Dancing with older people with dementia : a psychomotor intervention in care homes

• Main Author: Guzmán García, Azucena
• Published: University of Newcastle Upon Tyne 2012
• Subjects: 616.83
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.566947

In an independent report to the Department of Health on the use of antipsychotic medication for people with dementia, the seventh recommendation states: ‘There is a need to develop a curriculum for the development of the appropriate skills for care home staff in the nonpharmacological treatment of behavioural disorder in dementia, including the deployment of specific therapies with positive impact…’ (Banerjee, 2009). This built upon the work of the National Dementia Strategy, which recommended, in connection with care homes, ‘the formulation and deployment of non-pharmacological management strategies for behavioural disorder in dementia, so avoiding the initiation of antipsychotic medication’ (Department of Health, 2009). As I shall discuss, the evidence base for any particular form of nonpharmacological management of the behavioural and psychological symptoms of dementia (BPSD) is thin. In this thesis, I have sought to investigate Danzón (Latin ballroom dance), following the psychomotor dance-based approach as a feasible non-pharmacological intervention for care homes. I have used the Medical Research Council framework (MRC) as a model to inform the development of the intervention. Thus, in the first chapter of this thesis, a systematic literature review of qualitative and quantitative studies of dancing with older people with dementia, living in long-term care is presented. Although methodological difficulties are apparent and limited evidence found, it can be argued that dancing has promise as an intervention. The second chapter describes a qualitative pilot study, which aimed to investigate the effect of introducing the Danzón psychomotor intervention (DPI) for 13 participants with dementia living in care homes, with care staff acting as facilitators of the dance sessions. This led to two separate conceptual models, outlining positive outcomes and negative concerns around the use of Danzón, and depicting both the experiences of people with dementia and care staff. The third chapter presents an exploratory trial which focuses on individual variability (n=10) using a multiple-baseline single-case design with three phases: (A) pre intervention (B) dancing intervention and (C) a naturalistic observational follow-up period to measure individualised mood, behaviour and quality of life with standardized outcome measures. Results revealed that from the 32 individualised items, 21 had a positive small to medium effect; eight items showed no change and three items negative changes. In addition to the primary data analysis, in order to estimate the effect size and test the feasibility of a future Randomized Control Trial, group analyses were undertaken. The fourth chapter describes the qualitative evaluation of the dancing intervention facilitated by an external researcher. Participants were interviewed and questionnaires were collected from available care staff and relatives (n=35). Responses are presented in relation to the different experiences across the three private care homes. Overall, all residents provided positive responses. However, there was some concern amongst staff about the possibility of continuing to implement dancing because of work load and staff shortages. The fifth chapter discusses the contributions from the findings of this thesis to the National Dementia Strategy, as well as research limitations, intervention recommendations, and directions for future research. Despite some negative findings, I conclude that DPI can enhance positive mood, change dysfunctional behaviours, and improve general levels of satisfaction for care staff. The results (a) support a larger controlled experiment in keeping with the MRC framework, and (b) suggest the development of DPI as a potential non-pharmacological intervention to be facilitated by care staff, which – in keeping with national policy – should contribute to a reduction in the use of antipsychotic medication to treat behavioural and psychological symptoms in people with dementia.