Eilon Caspi, assistant research professor in the UConn Institute for Collaboration on Health, Intervention, and Policy (InCHIP) is publishing a book to help understand and prevent harmful interactions between residents with dementia in long-term care homes.
Caspi’s interest in the phenomenon began more than a decade ago when he conducted a study in two secured dementia care homes operated in an assisted living residence in Massachusetts. In this study, he looked at the circumstances surrounding these episodes and the psychosocial strategies direct care staff used to prevent and de-escalate them.
Caspi quickly realized there was little research examining this phenomenon.
A study by researchers at Cornell University found one in five residents are involved in a verbal, physical, or sexual incident every month. Studies have also shown these incidents can result in serious consequences as residents with dementia are at risk of physical injury such as when they are pushed by other residents and fall. In another study, Caspi examined the circumstances surrounding the death of 105 residents as a result of these incidents.
Caspi’s book is the culmination of years of research designed to help address this pervasive, but largely overlooked, public health problem.
His book is organized into three main sections: the spectrum and consequences of these incidents and twelve guiding principles for addressing them; contributing factors, causes, and triggers; and prevention and de-escalation strategies.
The book is designed to help direct care staff, nurses, social workers, administrators, and even family members of those living in long-term care homes.
The vast majority of these incidents are preventable. It’s a misconception that nothing can be done — Eilon Caspi
Often, these episodes are thought of as unpredictable and thus inevitable. However, Caspi emphasizes that in most situations, there are warning signs and situational triggers.
“The vast majority of these incidents are preventable,” Caspi says. “It’s a misconception that nothing can be done.”
Another major misconception Caspi hopes his book can help clear up is the perception that people with dementia are aggressive. In most situations, these incidents occur, not because those involved are inherently aggressive, but because their psychological and or other human needs are not being met, and when the interpersonal situational frustrations they experience are not addressed at all or in time.
“While a very small subgroup of individuals with dementia may be truly aggressive, the vast majority are not,” Caspi says. “And that’s one of the main messages of the book.”
For example, incidents often start when one resident in the mid-to-late stages of dementia invades the personal space of another, or enters another resident’s bedroom or bathroom.
The situation of living in a long-term care home in and of itself is often deeply frustrating to some residents. Most residents never chose to live in these environments and are now forced to spend their days and evenings with other residents, many of whom also have dementia, typically in small quarters, or share a bedroom with a stranger.
One of the chief challenges Caspi identifies in the book is how understaffing can contribute to dangerous incidents. Caring and dedicated, but overworked, staff often find it challenging to supervise all residents with dementia, which can allow incidents to develop and escalate.
“When you’re understaffed in an assisted living residence or a nursing home, it’s not only cruel to the residents with dementia whose needs are not being met, it’s also cruel to the care staff who are doing their best to care for them and keep them safe,” Caspi says.
Aside from having safe people-to-people ratios at all times, Caspi says care homes also need to put resources into making sure their staff are well-trained so that they can understand, prevent, and de-escalate these incidents.
One of the best ways to prevent these episodes is investing in a robust recreation therapy program. When residents with dementia are meaningfully engaged in an activity they enjoy, such as music therapy, art therapy, pet therapy, aroma therapy, or visiting with toddlers, they are much less likely to become involved in these incidents.
Caspi says it is important to acknowledge that people with dementia have unique histories, interests, and remaining abilities. With the right emotional supports and “cognitive crutches,” most people with dementia are capable of living fulfilling lives despite their cognitive disabilities.
Forming genuine relationships with residents can help avoid harmful incidents by better understanding each person’s unique life history, copying style, likes, dislikes, abilities, disabilities, and preferences.
“If you form close and trusting relationships with people with dementia, you’re in a much better position to detect subtle changes from baseline and what underlies their behavioral expressions,” Caspi says. “You’re also in a better able to prevent and de-escalate these episodes.”
Caspi has also developed an online companion to the book. The online manual called “Assessment and Prevention Plan Tools” will help care professionals identify and document causes or situational triggers for a resident’s engagement in these incidents and assist them in developing individualized care plans for meeting the human needs underlying these episodes.
Caspi’s book is now available for preorder online.
Caspi holds a Ph.D. from the University of Massachusetts, Boston. Beyond this phenomenon, his research interests include improving understanding and prevention of elder mistreatment in long-term care homes such as neglect of healthcare, financial exploitation, and thefts of opioid pain medications. He also specializes in psychosocial strategies for prevention of various forms of distressing and harmful behavioral expressions among elders living with dementia.
