Focusing on cohesion and support among staff is key to improving the wellbeing of aged care residents with depression and dementia-related behaviours, and those who care for them, according to new research.
The Institute for Health & Ageing (IHA) at Australian Catholic University developed and evaluated a new program that develops the knowledge, skills and confidence of aged care staff in dealing with depression and behavioural and psychological symptoms of dementia (BPSD) among residents.
The program then focuses on organisational factors, such as creating trust and cohesion between managers, nurses and personal care assistants, to empower and support frontline workers to identify and act on issues for residents in their care related to depression and BPSD.
The study implemented the training program at 21 residential care facilities across five different organisations, which included 252 staff and 378 residents.
The researchers investigated whether the program improved identification and referral for treatment of depression among residents and whether the level of BPSD for identified residents decreased.
IHA director Professor Marita McCabe said they found the number of people who were both identified and referred for depression went up both after the intervention and the three-month follow up, while the incidence of those dementia behaviours also went down at both.
“What was really pleasing was that because this had become embedded in their practice due to change in the organisational factors, this was maintained at follow up,” Professor McCabe told Australian Ageing Agenda.
She said the findings highlighted the importance of developing the skills of aged care staff while highlighting ways for aged care facilities to sustain changes in practice.
“Training on its own is not enough,” Professor McCabe said. “That knowledge is going to make staff feel better about their skill base and understanding but it won’t translate into improvements for residents unless there is a change to the way in which the organisation works.”
She said this approach helped staff recognise that dealing with depression and mental health issues was a part of their work and they felt empowered and far more likely to act.
The research also found that staff involved in the training experienced lower carer strain, a significant improvement in workplace trust, cohesion, communication and support, reduced absenteeism, and improvements in the mental health referral process in their facility.
Gold Age Respite and Aged Care Services was one of the providers to take part in the study. Clinical operations manager Karen McCauley said the results of the program had been significant.
“Since completing the training across all our sites and implementing the recommended protocols, staff have been more alert to the signs and symptoms of depression,” she said.
“Before, they would write off symptoms of unusual behaviour in their aged care clients and assume it was a one-off. Now they are able to recognise that something is wrong, and know exactly how and where to refer residents for treatment.”
The training program
The project addressed previous research findings indicating high rates of undiagnosed or untreated depression in aged care, said Professor McCabe. It also responded to previous IHA training programs, which led to improved knowledge and skills among aged care staff in dealing with depression and BPSD, but no change in how it was being managed.
“There was no change because residential care facilities are very hierarchical. We felt there was a need to change the way the organisation worked if that training was to be put into practice,” said Professor McCabe.
Recent feedback from participating facilities was that the model was still working 18 months later and incidences of BPSD were continuing to fall, she said.
As each organisation had both intervention and control, Professor McCabe said they could see the huge differences.
“The philosophy and the ethos were the same in the different facilities because they were the same organisation but they could see massive changes in the practice of staff and the care of residents in the intervention compared to the control.”
Following the study, the participating organisations rolled out the training program themselves to their other facilities, Professor McCabe said.
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