Background
Methods
Search strategy
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Dementia
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Crisis intervention
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Emergencies
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Human.
Inclusion criteria strategy
Data extraction and analysis
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information on the type of study (e.g. randomized controlled trial)
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the crisis definition used
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the perspective (person with dementia, informal caregiver, heath care provider)
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the recommendations pertaining to the crisis.
Results
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the presence of stressors
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the imbalance created by stressors
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the need for immediate decision
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the view of crisis as a process
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resolution.
Original article | Crisis definition |
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“The representation of a serious occasion or turning point occurring when an individual is faced with an obstacle that is important to life goals. A crisis is self-limiting because homeostatic mechanisms necessitate resolution of a crisis. A crisis results in depletion of system resources and eventually the system shuts down or ceases to function.” | |
“An obstacle that is insurmountable through customary methods of problems solving.” | |
Liken, 2001 [7] | “A process precipitated by a stressor that occurs only in the presence of mediating factors, when normal methods of problem solving have failed, and results in an outcomes or resolution.” |
“An imbalance between the difficulty and importance of the problem and resources immediately available to deal with it.” | |
“The dual experience of distress and sense of immediacy associated with a defined, problematic situation.” | |
Aguilera, 1998 [15] | “A perceived or actual imbalance between perceived difficulty of a life challenge and an available repertoire of coping skills.” |
England, 1994 [17] | “A decision point, an opportunity for growth.” |
“In crisis, experience within the niche is detached and out of sync with the rest of the domains of experiences, one or more structural domain.” | |
“Periods of disorganization experienced by the entire family that turn into opportunities of change.” |
Operationalized definition of crisis | Operationalization |
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“Self-reports of distress urgency and inability to engage in usual activities of daily living with a sense of wellbeing as a consequence of caregiving” | |
Filial crisis in clinical practice [17] | “A condition of urgency, excess emotional arousal, fatigue and difficulty with goal attainment in the caregiving situation” |
Evolutionary perspective on filial crisis [17] | “An ongoing period of unfolding of the filial relationship through caregiving” |
Implicit operationalization of crisis [21] | “The decision to institutionalize the patient in most cases had been acute when the relatives could not manage the situation anymore” |
Crisis experience [17] | “Spontaneously and repeatedly reported episodes of distress and urgency relative to the caregiving situation and inability to engage in usual activities of daily living with a sense of well-being as a consequence of caregiving” |
Caregiver crisis [22] | “Where informal skills and commitment are not enough” |
Episodic crisis in a nursing home [23] | “Any acute disruptive episode requiring non-routine intervention” |
Crisis in nursing home [24] | “Catastrophic psychiatric reactions that are aggressive or attacking” |
Definition of crisis and contents of the operational framework in dementia care
Crisis care from the perspective of the person with dementia, the informal carer and the health care provider
Perspective | Stressors/predictors of crisis | Crisis recommendations |
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Person with dementia | 1. Counselling [25] | |
2. Assisted living [29] | ||
4. General practitioner assessment [28] | ||
6. Improved information to general practitioner about dementia [27] | ||
3. Improved information to caregivers [27] | ||
5. Structured follow up after hospitalisation [33] | ||
6. Institutionalization [34] | ||
1. General practitioner management [28] | ||
5. Improved information to General practitioner about dementia [27] | ||
6. Fall prevention program in assisted living facilities [36] | ||
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] | ||
9. Structured follow up after hospitalization [33] | ||
1. Therapeutic interaction with nurse to promote orientation and psychosocial function [10] | ||
Caregiver | ||
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] | ||
3. Home care [38] | ||
4. Day care[38] | ||
4. Day care [38] | ||
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] | ||
6. Home care [38] | ||
9. Day care [38] | ||
11. Hospitalization [31] | ||
3. Community Care Support [22] | ||
4. Extra day care [38] | ||
6. Acute bed assessment of the person with dementia in hospital or psychiatric hospital [37] | ||
8. Forward planning in cases where the caregiver is old and frail [29] | ||
1. Forward planning in cases where the caregiver is frail [29] | ||
3. Emergency institutionalization [29] | ||
1. Increased preparation for the caregiver [17] | ||
Death of person with dementia [26] | 1. Counselling [26] | |
Nursing home perspective | ||
3. Develop documentation to track signalling events and treatment, | ||
8. Protection of the person with dementia, other residents and staff [24] | ||
9. Diversion and environment management [24] | ||
13. Nurse assistant creates structured program for persons with dementia [24] | ||
14. Staff should have compassion for persons with dementia [24] |
Crisis from the perspective of the person with dementia
Recommendations to prevent crisis after diagnosis disclosure
Recommendations to address persons with dementia’s inability to live independently
Addressing comorbid conditions and malnutrition leading to crisis
Recommendations to prevent falls
Addressing behavioural and psychological symptoms of dementia
Recommendations to approach newly institutionalized persons with dementia
Crisis from the perspective of the informal caregiver
Informal caregivers need for knowledge about dementia
Solutions to miscommunication between the general practitioner and the informal caregiver
Time management for informal caregiver’s personal and social activities
Solutions for the emotional toll informal caregivers face based on increasing dementia severity
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managing the day to day caring activities
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discharge from hospital planning
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surrogate decision-making in matters of health care
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decisions to institutionalize a family member.
Escalating costs due to dementia severity
Solutions to caregiver exhaustion
Addressing crisis in times of caregiver illness and death
Coping with institutionalization of the person with dementia
Coping with the death of the person with dementia
Crisis from the perspective of the nursing home
Solutions to nursing home crisis
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identify and appreciate the importance of immediate and gradual changes in behaviour
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notice subtle changes in the behaviour of persons with dementia who have trouble communicating
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notice an any unmet needs that may have been overlooked
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identify other signalling events
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keep a file for future reference
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develop documentation to track signalling events and treatment