None listed
Conditions
Brief summary
Compared with the general population, people with dementia and cognitive impairment are almost twice as likely to present to emergency departments (EDs). For people with dementia a sudden change in environment to a busy ED with unfamiliar care providers, coupled with acute injury or illness, can cause rapid disorientation and decline in responsive behaviours. When responsive behaviours such as wandering, agitation and aggression occur in the ED, they are typically managed with restrictive interventions or one-on-one nursing care. However, chemical restraint in the form of psychoactive or sedating medications can lead to worsening symptoms or delirium. One-on-one nursing is expensive and often conducted by unskilled staff who have neither the knowledge nor the experience to provide therapeutic interventions. While non-pharmacological treatments to manage responsive behaviours have been proposed as the gold standard, especially in sub-acute and residential aged care settings the evidence about their effectiveness in EDs is scarce. In this study we will determine the effectiveness of a therapeutic activity kit in ED patients who exhibit or are at risk of developing responsive behaviours, on the need for one-on-one nursing and chemical or physical restraint.
Interventions
Intervention: Therapeutic Activity Kit
The therapeutic activity kit is a container that contains a number of different activities and sensory stimuli with the aim of engaging the person with dementia. Similar kits have been previously used in reported literature; however, no commercially available kit is available (all of the constituents are commercially available). The investigators will assemble the kits prior to the commencement of the study.
Specifically, the kit contains:
• Word Searc
Intervention: Therapeutic Activity Kit The therapeutic activity kit is a container that contains a number of different activities and sensory stimuli with the aim of engaging the person with dementia. Similar kits have been previously used in reported literature; however, no commercially available kit is available (all of the constituents are commercially available). The investigators will assemble the kits prior to the commencement of the study. Specifically, the kit contains: • Word Search Puzzles • Doodling • Colouring • Reminiscence Cards • Playing Cards • Colour Changing Egg • Towel Folding • Music • Doll Participants who are randomised to the intervention will receive the kit, and in conjunction with the investigator and significant others (family), all of the contents will be explained and shown to the participant. The participant is free to use any of the contents of the kit, and they may also choose not to interact with the kit. The patient is monitored every 30min for the first two hours and then hourly after that for the entirety of their emergency stay by the study investigator, part of this monitoring is noting what aspects of the kit the participant is interacting with and what behaviours they may be displaying. Patients will only be monitored for the duration of their emergency department stay (median of 6 hours from previous work).
Sponsors
Rosemarry Bryant Foundation
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Caregiver)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants will be eligible for randomisation if they are exhibiting responsive behaviours or are at risk of responsive behaviours and have a surrogate decision-maker available to the research team to consent on behalf of the patient. As all Participants who have dementia and are being treated in an ED are at risk of developing responsive behaviours then all Participants with dementia who present to the ED will be eligible for this study. Responsive behaviours will be assessed by a standardised checklist that has been developed from the literature specifically for this study Inclusion Criteria To be included in the trial a Participant must meet all of the following criteria: • Participant has a history of dementia • Participant is currently exhibiting responsive behaviours or are at risk of developing responsive behaviours. • Participant has a surrogate decision maker available to provide informed consent to participate in the study.
Exclusion criteria
A Participant who meets any of the following criteria will be excluded from participation in the trial: • Participant has cognitive impairment due to cause other than dementia (e.g. organic illness, traumatic brain injury, hypoxia, etc.) • Participants with end stage dementia who are unlikely to benefit from any therapeutic intervention. • Patents whose illness or injury is of a sufficiently serious nature to prevent them from interacting with the therapeutic activity kit. • No surrogate decision maker is available to provide informed consent to participate.
Outcome results
None listed