Abstract
Dementia is a major public health issue in the United States (U.S.) that affects 10% of older adults 65 years of age and older with 10 million new cases developing each year (Alzheimer's Association, 2019). Moreover, 48% of nursing home residents are living with ADRD, while 42% of older adults in residential facilities, including assisted living, have some forms of ADRD (Alzheimer’s Association, 2019). Given there is no cure for dementia, non-pharmacological interventions can help families, workforce members, and communities understand and learn strategies to cope with dementia in different settings and circumstances. An exemplar book that provides strategies is authored by Dr Eilon Caspi, titled Understanding and Preventing Harmful Interactions between Residents with Dementia, which advocates improving dementia care. Caspi expresses concerns for people living with dementia (PLWD) as human beings, with a focus on their emotional experiences, while using a strength-based approach. This book illustrates the importance of dementia education, involving families and staff members in assessment of PWLD, and providing meaningful activities and organizations structure for an aging population.
In the first several chapters of the book, Caspi describes the spectrum and consequences of distressing and harmful resident-to-resident interactions (DHRRIs). He then details the principles for approaching these interactions. The central foundation of these principles is person-centered care. To address PLWD needs, healthcare professionals and families are encouraged to learn about the patient’s relational, emotional, and psychological needs. Providing PLWD with meaningful engagement is proven to reduce DHRRI episodes. In addition, staff need to be well trained and feel supported by management and colleagues to prevent harmful incidents. For example, low or poor staffing could cause preventable injuries and death of patients. Also, family members need education on the patient’s triggers and how to calm them. For example, understanding their personality and how to cope will help family members tap into their value system to better handle these situations. Lastly, intertwining culture is also related to value system, along with lifelong routines and understanding what brings them joy.
The middle section of the book provides detailed information on triggers to DHRRIs and specific measures that can be taken to address these troubling episodes. Caspi clearly understands that care partners play an integral role in the PLWD’s life and can prevent or mitigate these incidents (page 55). For example, adopting a strength-based approach that focuses on skills and preserved capabilities can reduce behavioral symptoms. An exemplar evidence-based program that proves this to be true is the Tailored Activity Program (TAP) developed by Gitlin and Piersol. TAP trains Occupational Therapists and other healthcare professionals to focus on development of easy-to use activities based on the person’s interest, capabilities, and management of challenging behaviors to keep them engaged. Moreover, Gitlin and colleagues demonstrated that caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%) (Gitlin et al., 2009). This indicates a high acceptability and proves to help caregivers better manage daily care challenges, take care of themselves, and reduce their own physical and psychological and emotional distress while keeping the person engaged with activities to reduce their behavioral symptoms.
The final third of the book focuses on prevention and de-escalation strategies. One of the more intriguing chapters examines how organization structure influences DHRRIs. Caspi states that an organizational culture that supports creative ideas among administrators and healthcare professionals is key to manage and decrease behavioral symptoms of PLWD (page 195). Caspi encourages healthcare professionals to seek out and/or create innovative and cost-effective ways to engage the residents. For example, singing and dancing in the dining room when most residents are dealing DHRRIs can be engaging. However, administrators must also be aware and support staff members, instead of perceiving them as “not doing their job.” Moreover, there may be instances where staff and family members suggest ideas that do not work; however, administrators should welcome ideas that may be unique to help the PLWD and staff members.
Considerations for safety and care for PLWD in long-term care settings has been thoroughly outlined in the book. Caspi’s background and experience as a social worker, consultant, applied researcher, educator, author, volunteer, and elder care advocate was showcased in the book. Rich experiences and detailed stories were helpful as a reader to visualize instances in the long-term care facility. For instance, the organization of the chapters includes scope of the issues, disease causes and factors, actions that should be taken before, during and after episodes, and interventions that may be helpful. Overall, the use of a lens from a patient, staff, and family perspective was woven into the chapters which illustrated considerations to contribute to the future of improving dementia care. This book appears to be targeted at several audiences, including educators, trainers, and facility management. Educators could use this as a supplemental text in undergraduate and graduate practice courses in social work, nursing, and healthcare management programs. The content of this book could also guide trainers in building continuing education training courses for direct care staff in long-term care facilities. Finally, facility managers could use this book to help inform policies and practices for working with PLWD.