Evaluating Person Centred Care and Dementia Care Mapping in a Psychogeriatric Hospital in New Zealand: A Pilot Study
Bone, Carlene, Cheung, Gary, Wade, Bev, New Zealand Journal of Occupational Therapy
Dementia Care Mapping (DCM, Brooker, 2006) is an observational tool that has been used in formal dementia care settings since 1992. It is an outcomes measurement designed to evaluate the well-being and/or ill-being of people with dementia. The application of DCM is based on person-centred care, a process which embraces the uniqueness of an individual life experience, and maintains personhood through recognition, respect and trust (Kitwood & Bredin, 1992). Few tools are available in clinical practice to monitor the effectiveness of a person-centred process and to capture the person with dementia's view of the world.
Participation in occupation is central to DCM which was designed to be used in a series of developmental evaluations that allow care teams to identify residents' needs with a view to improving the quality of care provision. The aim of this pilot study is use DCM to evaluate the effectiveness of person centred care while facilitating occupational and psychosocial interventions in a residential care setting. The occupations in the DCM Behavioural Category Coding (see Table 1) include expressive or creative activity (Code E), craft activity (Code H) and religious activity (Code R).
A significant number of people with moderate and severe dementia currently live in residential care facilities in New Zealand yet there is little literature on the quality of care provision. The recent Economic Impact of Dementia in New Zealand Report estimated there were 40,746 people currently living with dementia. By 2050, 2.7% of the population or 146,699 people will have dementia and new cases are projected to involve 0.8% of the population or 44,375 people each year (Access Economics, 2008). In 2008, the total financial cost of dementia was estimated to be $712.9 million. What is more, 27,449 years of healthy life were lost due to dementia across New Zealand. In view of these statistics research on the needs of people with dementia is needed.
Current research in New Zealand leans towards analysing service provision using risk and quality audits or behavioural surveys rather than attempting to understand the perspective of the person with dementia or consider the value of occupational and psychosocial interventions. For that reason, the findings of this pilot study have significance for clinicians, residential care staff, funders, and policy makers. Implementing person-centred care in residential care facilities in New Zealand may help to offset some of the behavioural symptoms of dementia.
Clinically significant behavioural and psychological symptoms affect as many as 90% of people with dementia during the neurodegenerative process (Davis, Buckwalter, & Burgio, 1997). Challenging or negative behaviours that are commonly reported include wandering, resistance to care, aggression and noisiness. These behaviours increase carer stress and consequently result in people with dementia entering residential care (Allen-Burge, Stevens, & Burgio, 1999; Drug and Therapeutics Bulletin, 2007). Chenoweth, et al. (2009) recently published a large cluster randomised controlled trial on DCM involving 289 residents in multiple sites. The residential sites were randomly assigned to person-centred care, dementia care mapping, and standard care. The main finding was that person-centred care seemed to reduce agitation. In Beavis, Simpson, and Graham's (2002) literature review, DCM was reported to have good face validity and reliability however the samples identified have been poorly described, with sampling bias and low patient numbers. Alternatively, Brooker (2005) reviewed 34 DCM publications which provided some evidence that DCM has a role in practice development and research within the broad aim of improving the quality of the lived experience for people with dementia.
The over use of antipsychotic medications, hypnotics, and benzodiazepines to manage behavioural problems in dementia have been widely reported (Ballard, et al. …