Authors (including presenting author) :
Li HY, Yuen WM, Mak PKF, Lui BKP, Li PY
Affiliation :
Department of Medicine & Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Recent study revealed that the prevalence of Dementia for people aged over 65 in Hong Kong increased from 6.8% to 7.2% in the past 5 years. The majority of people with dementia might experience Behavioral and Psychological Symptoms of Dementia (BPSD) at times during their illness which was perceived as challenges for both healthcare providers and caregivers to manage. To minimize its disturbance to the surrounding people, a program on TEA was introduced in 5 geriatric wards. It was a pilot project to engage patients in a variety of activities and social interactions that aimed for mood improvement, strengthening concentration, and reducing the recurrence of challenging behaviors.
Objectives :
- To promote elderly friendly care to patient with dementia through engaging them to own selected activities and the interaction with others
- To lower the frequency and severity of BPSD on patient with dementia
- To improve the awareness and the ability of professionals in handling patient having BPSD
- To equip wards with appropriate facilities or games for daily use
Methodology :
The pilot project was commenced in March 2018. A group of senior nurses consisting of WMs, APNs and DOM, developed the training plan, workflow assessment form as well as preparing a list of materials (tools) for the project. Four training workshops had been conducted for nurses and supporting staff in May 2018 to equip them with knowledge and the expected skills in conducting TEA. Ward nurse identified patients, who potentially would be benefitted from intervention, through observing their behavioral change. Agitation Assessment Score was used to evaluate their severity of presentation on aberrant vocalization, motor agitation, aggressiveness and resisting care before and after intervention. Designated APNs tried using different tools for TEA that suited patient’s preference in a person centered approach. And outcomes were evaluated three days afterward.
Result & Outcome :
Ten cases were recruited from June to Nov 2018 and all completed a three-day program. Their commonest problem was agitation. The assigned activities included sensorial (doll), daily living (colour matching, clipping) and language & math (calligraphy). The average duration of activities that patient could be engaged was about 40 minutes per session and nursing time used to introduce the activity to patient was about 10 minutes. It was noted that both the frequency and severity of such challenging behavior decreased after the 3-day interventional period. The average pre-score of Agitation Assessment was 5.9 out of 16 (range 1 - 11) and the average post score was 0.6 (range 0 – 5); while the most significant reduction was in motor agitation, which dropped from 2.3 to 0.2 in average. It was observed that the utilization of physical restraints had been reduced significantly by 57%. Amongst them, no one needed sedatives for agitation despite being prescribed by physician on prn basis. Though the sample size of this study could be more convincing, the result really demonstrated the effectiveness of TEA in caring our demented elders with a person-centered approach.
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