528073 research-article2014
CNRXXX10.1177/1054773814528073Clinical Nursing ResearchSefcik and Kolanowski
Guest Editorial
A Behavioral Health Toolkit That Can Support Researchers and Practitioners Alike
Clinical Nursing Research 2014, Vol. 23(2) 115–118 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1054773814528073 cnr.sagepub.com
Justine S. Sefcik, MS, RN1 and Ann M. Kolanowski, PhD, RN, FGSA, FAAN2
It is currently estimated that 35.6 million people worldwide are living with dementia and this number is expected to double by 2030 (World Health Organization, 2012). Dementia is an insidious disease that over time results in cognitive and behavioral decline. The most common behavioral and psychiatric symptoms of dementia (BPSD) include agitation, anxiety, irritability, apathy, and depression (Cerejeira, Lagarto, & Mukaetova-Ladinska, 2012). Difficulties with managing BPSD is a major reason why informal caregivers are burdened and people with dementia are institutionalized (Yaffe et al., 2002). Every formal caregiver working in a setting with older adults who have dementia will be challenged by the BPSD they encounter. Reported prevalence rates of BPSD are high. One recent systematic review of nursing home residents found a median prevalence rate of behavioral symptoms being 78% (with a range of 38%-92%) among the 58% (median rate with a range of 12%-95%) of residents with dementia (D. Seitz, Purandare, & Conn, 2010). Pharmacological interventions are often prescribed for BPSD, although the efficacy is generally modest at best and there are risks of adverse effects (Maher et al., 2011; D. P. Seitz et al., 2013).
1University
of Pennsylvania, Philadelphia, USA State University, University Park, USA
2Pennsylvania
Corresponding Author: Justine S. Sefcik, 2012-2014 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA. Email: [email protected]
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
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Clinical Nursing Research 23(2)
Table 1. Toolkit Development Subgroups. Topic
Developers
Philosophy Education and leadership Assessment Intervention System integration Specific behaviors Dissemination plan
Love, K.; Pinkerton, J. Lucas, J.; Beck, C.; Cleary, B.; Bossen, A.; Sefcik, J. Gitlin, L.; Marx, K.; Buckwalter, K.; Kovach, C.; Hansen, B. Nichols, S.; Jablonski, R.; Gilmore-Bykovskyi, A.; Molkina-Petrovsky, D.; Baker, N.; Bossen, A.; Evans, L.; O’Shea-Carney, K. Boltz, M.; Bowman, C.; Parmelee, P.; Powers, G. A. Gilmore-Bykovskyi, A.; Sefcik, J. Resnick, B.
For these reasons, experts state that the use of non-pharmacological interventions should be the first line for treating BPSD (American Geriatrics Society and American Association for Geriatric Psychiatry, 2003). However, staff members are not always equip to deal with BPSD and may feel insecure when implementing non-pharmacological interventions (Kolanowski, Fick, Frazer, & Penrod, 2010). To address these challenges, an expert team of clinicians and researchers led by Drs. Ann Kolanowski and Kimberly Van Haitsma, responded to the Centers for Medicare and Medicaid Services Initiative to Improve Behavioral Health and Reduce Antipsychotic Use in Nursing Homes. Together, this team (see Table 1) developed an evidencebased compendium of non-pharmacological approaches to BPSD. This toolkit is freely available at www.nursinghometoolkit.com and contains sections on a working description of person-centered care; educational programs for implementing non-pharmacological approaches; psychometrically sound measures of BPSD; evidence-based non-pharmacological interventions for BPSD, including clinical decision support algorithms; and techniques and resources for a system-wide step by step approach to ensuring uptake of alternatives to medication use. Not only is the toolkit useful for frontline employees and administrators of long-term care residential settings, but it is also a valuable tool for researchers in gerontological nursing whose programs of research focus on BPSD. For example, the staff educational programs described in that section can be used to develop training tools for research staff in clinical trials that test non-pharmacological approaches to BPSD. A link to each of these videos, manuals, and other training materials is provided. Researchers can select appropriate instruments for their projects by accessing the assessment section where a list and description of 44 psychometrically sound instruments for the
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
Sefcik and Kolanowski
117
measure of BPSD can be found. In the non-pharmacological intervention section, there is a succinct presentation of an integrated review of literature on the strength of the evidence for these approaches. Gaps in the literature can be identified and help focus next steps in the development of science in this area. Further valuable information for researchers is found in the clinical decision support and systems integration sections. The collated tools and additional information can be used to guide translational work where implementation and dissemination strategies from a system-wide perspective are being tested. This website brings to one’s fingertips a wealth of gathered information on BPSD, non-pharmacological interventions and research that has been done in these areas. We strongly encourage you to visit the website to use the materials to promote behavioral health among the older adults you work with. In addition, we encourage you to use this website as a catalysis to designing your next study and to join us in advancing the science in the care of older adults with BPSD. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by a Commonwealth Foundation Small Grant 20130170, awarded to Ann Kolanowski and Kimberly Van Haitsma. The investigators also acknowledge the generous support from the John A. Hartford Foundation.
References American Geriatrics Society and American Association for Geriatric Psychiatry. (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: Management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287-1298. Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, Article 73. doi:10.3389/fneur.2012.00073 Kolanowski, A., Fick, D., Frazer, C., & Penrod, J. (2010). It’s about time: Use of nonpharmacological interventions in the nursing home. Journal of Nursing Scholarship, 42, 214-222. Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J. H., Ewing, B., . . .Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
118
Clinical Nursing Research 23(2)
medications for off-label uses in adults: A systematic review and meta-analysis. The Journal of the American Medical Association, 306, 1359-1369. Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review. International Psychogeriatrics, 22, 1025-1039. Seitz, D. P., Gill, S. S., Herrmann, N., Brisbin, S., Rapoport, M. J., Rines, J., . . .Conn, D. K. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: A systematic review. International Psychogeriatrics, 25, 185-203. World Health Organization. (2012). Dementia: A public health priority. Retrieved from http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K., Dane, K., & Covinsky, K. E. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. The Journal of the American Medical Association, 287, 2090-2097.
Author Biographies Justine S. Sefcik, MS, RN, is a doctoral student at the University of Pennsylvania School of Nursing and a 2012-2014 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar. Ann M. Kolanowski, PhD, RN, FGSA, FAAN, is Elouise Ross Eberly Professor in the School of Nursing; Center Director, Hartford Center of Geriatric Nursing Excellence at Penn State; professor of psychiatry, College of Medicine.
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
CNRXXX10.1177/1054773814528073Clinical Nursing ResearchSefcik and Kolanowski
Guest Editorial
A Behavioral Health Toolkit That Can Support Researchers and Practitioners Alike
Clinical Nursing Research 2014, Vol. 23(2) 115–118 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1054773814528073 cnr.sagepub.com
Justine S. Sefcik, MS, RN1 and Ann M. Kolanowski, PhD, RN, FGSA, FAAN2
It is currently estimated that 35.6 million people worldwide are living with dementia and this number is expected to double by 2030 (World Health Organization, 2012). Dementia is an insidious disease that over time results in cognitive and behavioral decline. The most common behavioral and psychiatric symptoms of dementia (BPSD) include agitation, anxiety, irritability, apathy, and depression (Cerejeira, Lagarto, & Mukaetova-Ladinska, 2012). Difficulties with managing BPSD is a major reason why informal caregivers are burdened and people with dementia are institutionalized (Yaffe et al., 2002). Every formal caregiver working in a setting with older adults who have dementia will be challenged by the BPSD they encounter. Reported prevalence rates of BPSD are high. One recent systematic review of nursing home residents found a median prevalence rate of behavioral symptoms being 78% (with a range of 38%-92%) among the 58% (median rate with a range of 12%-95%) of residents with dementia (D. Seitz, Purandare, & Conn, 2010). Pharmacological interventions are often prescribed for BPSD, although the efficacy is generally modest at best and there are risks of adverse effects (Maher et al., 2011; D. P. Seitz et al., 2013).
1University
of Pennsylvania, Philadelphia, USA State University, University Park, USA
2Pennsylvania
Corresponding Author: Justine S. Sefcik, 2012-2014 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA. Email: [email protected]
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
116
Clinical Nursing Research 23(2)
Table 1. Toolkit Development Subgroups. Topic
Developers
Philosophy Education and leadership Assessment Intervention System integration Specific behaviors Dissemination plan
Love, K.; Pinkerton, J. Lucas, J.; Beck, C.; Cleary, B.; Bossen, A.; Sefcik, J. Gitlin, L.; Marx, K.; Buckwalter, K.; Kovach, C.; Hansen, B. Nichols, S.; Jablonski, R.; Gilmore-Bykovskyi, A.; Molkina-Petrovsky, D.; Baker, N.; Bossen, A.; Evans, L.; O’Shea-Carney, K. Boltz, M.; Bowman, C.; Parmelee, P.; Powers, G. A. Gilmore-Bykovskyi, A.; Sefcik, J. Resnick, B.
For these reasons, experts state that the use of non-pharmacological interventions should be the first line for treating BPSD (American Geriatrics Society and American Association for Geriatric Psychiatry, 2003). However, staff members are not always equip to deal with BPSD and may feel insecure when implementing non-pharmacological interventions (Kolanowski, Fick, Frazer, & Penrod, 2010). To address these challenges, an expert team of clinicians and researchers led by Drs. Ann Kolanowski and Kimberly Van Haitsma, responded to the Centers for Medicare and Medicaid Services Initiative to Improve Behavioral Health and Reduce Antipsychotic Use in Nursing Homes. Together, this team (see Table 1) developed an evidencebased compendium of non-pharmacological approaches to BPSD. This toolkit is freely available at www.nursinghometoolkit.com and contains sections on a working description of person-centered care; educational programs for implementing non-pharmacological approaches; psychometrically sound measures of BPSD; evidence-based non-pharmacological interventions for BPSD, including clinical decision support algorithms; and techniques and resources for a system-wide step by step approach to ensuring uptake of alternatives to medication use. Not only is the toolkit useful for frontline employees and administrators of long-term care residential settings, but it is also a valuable tool for researchers in gerontological nursing whose programs of research focus on BPSD. For example, the staff educational programs described in that section can be used to develop training tools for research staff in clinical trials that test non-pharmacological approaches to BPSD. A link to each of these videos, manuals, and other training materials is provided. Researchers can select appropriate instruments for their projects by accessing the assessment section where a list and description of 44 psychometrically sound instruments for the
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
Sefcik and Kolanowski
117
measure of BPSD can be found. In the non-pharmacological intervention section, there is a succinct presentation of an integrated review of literature on the strength of the evidence for these approaches. Gaps in the literature can be identified and help focus next steps in the development of science in this area. Further valuable information for researchers is found in the clinical decision support and systems integration sections. The collated tools and additional information can be used to guide translational work where implementation and dissemination strategies from a system-wide perspective are being tested. This website brings to one’s fingertips a wealth of gathered information on BPSD, non-pharmacological interventions and research that has been done in these areas. We strongly encourage you to visit the website to use the materials to promote behavioral health among the older adults you work with. In addition, we encourage you to use this website as a catalysis to designing your next study and to join us in advancing the science in the care of older adults with BPSD. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by a Commonwealth Foundation Small Grant 20130170, awarded to Ann Kolanowski and Kimberly Van Haitsma. The investigators also acknowledge the generous support from the John A. Hartford Foundation.
References American Geriatrics Society and American Association for Geriatric Psychiatry. (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: Management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287-1298. Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, Article 73. doi:10.3389/fneur.2012.00073 Kolanowski, A., Fick, D., Frazer, C., & Penrod, J. (2010). It’s about time: Use of nonpharmacological interventions in the nursing home. Journal of Nursing Scholarship, 42, 214-222. Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J. H., Ewing, B., . . .Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
118
Clinical Nursing Research 23(2)
medications for off-label uses in adults: A systematic review and meta-analysis. The Journal of the American Medical Association, 306, 1359-1369. Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review. International Psychogeriatrics, 22, 1025-1039. Seitz, D. P., Gill, S. S., Herrmann, N., Brisbin, S., Rapoport, M. J., Rines, J., . . .Conn, D. K. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: A systematic review. International Psychogeriatrics, 25, 185-203. World Health Organization. (2012). Dementia: A public health priority. Retrieved from http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K., Dane, K., & Covinsky, K. E. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. The Journal of the American Medical Association, 287, 2090-2097.
Author Biographies Justine S. Sefcik, MS, RN, is a doctoral student at the University of Pennsylvania School of Nursing and a 2012-2014 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar. Ann M. Kolanowski, PhD, RN, FGSA, FAAN, is Elouise Ross Eberly Professor in the School of Nursing; Center Director, Hartford Center of Geriatric Nursing Excellence at Penn State; professor of psychiatry, College of Medicine.
Downloaded from cnr.sagepub.com at UCSF LIBRARY & CKM on March 7, 2015
