, pp.12-17 http://dx.doi.org/1.14257/astl.215.14.22 Effects of Dementia Intervention Programs on the Elderly with Dementia and Professional Caregivers in LTCF Young-Sun Park 1, Young-Ju Jee 2 1 Dept. of Nursing, Kyungbok University Sinpyeong ro 154 Sinbuk-myeon, Pocheon-si, Gyeonggi-do, KOREA. yspark@kbu.ac.kr 2 College of Nursing Kyungnam University, Woryeongbuk 16-gil Masanhappo-gu, Changwon-si, Gyeongsangnam-do, KOREA Corresponding Author: jeeyoungju@kyungnam.ac.kr Abstract. To verify the effects of dementia intervention programs offered in long-term care facilities (LTCF) on the elderly with dementia and professional caregivers, this study employed a one-group pretest-posttest pre-experimental design. The subjects were the elderly with dementia who received 8 sessions (once or twice weekly) of dementia intervention programs in 11 facilities nationwide and their professional caregivers who had been working in the facilities for more than a month. The outcome variables in the elderly with dementia included cognitive functions(mmse-kc), depression(sgds_k), activities of daily living(barthel Activity of Daily Living Index), and psycho-behavioral functions(npi-k). The professional caregivers' outcome variables included selfefficacy(ignse) and care burden(s-zbi). In brief, dementia intervention programs significantly improved the dementia subjects' cognitive functions(t=-2.5 p=.16), depression(t=4. p<.1) and psycho-behavioral functions(t=3.9, p=.3). The subjects' activities daily of living(t=-1.56 p=.126) and professional caregivers' self-efficacy(t=-1.67, p=.11) and care burden(t=.53, p=.598) improved marginally, showing no statistical significance. Importantly, professional caregivers' decreasing self-efficacy and increasing care burden should be noted in comparison to the functional improvement in the elderly with dementia. Hence, the findings suggest that current dementia intervention programs should be constantly offered in LTCF and that sophisticated intervention programs should be developed that are effective for raising professional caregivers' selfefficacy whilst lessening their care burden. Keywords: Dementia, Intervention, Professional caregiver, Self-efficacy, Care burden 1 Introduction 1.1 Rationale ISSN: 2287-1233 ASTL Copyright 215 SERSC
Growing population of senior citizens and persons with dementia in tandem with social changes has triggered the increase in long-term care facilities especially since the adoption of 28 Long-term Care Insurance for the Aged. More than 1, long-term care facilities emerged yearly, adding up to 4,23 facilities nationwide in 212[1]. About 44.3% of newly admitted inmates in long-term care facilities have dementia, whilst 7.4% have suspected dementia[2]. This finding suggests the future growth of elderly inmates with dementia in long-term care facilities. Dementia is a degenerative brain disease causing cognitive impairment including memory, emotional changes, psychobehavioral symptoms, and decreased mobility[3]. The elderly with dementia are affected by cognitive impairment leading to persistent disabilities in activities of daily living and psychobehavioral symptoms, which calls for long-term care [4][5]. In long-term care facilities, professional caregivers constantly interact with the elderly with dementia, and provide nursing care in person for them[6]. However, psychobehavioral symptoms of the elderly with dementia often occur abruptly without any antecedent symptoms, which results in care-related stress and conflicts more often than not[7]. Therefore, professional caregivers in long-term care facilities are reported to feel significantly heavier care burden than those working in community senior service facilities[8]. This study investigated the effects of dementia intervention programs offered in long-term care facilities for improving and maintaining the functions on the elderly with dementia and their professional caregivers, so as to shed light on problems relevant to such programs and provide reference data conducive to developing more effective intervention programs. 1.2 Objective Specific goals are:1) To identify demographics and dementia-related characteristics of the elderly with dementia and professional caregivers; and 2) To analyze the effects of dementia intervention programs offered in long-term care facilities on cognitive functions, depression, activities of daily living and psychobehavioral functions of the elderly with dementia and on professional caregivers' self-efficacy and care burden. 2 Method 2.1 Design The present study is a one-group pretest-posttest time series design intended to verify the effects of dementia intervention programs on the elderly with dementia and professional caregivers in long-term care facilities. Copyright 215 SERSC 13
2.2 Subjects 11 facilities in 6 provinces nationwide accommodating over 25 inmates were included in this study. The subjects(n=53) had been diagnosed with dementia and received the dementia intervention programs in the 11 facilities from May 1 to November 3, 214. The professional caregivers(n=53) included in this study had been taking care of the elderly with dementia for over a month. Thus, in total, 53 persons with dementia and 53 professional caregivers were included in the final data analysis. 2.3 Dementia intervention programs The studied dementia intervention programs were offered in care facilities for the benefit of the elderly with dementia as part of their care services. In particular, such programs were systematic enough to understand and assist the elderly with dementia with social problems due to their cognitive function impairment and various psychobehaviors. This paper selectively measured the effects of art and reminiscence therapies among the dementia intervention programs offered in 11 participant facilities. The programs are named in this paper as they were called in facilities. From May 1 to November 3, 214, the intervener provided 8 sessions (once/twice weekly) of the programs in each of the 11 facilities. 2.4 Data analysis SPSS version 21. for Windows was used here for data analysis. For the demographics of the elderly with dementia and professional caregivers, descriptive statistics (real numbers, percentages, means and standard deviation) was used. To verify the effects of dementia intervention programs on the cognitive functions, depression, activities of daily living and psycho-behavioral functions of the elderly with dementia and on professional caregivers' self-efficacy and care burden, paired t- test was used. 3 Results 3.1 Verifying the effects of dementia intervention programs 3.1.1 Effects of dementia intervention programs on the elderly with dementia 14 Copyright 215 SERSC
Table 1. Demographics & Dementia-related Characteristics of Professional Caregivers (N=53) Variables Characteristics Category Frequency(%) Professional caregivers Gender Age Education Monthly wage Understanding about the elderly Participation in dementiarelated information programs Skillfulness at caring the elderly with dementia Field experience Female 18(9.6) Others 5(9.4) Younger than 5 years 6(11.4) 5 55 years 17(32.1) 55 6 years 19(35.8) 6 years + 6(11.3) No response 5(9.4) Primary or lower 3(5.7) Middle school 4(7.6) High school 25(47.2) No response 21(39.5) 1M 1.5M Won 45(84.9) 1.51M 2M Won 1(1.9) No response 7(13.2) Little 1(1.9) Much 33(62.3) Very much 12(22.6) No response 7(13.2) Never 3(5.7) Once 6(11.3) Several times 33(62.3) Often 4(7.5) No response 7(13.2) Novice 1(18.9) Skilled 26(49.1) Professional 1(18.9) No response 7(13.1) 1 year 5(9.4) 1 3 years 19(35.8) 3 5 years 12(22.7) 5 years + 12(22.7) No response 5(9.4) Copyright 215 SERSC 15
Working hours 8 hours 27(51.) 9 12 hours 13(24.5) 13 hours + 8(15.1) No response 5(9.4) 3.1.2 Verifying the effects of dementia intervention programs on professional caregivers Table 2. Effects of Intervention Programs on Subjects with Dementia and Professional caregivers (N=53) Variables Area Instrument Pretest (M±SD) Posttest (M±SD) t p Dementia subjects Caregivers Cognitive function MMSE-DS 14.15±4.64 15.77±4.46 Depression GDS-K 7.48±3.49 4.96±3.78 Activities of daily living Psychobehavioral function Selfefficacy Care burden Barthel ADL Barthel Count NPI-K ADL 58.3±29.6 3 63.4±28.6 6.2±3.42 3.59±2.84 19.42±24.2 5 12.83±17.8 IGNSE 49.65±8.44 52.4±9.37 S- ZBI - 2.5 4. - 1.5 6 5.2 3 3. 9-1.6 7.16 <. 1.126 <. 1 Personal 8.92±6.15 8.4±5.97.58.56.3.11 Role 5.71±2.41 5.8±2.49 -.2.845 Total score 14.82±7.38 14.25±7.3.53.598 4 Conclusion Based on the limitations, this paper suggests the following. First, considering the finding that the intervention programs were less effective for professional caregivers' self-efficacy and care burden than for the cognitive functions, activities of daily living, depression and psych-behavioral symptoms of the elderly with dementia, a replication study is needed with more extensive intervention programs and subjects included. 16 Copyright 215 SERSC
Second, given that dementia intervention programs enhanced the self-efficacy of caregivers as well as the elderly with dementia and reduced the care burden of the former, further studies are needed to help long-term care facilities to develop, apply and continue dementia intervention programs, and to verify their effects. References 1. National Health Insurance Cooperation.: Bureau of long term health insurance statistics, Retrieved January 1, 212, from http://www.nhic.or.kr/portal/site/main/menuitem. 2. Seoul National University Hospital.: Survey of dementia prevalence Seoul: Ministry of Health, Welfare, and Family,(29) 3. Roger, K. S.: Priorities for people living with dementia: Education, counseling, research, Clinical Interventions inaging, Vol.3, No.1, pp.573-579(28). 4. Etters, L.,Goodall, D., Harrison, B. E.: Caregiver burden amongdementia patient caregivers: a review of the literature, Journal of the American Academy of the Nurse Practitioners, Vol.2, No.8, pp.23-8(28) 5. Park, M. H., Park, M. H., K, H. H.: Effects of a Multimodal Psychoeducational Program on Burden, Depression, and Problem Coping Behaviors in Family Caregivers on Patients with Dementia, Journal of Korean Gerontological Nursing, Vol.17, No.1, pp.1-19(215) 6. Park, K. I., Kwon, J. A., Kim, H. K.: Influence the Elderly Caregivers Conflict and Care Attitudes in Elderly Nursing Homes on Their Turnover Intention, Journal of Welfare for the Aged, Vol.63, pp.149-173(214) 7. Kim, H. Y., Mo, J. H., Kim, S. H.: The Effects of Turnover Intension on Long-term Care Workers Occupational Stress, The Korean Association For Governance, Vol.17, No.2, pp.25-227(21) 8. Winslow, B. W., Carter, P. Patterns of burden in wives who care for husbands with dementia, The Nursing clinics of North America, Vol.34, No.2, pp.71-12(1999) Copyright 215 SERSC 17