Translating dementia research into practice Corporate partnerships Translating evidence Research partnerships DEMENTIA RESEARCH Are you sitting comfortably?

Translating dementia research into practice

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DEMENTIA RESEARCH

Are you sitting comfortably?

Juliet Kelly

What is a comfortable chair?


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Review of current seating practices in supporting people living with dementia in residential aged care – a pilot study


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Review of current seating practices in supporting people living with dementia in residential aged care – a pilot study

Partners - Brightwater Group, Dementia Centre, HammondCare, Independent Living Centre, University of New South WalesFunded by DCRCCarers and Consumers, QUT


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InvestigatorsChief Investigator

• Associate Professor Christopher Poulos Hammond Chair of Positive Ageing and Care, School of Public Health and Community Medicine, University of New South Wales.

Associate Investigators

• Juliet Kelly RN, Project Manager, Researcher and Dementia Consultant.

• Robyn Chapman Chief Executive Officer Independent Living Centre NSW.

• Annette Crane Allied Health Consultant Brightwater Care Group.

• Rebecca Forbes Project Officer, HammondCare.

• Meredith Gresham Senior Dementia Consultant, HammondCare.

• Rejane LeGrange Senior Dementia Consultant, HammondCare.

• Virginia Moore Manager Customer Wellbeing Brightwater Care Group.

• Sam Neylon, Manager Specialised Services and Environmental Standards, Brightwater Care Group.

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Aims• Review relevant academic and grey literature

• Identify the seating products currently used in residential aged care

• Benchmark current practice

• Identify and describe seating principles for people living with dementia and impaired posture

• Lay a foundation for future research and practice development

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Significance and impact


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What is postural care?

• Maintaining range of movement and joint mobility

• Supporting neutral posture to prevent destructive posture and pressure damage

• Maintaining upright seated posture for as long as possible

• Appreciation of the role of a supported, stable, upright posture to create physical comfort and the significance of this in enabling the person to optimise their functional capacity

• What can we support the person to “do” ?


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“How” of good postural care


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• Assessment and early intervention by experts

• An enablement approach

• 24hr plan includes resident goals, therapeutic intervention

• Fit of seating...stable pelvis, knees, shoulders, feet; supported trunk, thighs, neck, head

• Frequent changes of position - different chairs for different activities

• Supporting fixed distortions and preventing further deterioration

• Understanding how to use tilt and recline and gravity

“Why” of postural care?

• Posture affects many aspects of human function

• Breathing• Circulation• Eating, drinking,

nutrition

• Pressure damage and skin integrity

• Muscular skeletal functioning

• Social interaction• Visual field• Cognition


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Maximises person’s potential

Lack of postural care precipitates advanced dementia


Postural care means “living better” with dementia


What is the most uncomfortable sitting experience?

• The aeroplane seat• But this is what is

often expected in residential aged care


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The residential aeroplane seat

• Breakfast in bed • Bed bath or shower• Seated in a reclined

pressure relief chair• Wheeled to communal

area• Sat up for morning tea

• Might go to “an activity" for 30 minutes

• Sat up for lunch, • Continence care• Afternoon tea, sat up • Sat up for dinner• Bed


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Postures of concern• Recline 1 • Trying not to slip out

• Bracing with heels• Bracing with elbows• Increases tone in joints• Reduced body contact

with chair• Lifting head to see• Exhausting


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Postures of concern• Recline 2 • Slipping out

• Shearing causing skin damage

• Head unsupported• Reduced body contact

with chair increasing pressure at points of contact

• Uncomfortable


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Recline and tilt • Deep, soft chair creates

curled up posture• Seat /back position• Lack of strength to stabilise

shoulders • Visual field disrupted• Complex mechanisms• Identity


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Redefining comfortable

• Physical comfort is challenged by ageing and co morbidities

• A structured chair which supports an aligned and upright posture may be more comfortable than the large soft chair

• Enables function, social engagement and human interaction and contributes to maintaining personhood.....a wider sense of comfort


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We’ve come a long way.....

• Aged care and dementia care workforce are hard working and doing their best with the knowledge, skills and resources available


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Risks we need to take.....

• Investment in different types of seating which better support functional capacity

• Individually customised wheelchair seating

• Investment in more allied staff to support the knowledge and skill development required of care workers

• 24/7 x 365postural care

• Change a persons position more frequently

• Enable and maintain function by preventing postural decline


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Barriers

• W/C belongs in disability; culture of nihilism in dementia.

• Limited perception of comfort

• Difference between seating for function and seating for resting not appreciated.

• Complexity of continuous assessment.

• Multidisciplinary working Vs interdisciplinary working on resident identified goals

• Lack of awareness of the fundamental nature of postural care

• Resource allocation, professional staff and equipment


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Outcomes of improving postural care

• Increased physical comfort

• Fewer and less severe joint contractures and pressure damage

• Improved respiratory and digestive function, reduce modified diets

• Greater levels of social engagement

• Fewer behaviours of excess or omission in the person living with dementia

• Alter the progression of dementia

• Improved quality of life for the person with dementia

• Improved manual handling for care staff and improved ability to provide care.


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What next.....?• A service which is able to pool, adjust, rebuild and reallocate

resources according to individual need has greater opportunity to provide the right therapeutic seating intervention

• Maintenance of seating resources

• Investment in knowledge and skills development for care workers and resources

• Cost/benefit analysis of seating intervention considering full range of short and long term outcomes for person living with dementia, families and staff. Extending evidence base.


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What next...?

• Work closely with OTs and Physios who already have this knowledge; e.g. providing stretch through bed positioning

• Look at residents postures and make adjustments to support neutral positions

• Be prepared to make frequent small adjustments to position

• Don’t expect people to sit in the same chair/one position all day

• Plan care which maintain body alignment to prevent pressure damage and maintain function

• Question cause of physical decline; is it disease process or care practises


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Further information

• Study report shortly to be published at DCRC Carers and Consumers website

• HammondCare 10 tips for postural care and seating

Free download available on the HammondPress website


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Translating dementia research into practice Corporate partnerships Translating evidence Research partnerships DEMENTIA RESEARCH Are you sitting comfortably?