Agitation near the end of life with dementia: An ethnographic study of care

Gerard Leavey, Elizabeth L. Sampson, Gill Livingston, Aisling Stringer

    Research output: Contribution to journalArticle

    Abstract

    Background and objectives Agitation is common in people living with dementia especially at the end of life. We examined how staff interpreted agitation behavior in people with dementia nearing end of life, how this may influence their responses and its impact on the quality of care. Research design Ethnographic study. Structured and semi-structured non-participant observations (referred to subsequently in this paper as “structured observations”) of people living with dementia nearing the end of life in hospital and care homes (south-east England) and in-depth interviews with staff, conducted August 2015-March 2017. Methods Three data sources: 1) detailed field notes, 2) observations using a structured tool and checklist for behaviors classed as agitation and staff and institutional responses, 3) staff semi-structured qualitative interviews. We calculated the time participants were agitated and described staff responses. Data sources were analyzed separately, developed continuously and relationally during the study and synthesized where appropriate. Results We identified two main ‘ideal types’ of staff explanatory models for agitation: In the first, staff attribute agitated behaviors to the person’s “moral judgement”, making them prone to rejecting or punitive responses. In the second staff adopt a more “needs-based” approach in which agitation behaviors are regarded as meaningful and managed with proactive and investigative approaches. These different approaches appear to have significant consequences for the timing, frequency and quality of staff response. While these models may overlap they tend to reflect distinct organizational resources and values. Conclusions Care worker knowledge about agitation is not enough, and staff need organizational support to care better for people living with dementia towards end of life. Positional theory may help to explain much of the cultural-structural context that produces staff disengagement from people with dementia, offering insights on how agitation behavior is reframed by some staff as dangerous. Such behavior may be associated with low-resource institutions with minimal staff training where the personhood of staff may be neglected.

    LanguageEnglish
    Article numbere0224043
    Pages1-19
    Number of pages19
    JournalPLoS ONE
    Volume14
    Issue number10
    DOIs
    Publication statusPublished - 23 Oct 2019

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    dementia
    agitation
    Dementia
    Information Storage and Retrieval
    interviews
    Interviews
    Personhood
    Quality of Health Care
    Home Care Services
    Checklist
    England
    Research Design
    experimental design

    Cite this

    Leavey, Gerard ; Sampson, Elizabeth L. ; Livingston, Gill ; Stringer, Aisling . / Agitation near the end of life with dementia: An ethnographic study of care. In: PLoS ONE. 2019 ; Vol. 14, No. 10. pp. 1-19.
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    abstract = "Background and objectives Agitation is common in people living with dementia especially at the end of life. We examined how staff interpreted agitation behavior in people with dementia nearing end of life, how this may influence their responses and its impact on the quality of care. Research design Ethnographic study. Structured and semi-structured non-participant observations (referred to subsequently in this paper as “structured observations”) of people living with dementia nearing the end of life in hospital and care homes (south-east England) and in-depth interviews with staff, conducted August 2015-March 2017. Methods Three data sources: 1) detailed field notes, 2) observations using a structured tool and checklist for behaviors classed as agitation and staff and institutional responses, 3) staff semi-structured qualitative interviews. We calculated the time participants were agitated and described staff responses. Data sources were analyzed separately, developed continuously and relationally during the study and synthesized where appropriate. Results We identified two main ‘ideal types’ of staff explanatory models for agitation: In the first, staff attribute agitated behaviors to the person’s “moral judgement”, making them prone to rejecting or punitive responses. In the second staff adopt a more “needs-based” approach in which agitation behaviors are regarded as meaningful and managed with proactive and investigative approaches. These different approaches appear to have significant consequences for the timing, frequency and quality of staff response. While these models may overlap they tend to reflect distinct organizational resources and values. Conclusions Care worker knowledge about agitation is not enough, and staff need organizational support to care better for people living with dementia towards end of life. Positional theory may help to explain much of the cultural-structural context that produces staff disengagement from people with dementia, offering insights on how agitation behavior is reframed by some staff as dangerous. Such behavior may be associated with low-resource institutions with minimal staff training where the personhood of staff may be neglected.",
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    Leavey, G, Sampson, EL, Livingston, G & Stringer, A 2019, 'Agitation near the end of life with dementia: An ethnographic study of care', PLoS ONE, vol. 14, no. 10, e0224043, pp. 1-19. https://doi.org/10.1371/journal.pone.0224043

    Agitation near the end of life with dementia: An ethnographic study of care. / Leavey, Gerard; Sampson, Elizabeth L.; Livingston, Gill; Stringer, Aisling .

    In: PLoS ONE, Vol. 14, No. 10, e0224043, 23.10.2019, p. 1-19.

    Research output: Contribution to journalArticle

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