en kortvarig effekt på patienterna medan omvårdnadsinterventioner baserade på individens behov antydde ett bättre och mer långvarigt resultat. Konklusion: Rätt metoder är en förutsättning för att kunna hjälpa människor samt att de är utformade för rätt målgrupp och sker evidensbaserat. Eftersom omvårdnadsinterventioner vid hyperaktivitet indikerade en kortvarig effekt behöver samtlig personal arbeta aktivt och kontinuerligt med individuellt anpassade omvårdnadsinterventioner med hänsyn till patientens bakgrund, vilket överensstämmer med Socialstyrelsens riktlinjer (Socialstyrelsen 2010). / Background: Dementia is increasingly common, and the risk increases with age. Behavioral and psychological symptoms of dementia (BPSD) sometimes occur as a result of dementia. BPSD is divided into four main groups where hyperactivity containing wandering, verbal behavior and agitation/aggression, is one of the most difficult and challenging symptoms that both caregivers and family members are faced with. The purpose: The purpose was to compile nursing interventions that can limit hyperactivity in dementia care. Method: The method was a systematic literature review carried out under SBUs guidelines. The quantitative studies were analyzed with the support of the process of content analysis according to Graneheim & Lundman (2003). Results: The result revealed two main types of nursing interventions: General nursing interventions with three groups: Music reduces agitation and aggression, Dogs within close proximity can stabilize both agitation and aggression and Light therapy improves circadian rhythm and thereby decreases agitation. Personalized care interventions with two groups: Patient interest based interventions decreases behavioral problems and Montessori interventions which focus on the person as an individual reduces agitation. The result indicated that the general nursing interventions had a short term effect on patients. However, the interventions based on individualized care suggested a better and longer lasting effect. Conclusion: The right methods are a prerequisite to be able to help people and that they are formed evidence based for the right purpose. As the nursing interventions for hyperactivity only provide short term effect, the staff caring for the patient need to work actively as well as continuously with individualized interventions with respect to the patients background, which is consistent with the Social board’s guidelines (The Social board 2010).

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

本研究旨在比較不同背景和臨床因素的乳癌患者其因應策略、正向情緒和心理症狀的差異情形。本研究除了關注個體所採取的因應策略與情緒的關聯性；另一方面，研究者認為患者的情緒亦可能影響其因應策略之選擇，因此因應策略與情緒間的變化關係，亦為本研究目的之一。 本研究採立意取樣，並以中部某一教學醫學乳房中心初診斷之乳癌患者共計113位為研究對象，蒐集患者之｢基本資料表｣、｢短版因應策略量表｣、｢醫院版焦慮-憂鬱量表｣和｢情緒平衡量尺｣，並以術後3個月和6個月進行追蹤研究。 資料處理以相關分析、t考驗、單因子變異數分析及階層迴歸分析等統計方法為主。由於本研究擬以Brief COPE作為臺灣乳癌病患因應壓力之測量工具，因此將採用探索性因素分析(Exploratory Factor Analysis；EFA)，探討此量表在初診斷乳癌患者身上的因素結構。 依據本研究問題與假設，主要發現摘述如下: 一、本研究以主成分分析法抽取Brief COPE量表因素，並以斜交轉軸進行因素轉軸，依據陡坡圖和平行分析結果抽取三個因素。此三因素的解釋總變異量為62.1%。研究者將因素I命名為｢趨近因應｣；因素II命名為｢情緒性因應｣和因素III命名為｢逃避因應｣。 二、教育程度、收入和有無職業與正向情緒呈正相關；現有小孩人數和年齡與正向情緒呈負相關；年齡和副作用與憂鬱具有正向關係，教育程度則與憂鬱呈負相關;副作用與焦慮呈正相關。有無結婚、有無職業、教育程度、收入、乳房重建與趨近因應呈正相關，期數和年齡則和趨近因應有顯著負相關；有無職業和情緒性因應呈正相關。 三、乳癌患者於術後3、6個月最常採用的因應策略為趨近因應，其次為情緒性因應，最少採用逃避因應。 四、焦慮對逃避和趨近因應有獨特的預測力，即焦慮程度愈高會愈使用逃避和趨近因應策略；憂鬱則對趨近因應有獨特的預測力，憂鬱程度愈高者，其趨近因應的使用愈少；在因應策略的部分，只有趨近因應可顯著預測正向情緒；正向情緒在趨近因應和焦慮的關係中並無法形成部份或完全中介之角色。 最後，根據研究結果與限制提出若干具體建議，以供臨床工作者及未來研究之相關人員參考。 / The purpose of this study is to explore the differences of coping strategies, positive affect and psychological symptoms among newly-diagnosed breast cancer patients in different sociodemographic backgrounds. Research has found that coping strategies predict psychological outcomes; however, a few studies have also reported that psychological symptoms could predict the use of coping strategies. Therefore, the relationship between coping strategies and psychological symptoms was the first aim of the current study. One-hundred and thirteen participants were recruited by purposive sampling. The data were draw from newly-diagnosed breast cancer patients in a breast center unit at a hospital in central of Taiwan. Demographic and clinical data were gathered at the first time point, and the Brief Coping Orientations to Problems Experienced scale (Brief COPE), the Hospital Anxiety and Depression Scale (HADS), Positive Affect subscale of Affect Balance, and side effect checklists were gathered 2 times during the first 3- and 6-month after discharge respectively. Pearson product-moment correlation, t-test, one-way ANOVA, post Scheffe test and hierarchical regression analysis were applied. In an attempt to confirm the factor structure of the Brief COPE, the Exploratory Factor Analyses (EFA) were performed before those analyses. The major findings of the current study were as follows： 1.Using principal components factor analysis with oblique rotation, scree plot and parallel analyses revealed three factors for the Brief COPE were the best factor structure of the current sample: (1) approach coping, (2) emotional coping, and (3) avoidance coping. These 3 factors accounted for 62.1% of the total variance of the data. 2.Education, income and employment status were significantly correlated with positive affect. Number of kids and age were found to be inversely correlated with positive affect. Age and side effects were positively correlated with depression. Side effects were found to be correlated with anxiety. Marital status, employment status, cancer stage, education, income, age, breast reconstruction surgery were found to be correlated with approach coping. Meanwhile stage and age were found to be negatively correlated with emotional coping. 3.Approach coping was the most commonly used coping strategies, while avoidance coping was the least commonly used coping strategies. 4.Anxiety could reliably predict the use of avoidance and approach coping. High anxiety level predicted more use of avoidance and approach coping, whereas depression predicted the use of approach coping, high depressive mood predicted less use of approach coping. Approach coping predicted higher positive affect, but positive affect was fail to be the mediator between approach coping and anxiety. Implications for these results were discussed. The results can also serve as a helpful reference for healthcare professionals.

Cette étude a pour but d’identifier les principaux facteurs associés au fardeau des aidants de patients atteints de démence. A ce jour, les résultats de la littérature ne mettent pas clairement en évidence la spécificité du lien entre les symptômes comportementaux et psychologiques (SCP) et le fardeau de l’aidant. Cette étude a pour objectif d’étudier l’association entre les SCP et le fardeau de l’aidant, dans le cadre spécifique d’un Centre Local d’Information et de Coordination (CLIC). Celui-ci a comme particularité de toucher une population vivant majoritairement à domicile et en milieu rural, éloignée des centres experts. Les évaluations se sont effectuées au domicile du patient. Les SCP ont été mesurés en utilisant le NPI chez 100 patients présentant une démence. Le fardeau de l’aidant a été évalué en utilisant l’échelle de fardeau de Zarit. Les résultats des analyses de régression linéaire montrent une association significative entre le score global du NPI et le score de fardeau. Cette association perdure, même après l’ajustement de ce score avec d’autres variables explicatives. D’autre part, des analyses univariées ont permis de mettre en évidence une association entre quasiment tous les SCP et le fardeau de l’aidant. Enfin, une analyse hiérarchique a permis de définir plusieurs profils de binômes aidant-aidé. Cette étude renforce l’idée de la nécessité d’un accompagnement spécifique des aidants de patients atteints de démence. Dans le cadre du CLIC, une étude pilote a ainsi pu être initiée avec une intervention structurée auprès des aidants depuis le mois d’avril 2007. Elle est précisément centrée sur la prise en compte des stratégies d’ajustement face aux SCP. / The purpose of this study is to identify the principal factors associated with the burden of caregivers of patients with dementia. To date, the results of the literature do not clearly underline the specificity of the link between the Behavioral and psychological symptoms (BPS) and the burden of caregiver. This study aims then to study association between the BPS and the burden of caregiver, within the particularly framework of a Local Center of Information and Coordination (CLIC), touching a population alive mainly in residence in rural environment and far away from the expert centers. The evaluations were carried out in the residence of the patients. The BPS were evaluated by using the NPI among 100 patients with dementia. The burden of caregiver was evaluated by using the scale of burden of Zarit. The results of the linear regression analyses show a significant association between the total score obtained with the NPI and the score of burden. This association continues, even after the adjustment of this score with other known explanatory variables. In addition, the univaried analyses enabled us to highlight an association between almost all the BPS and the burden of caregiver. Distinct profiles of patient and caregiver are also defined. This study reinforces the idea of the need for a specific accompaniment of caregiver of patients with dementia. Within the framework of the CLIC, a pilot study thus could be initiated with an intervention structured near caregiver since April 2007. It is precisely centered on the taking into account of the strategies of adjustment facing BPS.

Alzheimer’s disease (AD) is the most common form of dementia and affects an individual’s overall cognitive function, including orientation, memory, and executive function. Most AD patients in the United States reside in residential care facilities or private homes under the care of individuals with little education on the challenges of the AD patient. Among the challenges faced by caregivers are behavioral and psychological symptoms related to dementia (BPSD). Education has been shown to improve caregivers’ treatment of BPSD in AD patients and to improve caregiver retention. The purpose of this project was to develop an evidence-based education module guided by Kolcaba’s comfort theory that could be provided to home care nurses who provide care for AD patients with BPSD. A 5-point, 15-item, Likert-scale evaluation survey was developed and administered to a panel of 5 professional content experts who reviewed and scored the educational module for clarity, usability, and applicability. The mean score of 4.6 indicated that the expert panel found the education module to meet the expected standards for use with AD caregivers. Recommendations from the panel of experts were to proceed with the caregiver education module as planned. Implementation of the module may lead to positive social change through the provision of education to caregivers on care of patients with AD and caregiver self-care.

Bakgrund: I takt med att människan blir allt äldre ses en ökning av att fler drabbas av en demenssjukdom. På grund av nedsatt kommunikationsförmåga vid demenssjukdom är det många patienter som utvecklar någon form av beteendemässiga och psykiska symtom vi demenssjukdom (BPSD). Sjuksköterskor som arbetar inom demensvården upplever ofta både verbalt och icke verbalt våld, som kan leda till en svår arbetssituation för sjuksköterskor. Syfte: Syftet med studien var att belysa sjuksköterskors upplevelser av att vårda patienter med demenssjukdom som utvecklat BPSD. Metod: En allmän litteraturöversikt där 11 vetenskapliga artiklar granskades. Resultat: Resultatet visar att sjuksköterskor ofta upplever någon form av BPSD i vården av patienter med demenssjukdom. De beskriver situationen som komplex och att etiska konflikter ofta uppstår. Sjuksköterskor ser BPSD som en naturlig del av demensprocessen. Personcentrerad vård, miljöanpassning samt bemötandet ses som främjande åtgärder och minskar risken att BPSD uppstår. I vissa fall kan läkemedel krävas för att minska lidande. Slutsats: Studien visar att sjuksköterskors upplevelser av BPSD i stor utsträckning påverkar sjuksköterskors välbefinnande och hälsa. Studien belyser vikten av förstående chefer, ett öppet arbetsklimat samt utbildning och kunskap som viktiga faktorer. / Background: As people get older, there is an increase in more people suffering from dementia. Due to impaired communication skills in dementia, many patients develop some form of behavioral and mental symptoms in dementia (BPSD). Nurses who work in dementia care often experience both verbal and non-verbal assault, which can lead to a difficult work situation for nurses. Aim: The aim of the study was to shed light on nurses' experiences of caring for patients with dementia who have developed BPSD. Method: A general literature review where 11 scientific articles were reviewed. Results: The results show that nurses often experience some form of BPSD in the care of patients with dementia. They describe the situation as complex and that ethical conflicts often arise. Nurses see BPSD as a natural part of the dementia process. Person-centered care, environmental adaptation and treatment are seen as preventative measures and reduce the risk of BPSD occurring. In some cases, medication may be required to reduce suffering. Conclusion: The study shows that nurses 'experiences of BPSD to a large extent affect nurses' well-being and health. The study highlights the importance of understanding managers, an open work climate and education and knowledge as important factors.

Bakgrund Demenssjukdom utgör ett stort hälsoproblem med både emotionella och fysiska konsekvenser. Många av de personer som lever med demenssjukdom flyttar till särskilda boenden när de inte längre klarar sig på egen hand. Beteendemässiga och psykiska symtom vid demens (BPSD) innefattar olika vanligt förekommande symtom vid demenssjukdom. Symtombehandling med läkemedel medför risker i form av förvirring, olyckor och fall. Syfte Syftet med denna litteraturöversikt är att beskriva effekter och användande av icke-farmakologiska metoder för att lindra symtom vid demens. Metod Litteraturöversikten baserades på 13 vetenskapliga artiklar, varav 11 kvantitativa och 2 kvalitativa, publicerade mellan 2012 och 2021. Artiklarna inhämtades från databaserna CINAHL, PubMed och PsycInfo. Studierna granskades enligt Örebros universitets mallar och därefter analyserades innehållet. Resultat Resultatet utgjordes av två huvudkategorier; Interventioners effekter med underkategorierna BPSD, Kognition, ADL, Livskvalitet och Vårdgivarbörda samt Användande av icke-farmakologiska metoder, med underkategorierna Tillfällen för icke-farmakologiska metoder, Kunskap och Hindrande faktorer. Resultatet visade att icke-farmakologiska metoder hade god effekt vid lindring av symtom vid demens. Effekten på olika symtom och grad av demens varierade beroende på metod. Slutsats Eftersom effekterna av de icke-farmakologiska metoderna varierade, krävdes en personcentrerad inställning där interventionerna individanpassades. Vid sidan av symtomlindring sågs effekter i form av ökad ADL-förmåga, ökad livskvalitet och minskad vårdgivarbörda. / Background Dementia constitutes a large threat on health and has both emotional and physical consequences. Many people that live with dementia move into care facilities when they can no longer cope on their own. Behavioural and psychological symptoms of dementia(BPSD) include different symptoms that are common in dementia. To treat these symptoms with drugs entails risks, such as confusion, accidents and falls. Aim The aim of this study is to describe effects, and use of, non-pharmacological methods to alleviate symptoms of dementia. Method This literature rewiev is based on 13 scientific articles; 11 quantitative and 2 qualitative, published between 2012 and 2021. The articles were obtained from the databases CINAHL, PubMed and PsycInfo. The studies were reviewed according to templates by Örebro University and thereafter the content was analysed. Results The result was divided into two main categories; The effects of interventions, with the subcategories BPSD, Cognition, ADL, Quality of life and Caregiver burden and The use of non-pharmacological methods, with the subcategories Opportunities for non-pharmacological methods, Knowledge and Hindering factors. The result indicated that non-pharmacological methods were effective for alleviation of symptoms of dementia.The effect on different symptoms and degree of dementia varied depending on method. Conclusions Since the effects of the non-pharmacological methods varied, a person-centred approach with individualized interventions was necessary. In addition, there were positive effects in form om increased capability to perform ADL, increased quality of life and reduced caregiver burden.

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether an education program on care of patients with BPSD increased staff members' perceived knowledge and competence in providing care to these patients. This education program focused on comprehensive assessment, individualized care planning, and individualized nonpharmacological interventions to manage older adults with dementia. Descriptive statistics were used to analyze performance outcomes data before and after staff education. In addition, care plans of patients were reviewed. Results included a 100% increase in recognition of core concepts of the education program; a 48% to 86% increase in staff willingness to use interdisciplinary care plans; and a 6.6% to 95% increase in documentation of key interventions in care plans for 6 behaviors of dementia. The results of this project might bring about social change by improving the skills and competence of nursing staff in managing the patients with dementia, thus positively impacting the quality of life of patients with BPSD by benefiting from nonpharmacological interventions.