Study On The Service And Management Standard For Dementia In Elderly Institutions

Background: Due to the kernelization of family structure and its weakening of care function,gradually,dementia care shifts from family to elderly institutions.Then the need of institutional care increase rapidly.However,most of the elderly institutions in our country still have some problems,refusing to accept dementia,lacking of systematic planning and management.The satisfaction of special needs in physical environment is not ideal.Adverse events frequently occurrence.Only pay attention to the most basic physiological and safety needs.Needs are still deficiencies in meeting high-level needs;the care of nursing home staff is in low quality which lacking of knowledge,skills and job training.The providing of professional care is less.The problem of dementia in elderly institutions has gradually drawn the attention of the government,society and academia.To formulate a certain scientific and systematic standard can guide the service and management of dementia in elderly institutions.It also can promote the care demand of the elderly.Objective: This study is based on the status and needs of dementia care services and management in China's elderly institutions,guided by general systems theory,preserved implicit memory model and Need-Driven Dementia-Compromised behavior model,formulate a set of systematic and standardized service and management specification for dementia in elderly institutions,to standardize the service and management of dementia disorders in elderly institutions.Methods: On the basis of literature research,this study interviewed 10 dementia workers,conceptualized analysis of standard sentences,and prepared the“pre-test questionnaire for dementia service and management specification of elderly institutions”,181 managers,nurses,nursing staff and other staff members in dementia care area of 22 elderly institutions were surveyed to determine the standard framework and index system;Delphi method was used to inquire 15 experts,through the integration of opinions,agreed to determine the standard review draft;Eight authoritative experts were invited to hold an expert consensus meeting to evaluate the review draft,integrated expert opinions,revised,supplement and improve standards,then formed a final draft.Results:(1)The results of the interviews showed that elderly institutions had consciously designed the physical environment to fundamentally refine the environmental design of demented,but lacked of pertinence;Relatively inadequate staffing,lacked of mastery of dementia expertise in staff training;In life caring,the elderly who still have self-care ability to work independently,caregivers only provided guidance or assistance;Measures in managing behavioral and psychological symptoms ware such as diversion,drugs,protective restraints,etc;Rehabilitation training was mostly volunteers,lacked of effectiveness and professionalism.(2)The results of the questionnaire solicitation showed that dementia workers in elderly institutions had a high degree of practical recognition of the standard sentences and their opinions were relatively consistent.so all the standard sentences could be included in the indicator system basically.There were only 8 items with inconsistent opinions.According to the suggestions and discussions,decisions were made or rejected.(3)Delphi enquiry revealed that two rounds of questionnaires had higher recovery rates and higher rates of experts,indicating that the experts had high enthusiasm and attention on the study.Cr of two rounds of experts was 0.89,indicating that 15 experts had better authority and higher credibility of results.Average value of indicators was much greater than 3.5,and the CV was less than 0.3,indicating that experts had relatively uniform opinions on the indicators.Conclusions: The service and management specification for dementia in elderly institutions established in this study is scientific,reliable and highly feasible.It provides the basis for the construction of relevant standards,lays the foundation for the standardization of service and management of dementia in elderly institutions.