Behaviour assessment tools in long-term care homes in Canada: a survey

Abstract

Objective

Many people living in long-term care homes (LTCH) experience changes in behaviour termed the behavioural and psychological symptoms of dementia (BPSD). The valid and reliable assessment of BPSD is essential to guide treatment and monitor the effect of interventions. The aim of this study was to identify behavioural assessment tools implemented in LTCH and factors that impact on their use in clinical care.

Methods

We completed an online mixed-design survey of 300 randomly selected Canadian LTCH between September and November 2018. Respondents were asked to report tools used, reasons for use, methods of administration, training/supports available, confidence in use and challenges faced. Survey results were summarized descriptively and the correlation between implementation supports and confidence examined. Free-text responses were analysed qualitatively.

Results

Of 300 LTCH invited to participate, 103 completed the survey. Homes reported using a mean 2.2 ± 1.1 (range 0-7) different tools. The two most commonly used tools were the Dementia Observation System (DOS) and Cohen-Mansfield Agitation Inventory (CMAI). Overall confidence in most aspects of tool use was reported to be high, with workload identified as the greatest challenge. Training and supports correlated with confidence in tool use. Qualitative findings indicate tools provide valuable data to understand behaviours, facilitate team communication, target interventions and track outcomes.

Conclusions

Behavioural assessment tools, in particular a direct observation tool, are widely used in clinical care in Canadian LTCH. Education, enhanced resources, leadership support and applications of technology represent opportunities to improve their use.

Keywords:

• Long-term care
• nursing home
• dementia
• behavioural and psychological symptoms of dementia
• responsive behaviour
• neuropsychiatric symptoms
• measurement

Disclosure statement

The authors have no financial conflicts to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by The Walter and Maria Schroeder Institute for Brain Health and Innovation and The Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 11. CCNA is supported by a grant from the Canadian Institutes of Health Research with funding from several partners (CIHR Funding Reference Number CAN 137794).