McDonald, T. A. (ACKNOWLEDGE Thompson, R. (CEO) & Kwok, C. (DCEO)), 2008
Better Practice Conference, Sydney
What is the better practice initiative?
When a person has PTSD compounded by dementia the symptoms they quite often display are known as 'challenging behaviours' and frequently they are provided with the same care and treatment as others with severe dementia. In this project we have found a way to discriminate between dementia and PTSD and have developed a care pathway specific to the needs of PTSD sufferers resulting in a reduction of challenging behaviours and a stabilisation of their condition with minimal medication.
What was the trigger for this initiative?
Across Australia there is a growing tendency for people from age 55 years, with mental illnesses, to be referred to residential aged care. Provision of mental health services has been a long-term undertaking at the RSL Veterans’ Retirement Village because of the focus on Veteran health, and in particular the emergence of post traumatic stress disorder in the presence of dementia symptoms. Further, the danger to resident of using the ‘dementia’ description to encompass all cognitive and personality disorders lies in their not receiving appropriate and timely care and treatment for their mental illnesses.
What aspects of this better practice initiative makes it unique?
Post-traumatic stress disorder (PTSD) is easily mistaken for dementia in older adults and is sometimes the cause of what many refer to as ‘challenging behaviours’ yet the aetiology and treatment delivered is often that generally provided for dementia sufferers. The approach taken at the village, particularly in relation to veterans’ mental health issues, separates out residents’ needs for general aged care; specific dementia care; and psychogeriatric care so that each element of need can be assiduously diagnosed so that effective care and treatment can be provided.
What results and evidence support your initiative?
Clinical psychology services have been provided at the Village site since 2003 and within that focus, PTSD has been identified and treated. In 2005 research into PTSD needs associated key symptoms of PTSD with care interventions and provided evidence upon which a specific clinical pathway for PTSD could be developed. This pathway was introduced in 2007 and has been used to guide further investigations, psychiatric interventions, focused care and management and staff training in the care of people with both PTSD and dementia. (Results? How many are on it? What outcomes have been noted?)
What are the key success factors to making this initiative work?
It is important for aged care managers to acknowledge that not all mental confusion or disinhibited behaviours are as a result of dementia-causing disease. Staff working in high care dementia units need to learn to discern differences in symptomatology and have appropriate care options available. Families and residents also need to be core partners in any care strategies and to work with staff to implement all aspects of PTSD diagnosis and interventions.
What were the challenges and how were they overcome?
The long-term clinical psychology services identified many residents with PTSD however because this is primarily a Veterans’ service it was necessary to develop both a means for staff identification of possible PTSD affected residents, and to initiate a plan of care and treatment. The PTSD clinical pathway was designed to ensure that diagnosis is confirmed by appropriately qualified personnel and that interventions and care go beyond that provided to general aged care and dementia cases and includes specifically tailored psychiatric care.
Resources were allocated in relation to increased clinical psychology hours; employment of psychiatric nurses; staff training and changes to documentation and alert systems.
Outline the strategies involved in implementing this initiative.
Initial commitment by management to providing psychogeriatric services including PTSD care and support led into (i) provision of clinical psychology services; (ii) employment of psychogeriatric qualified nurses; (iii) development of clinical pathway for PTSD sufferers; (iv) staff training in care and management of PTSD; and (v) ongoing research and evaluation of outcomes of interventions for this group of Australian veterans.
CITATION McDonald, T. A. (2008) Meeting the special needs of Veterans with Post Traumatic Stress Disorder (PTSD) Better Practice Conference. National Aged Care Standards and Accreditation Agency, Sydney