Identifying the causes, prevention and management of crises in dementia. An online survey of stakeholders.
BACKGROUND
Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises.


OBJECTIVE
Our objective was to identify the main causes of crisis and interventions to treat or prevent crisis in persons with dementia based on different stakeholder perspectives.


METHODS
An online questionnaire was developed to identify the causes of crisis and appropriate interventions in a crisis. Participants included people with dementia, family carers and staff working in health and social care, including emergency and voluntary sectors, and academia.


RESULTS
The results ranked the main causes of crisis, interventions that can prevent a crisis and interventions that can be useful in a crisis. Wandering, falls and infection were highly rated as risk factors for crises across all stakeholder groups. Consumers rated aggression as less important but severity of memory impairment as much more important than the other groups did. Education and support for family carers and home care staff were highly valued for preventing crises. Well-trained home care staff, communication equipment, emergency contacts and access to respite were highly valued for managing crises.


CONCLUSIONS
We identified triggers and interventions that different stakeholders see as important for crisis in dementia. Recognition of these may be critical to planning effective and accepted support and care for people with dementia.
Dementia Care Research Centre, North East London NHS Foundation Trust, London, UK.
Ritchard
R
Ledgerd
Division of Psychiatry, University College London, London, UK.
Juanita
J
Hoe
Institute of Medical and Social Care Research, Bangor University, Bangor, UK.
Zoë
Z
Hoare
Dementia Care Research Centre, North East London NHS Foundation Trust, London, UK.
Mike
M
Devine
Dementia Care Research Centre, North East London NHS Foundation Trust, London, UK.|Division of Psychiatry, University College London, London, UK.
Sandeep
S
Toot
PSSRU, University of Manchester, Manchester, UK.
David
D
Challis
Dementia Care Research Centre, North East London NHS Foundation Trust, London, UK.|Institute of Mental Health, University of Nottingham, UK.
Martin
M
Orrell
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D003419:Crisis Intervention / Q000379:methods*; D003704:Dementia / Q000150:complications / Q000451:nursing / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000451:nursing / Q000517:prevention & control; D012307:Risk Factors; D013315:Stress, Psychological / Q000517:prevention & control; D011795:Surveys and Questionnaires
comparisons; crisis; dementia; interventions