DEMENTIA RESEARCH

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

Partner logo here What is a comfortable chair? Translating dementia research into practice

Partner logo here Review of current seating practices in supporting people living with dementia in residential aged care – a pilot study Translating dementia research into practice

Partner logo here 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 Wales Funded by DCRC Carers and Consumers, QUT Translating dementia research into practice

Partner logo here Investigators Chief 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. Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here Significance and impact Translating dementia research into practice

Partner logo here 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” ? Translating dementia research into practice

Partner logo here “How” of good postural care • 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 Translating dementia research into practice

Partner logo here “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 Maximises person’s potential Translating dementia research into practice

Lack of postural care precipitates advanced dementia Translating dementia research into practice

Postural care means “living better” with dementia Translating dementia research into practice

Partner logo here What is the most uncomfortable sitting experience? • The aeroplane seat • But this is what is often expected in residential aged care Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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. Translating dementia research into practice

Partner logo here 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. Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

Partner logo here 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 Translating dementia research into practice

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DEMENTIA RESEARCH