Nunn Katherine, Crooks Suzanne, Gilroy Donna
Forensic Psychology, NHS Lothian, Edinburgh, UK.
Older People's Psychology Service, Borders General Hospital, Scotland.
Dementia (London). 2025 Jan;24(1):171-190. doi: 10.1177/14713012241287572. Epub 2024 Oct 15.
Behaviours such as hitting-out and declining personal care are commonly exhibited by people living with dementia and are associated with care-giver stress and anxiety and care home placement breakdowns. Traditionally, pharmacological approaches have been used to manage behaviour; however, research indicates limited effectiveness. National guidelines recommend use of non-pharmacological interventions as first line treatment for distress, but further research is required to elucidate the components that lead to improved care for people living with dementia. This study aims to explore what works, examining case studies in which a non-pharmacological clinical intervention, the Newcastle Model, was used to understand and manage distressed behaviour in dementia care within care home settings. A qualitative case study design was used. Three cases were selected from the Edinburgh Behaviour Support Service for their success in preventing care home placement breakdown during a distressed behaviour intervention in NHS Scotland. Family members and staff involved in the interventions within these cases were interviewed ( = 6). Thematic analysis was used to analyse data. All participants reported positive outcomes from the intervention. Three key themes were identified, each with subthemes. Participants described a supportive, non-judgmental environment which allowed them to integrate knowledge about dementia and tailor interventions to the specific needs of the individual living with dementia. There was also a sense of family and staff coming together to unite with shared goals. A preliminary model of all of themes and their interactions is presented. The study supports use of biopsychosocial, formulation-led approaches in the understanding and treatment of complex behavioural presentations in community care settings. It suggests that clinicians should endeavour to facilitate safe and open environments for care home staff and family members, in order to promote attribution change and person-centered care, and to help mediate differences and conflict between staff and family members.
诸如攻击他人和拒绝个人护理等行为在痴呆症患者中很常见，并且与护理人员的压力和焦虑以及养老院安置失败有关。传统上，一直采用药物治疗方法来管理这些行为；然而，研究表明其效果有限。国家指南建议使用非药物干预作为痛苦症状的一线治疗方法，但需要进一步研究以阐明哪些因素能改善对痴呆症患者的护理。本研究旨在探索有效的方法，通过案例研究来考察一种非药物临床干预措施——纽卡斯尔模式，以了解并管理养老院环境中痴呆症护理中的痛苦行为。采用了定性案例研究设计。从爱丁堡行为支持服务中心选取了三个案例，因其在苏格兰国民保健服务体系（NHS）的痛苦行为干预期间成功防止了养老院安置失败。对这些案例中参与干预的家庭成员和工作人员进行了访谈（n = 6）。采用主题分析法对数据进行分析。所有参与者都报告了干预取得的积极成果。确定了三个关键主题，每个主题都有子主题。参与者描述了一个支持性的、不评判的环境，这使他们能够整合有关痴呆症的知识，并根据痴呆症患者的具体需求调整干预措施。同时也有一种家庭成员和工作人员团结一心、目标一致的感觉。呈现了所有主题及其相互作用的初步模型。该研究支持在社区护理环境中运用生物心理社会、以制定方案为主导的方法来理解和治疗复杂的行为表现。研究表明，临床医生应努力为养老院工作人员和家庭成员营造安全、开放的环境，以促进归因改变和以人为本的护理，并帮助调解工作人员与家庭成员之间的分歧和冲突。
