translating dementia research into practice corporate partnerships translating evidence research...
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Translating dementia research into practice
Corporate partnerships • Translating evidence • Research partnerships
DEMENTIA RESEARCH
Are you sitting comfortably?
Juliet Kelly
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What is a comfortable chair?
Translating dementia research into practice
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Review of current seating practices in supporting people living with dementia in residential aged care – a pilot study
Translating dementia research into practice
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Review of current seating practices in supporting people living with dementia in residential aged care – a pilot study
Partners - Brightwater Group, Dementia Centre, HammondCare, Independent Living Centre, University of New South WalesFunded by DCRCCarers and Consumers, QUT
Translating dementia research into practice
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Translating dementia research into practice
InvestigatorsChief Investigator
• Associate Professor Christopher Poulos Hammond Chair of Positive Ageing and Care, School of Public Health and Community Medicine, University of New South Wales.
Associate Investigators
• Juliet Kelly RN, Project Manager, Researcher and Dementia Consultant.
• Robyn Chapman Chief Executive Officer Independent Living Centre NSW.
• Annette Crane Allied Health Consultant Brightwater Care Group.
• Rebecca Forbes Project Officer, HammondCare.
• Meredith Gresham Senior Dementia Consultant, HammondCare.
• Rejane LeGrange Senior Dementia Consultant, HammondCare.
• Virginia Moore Manager Customer Wellbeing Brightwater Care Group.
• Sam Neylon, Manager Specialised Services and Environmental Standards, Brightwater Care Group.
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Translating dementia research into practice
Aims• Review relevant academic and grey literature
• Identify the seating products currently used in residential aged care
• Benchmark current practice
• Identify and describe seating principles for people living with dementia and impaired posture
• Lay a foundation for future research and practice development
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Significance and impact
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What is postural care?
• Maintaining range of movement and joint mobility
• Supporting neutral posture to prevent destructive posture and pressure damage
• Maintaining upright seated posture for as long as possible
• Appreciation of the role of a supported, stable, upright posture to create physical comfort and the significance of this in enabling the person to optimise their functional capacity
• What can we support the person to “do” ?
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“How” of good postural care
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• Assessment and early intervention by experts
• An enablement approach
• 24hr plan includes resident goals, therapeutic intervention
• Fit of seating...stable pelvis, knees, shoulders, feet; supported trunk, thighs, neck, head
• Frequent changes of position - different chairs for different activities
• Supporting fixed distortions and preventing further deterioration
• Understanding how to use tilt and recline and gravity
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“Why” of postural care?
• Posture affects many aspects of human function
• Breathing• Circulation• Eating, drinking,
nutrition
• Pressure damage and skin integrity
• Muscular skeletal functioning
• Social interaction• Visual field• Cognition
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Maximises person’s potential
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Lack of postural care precipitates advanced dementia
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Postural care means “living better” with dementia
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What is the most uncomfortable sitting experience?
• The aeroplane seat• But this is what is
often expected in residential aged care
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The residential aeroplane seat
• Breakfast in bed • Bed bath or shower• Seated in a reclined
pressure relief chair• Wheeled to communal
area• Sat up for morning tea
• Might go to “an activity" for 30 minutes
• Sat up for lunch, • Continence care• Afternoon tea, sat up • Sat up for dinner• Bed
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Postures of concern• Recline 1 • Trying not to slip out
• Bracing with heels• Bracing with elbows• Increases tone in joints• Reduced body contact
with chair• Lifting head to see• Exhausting
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Postures of concern• Recline 2 • Slipping out
• Shearing causing skin damage
• Head unsupported• Reduced body contact
with chair increasing pressure at points of contact
• Uncomfortable
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Recline and tilt • Deep, soft chair creates
curled up posture• Seat /back position• Lack of strength to stabilise
shoulders • Visual field disrupted• Complex mechanisms• Identity
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Redefining comfortable
• Physical comfort is challenged by ageing and co morbidities
• A structured chair which supports an aligned and upright posture may be more comfortable than the large soft chair
• Enables function, social engagement and human interaction and contributes to maintaining personhood.....a wider sense of comfort
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We’ve come a long way.....
• Aged care and dementia care workforce are hard working and doing their best with the knowledge, skills and resources available
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Risks we need to take.....
• Investment in different types of seating which better support functional capacity
• Individually customised wheelchair seating
• Investment in more allied staff to support the knowledge and skill development required of care workers
• 24/7 x 365postural care
• Change a persons position more frequently
• Enable and maintain function by preventing postural decline
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Barriers
• W/C belongs in disability; culture of nihilism in dementia.
• Limited perception of comfort
• Difference between seating for function and seating for resting not appreciated.
• Complexity of continuous assessment.
• Multidisciplinary working Vs interdisciplinary working on resident identified goals
• Lack of awareness of the fundamental nature of postural care
• Resource allocation, professional staff and equipment
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Outcomes of improving postural care
• Increased physical comfort
• Fewer and less severe joint contractures and pressure damage
• Improved respiratory and digestive function, reduce modified diets
• Greater levels of social engagement
• Fewer behaviours of excess or omission in the person living with dementia
• Alter the progression of dementia
• Improved quality of life for the person with dementia
• Improved manual handling for care staff and improved ability to provide care.
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What next.....?• A service which is able to pool, adjust, rebuild and reallocate
resources according to individual need has greater opportunity to provide the right therapeutic seating intervention
• Maintenance of seating resources
• Investment in knowledge and skills development for care workers and resources
• Cost/benefit analysis of seating intervention considering full range of short and long term outcomes for person living with dementia, families and staff. Extending evidence base.
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What next...?
• Work closely with OTs and Physios who already have this knowledge; e.g. providing stretch through bed positioning
• Look at residents postures and make adjustments to support neutral positions
• Be prepared to make frequent small adjustments to position
• Don’t expect people to sit in the same chair/one position all day
• Plan care which maintain body alignment to prevent pressure damage and maintain function
• Question cause of physical decline; is it disease process or care practises
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Further information
• Study report shortly to be published at DCRC Carers and Consumers website
• HammondCare 10 tips for postural care and seating
Free download available on the HammondPress website
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