The developed world is on the brink of a population explosion of people aged 65 years and over. Accompanying old age is a higher incidence of disease and disability. Health care professionals and governments have to put in place infrastructure to deal with this growing problem. Economic factors have driven government policies designed to keep these older people in the care of their families. For this to happen families need support to help manage this often substantial burden of care. Respite care is one option for support, where the older person is placed in alternative, short-term care while the home caregiver has a break.
Respite care takes many forms, but the one chosen for examination in this thesis is residential respite care, where the older person stays at a residential respite care facility for an extended period of time, usually one week or more. Older people with some level of dependency most commonly require this care option, and a significant number of these people have dementia. Dementia affects the cognitive, functional, psychiatric and behavioural domains of a person.
The prevalence of behavioural problems in Australian residential aged care facilities has been reasonably well established, but this phenomenon has not been examined in the very different respite care population who access these facilities for shorter periods. Within the literature, five non-Australian studies that examined the influence residential respite care has on the behaviour of older people were found. These studies gave contradictory results, ranging from a worsening of behaviour, to no change, to an improvement in behaviour. While there is good evidence that residential respite care is associated with a reduced carer burden, there is inconclusive evidence that residential respite care has a significant effect on disruptive behaviour displayed by older people. Against this background of available empirical evidence three studies were conducted to investigate the impact of residential respite care admissions to aged care facilities in a provincial Australian city.
The aim of Study One was to determine whether residential respite care for older people was used because of disruptive behaviour. A quantitative approach, using a cross-sectional survey, was employed. The subjects were older people (N=35) admitted for residential respite care. Disruptive behaviours were rated by primary nurses one week after admission using the Dementia Behaviour Disturbance Scale (DBDS: Baumgartner, Becker & Gauthier 1990). The DBDS was identified as the most appropriate measurement tool. Elderly widows who live alone in their own homes are most likely to be admitted for residential respite care. Giving a home caregiver a "break" from older people displaying disruptive behaviour was the major reason for nearly half of the residential respite admissions. People with dementia scored significantly higher than people without dementia on the DBDS. The majority of dementia sufferers were prescribed psychotropic medications. It was concluded that despite residential respite care being offered primarily to assist with caregiver burden it is not being used significantly for older people who display disruptive behaviour.
In Study Two the inter-rater and test-retest reliability of the DBDS was studied in older people (N=10) admitted for respite care in a residential aged care facility. The DBDS demonstrated good inter-rater (0.93) and test-retest reliability (0.942). This study provided support for the contention that the DBDS is a reliable measure of behaviour disturbance among older people admitted for residential respite care in aged care facilities.
The principal aim of Study Three was to examine the impact of residential respite care on disruptive behaviour displayed by community-residing older people, particularly those with dementia. A subsidiary aim was to examine the relationship between respite care, disruptive behaviour and carer burden. A prospective, repeated measures design was employed. The subjects were older people (N=100) booked for a respite admission. Disruptive behaviours were rated by home caregivers (N=100) and primary nurse (N = 25) using the DBDS. The majority of the sample was widowed females living in their own home. One-third of the sample had a reported diagnosis of dementia. Results indicated that residential respite care was associated with a significant reduction in the frequency of reported disruptive behaviours in older people. Dementia and carer burden are strong predictors of disruptive behaviour. Nurses and home caregivers use different strategies for managing disruptive behaviour. Nurses predominantly use praise whereas home caregivers tend to use reasoning more.
Registered nurses are the primary caregivers of highly disruptive older people in residential aged care facilities. Residential respite care is increasingly recognised as an important component of health care service delivery for older people. As the population ages the number of people requiring respite care in residential aged care facilities will increase. The most likely group of residential respite care recipients to exhibit disruptive behaviour will be those with dementia. The findings reported in this thesis indicated that residential respite care is likely to be associated with a temporary improvement in the respite care recipient's behaviour.