Table 3

Identification of stressors, life imbalance, decisions and crisis outcomes
Perspective Stressors/predictors of crisis Crisis recommendations
Person with dementia Diagnoses [25,26] 1. Counselling [25]
Inability to live on their own [7,27-31] 1. Lives with family or friends [29,30]
2. Assisted living [29]
3. Institutionalization [29,32]
4. General practitioner assessment [28]
5. Improved information to caregiver and person with dementia on activities of daily living [27,28,33,34]
6. Improved information to general practitioner about dementia [27]
Comorbid conditions [27,28,31,33,35] 1. General practitioner management to detect specific conditions earlier [28,33]
2. Improved information to health care professionals about dementia [27,33]
3. Improved information to caregivers [27]
4. Acute hospitalization/Geriatric home hospitalization [31,33,35]
5. Structured follow up after hospitalisation [33]
6. Institutionalization [34]
Malnutrition [27,28,31,35] 1. General practitioner management [28]
2. Geriatric home hospitalizations/Hospitalization[31,35]
Falls [27,28,32,36] 1. General practitioner management [28,33]
2. Hospitalization [31,35,36]
3. Institutionalization [32,36]
4. Improved information to caregiver [27,28,33,34]
5. Improved information to General practitioner about dementia [27]
6. Fall prevention program in assisted living facilities [36]
Behavioural and psychological symptoms of dementia [7,27,28,31,32,37] 1. General practitioner management [22,28],
2. Careful management of drug therapy [27,31,38]
3. Improved information to caregiver [28,33,34]
4. Improved information to General practitioner about dementia [27]
5. Case management/care consultant [39]
6. Acute bed assessment of the person with dementia in hospital or psychiatric hospital [37]
7. Geriatric home hospitalization [35]
8. Acute hospitalization [31,35]
9. Structured follow up after hospitalization [33]
10. Institutionalization [29,32,34]
Newly institutionalized [10,26] 1. Therapeutic interaction with nurse to promote orientation and psychosocial function [10]
Caregiver Lack of knowledge [28,31] 1. General practitioner provides information [21,28,31,34]
2. Carer Support [12,13,17,22]
3. Care packages [38]
Miscommunication with general practitioner [34] 1. Clearer communication with the caregiver [34]
2. Caregiver must be open about caregiving situation [34]
3. Case management/nurse involvement to assess home situation [34]
Lack of time for personal or social activities due to increased caring [12,13,17] 1. Temporary respite/temporary admission to nursing home [38,40]
2. Carer support by community services, professionals, family members [21,38]
3. Home care [38]
4. Day care[38]
Emotional toll of increased dementia severity [26,28,34,41] 1. Introduce care plans [7,17,38]
2. Carer support by community services, nurse [41], professionals, family members to come up with coping strategies [13,38]
3. Home care [28,38]
4. Day care [38]
5. Temporary respite/temporary admission to nursing home [28,38,40,41]
6. Institutionalization [34]
Escalating costs due to dementia severity [38] 1. Customized care plans [38]
2. Public private partnerships of care offering low cost support services [38]
Caregiver exhaustion [12,13,19,21,28,29,31,34,40] 1. Advance care planning [7,17,29]
2. Care plans [17,21,38,39]
3. Carer support by community services, professionals, family members [13,19,22,31,32,34,38]
4. Case management [7,13,30,32,38,39]
5. Social services for patient and caregiver [12,13,31,34]
6. Home care [38]
7. General practitioner management of comorbid conditions, caregiving situation, structured follow up after hospitalization [21,28,31,34]
8. Therapy [13,19,21]
9. Day care [38]
10. Temporary respite/temporary admission to nursing home [38,40,42,43]
11. Hospitalization [31]
12. Institutionalization [19,21,34]
Caregiver Illness [13,19,22,28,29,31,34,37] 1. Advance planning [17,29]
2. General practitioner management [22,28,31]
3. Community Care Support [22]
4. Extra day care [38]
5. Temporary respite/temporary admission to nursing home, hospital or psychiatric hospital [37,38,40]
6. Acute bed assessment of the person with dementia in hospital or psychiatric hospital [37]
7. Emergency institutionalization [19,29,34]
8. Forward planning in cases where the caregiver is old and frail [29]
Death of caregiver [26,28,29,31] 1. Forward planning in cases where the caregiver is frail [29]
2. General practitioner management [28,31]
3. Emergency institutionalization [29]
Person with dementia institutionalization [7,17,26] 1. Increased preparation for the caregiver [17]
Death of person with dementia [26] 1. Counselling [26]
Nursing home perspective Signalling events: physiological, mechanical, psychological, social, or environmental change that affect client status [23,24] 1. Predict and prevent crisis through identification of signalling events [23,24]
2. Train nursing home staff to identify and appreciate the importance of immediate and gradual changes in behaviour [23,24]
3. Develop documentation to track signalling events and treatment,
4. Establish proper procedures for crisis intervention [23,24]
5. Educate staff to become attuned to subtle changes in the behaviour of persons with dementia who have trouble communicating [23,24]
6. Identify clients that complain repeatedly as an unmet need may have been overlooked [23,24]
7. Identify other signalling events and maintain a file for future reference [23,24]
8. Protection of the person with dementia, other residents and staff [24]
9. Diversion and environment management [24]
10. Assessment interventions [23,24]
11. Increased staff interaction with patients [10,23,24]
12. Increased family intervention [23,24]
13. Nurse assistant creates structured program for persons with dementia [24]
14. Staff should have compassion for persons with dementia [24]

Vroomen et al.

Vroomen et al. BMC Geriatrics 2013 13:10   doi:10.1186/1471-2318-13-10

Open Data