NMHS43230 Cognit & Mental Health in Old

Academic Year 2021/2022

This module introduces issues related to the cognitive impairment and mental health of older people. It includes a review of current physiological understandings of brain changes in the older adult and distinguishes between age related changes and disease pattern changes. The module also critically reviews mental health issues related to the older person population.

The aims of the module are:
• 1. critically review the distinctions between normal ageing and pathological patterns in relation to cognitive impairments in older people.
2. analyse delirium in older people.
3. examine the NICE guidelines on dementia care (Best practice in screening, management).
4. understand the components of dementia care audits
5. provide an opportunity to examine the pathophysiological changes in dementia.
6. review the complementary therapies in dementia care.
7. promote individual identity in dementia care.
8. examine issues related to ethics, capacity (Functional, status and outcome approaches) and the law (Irish & UN Convention).
9. understand symptom management in dementia: pain, aggression, agitation, etc
10. facilitate an understanding of processes of dementia trajectories.
11. review common mental health challenges for older people.
12. integrate person centred care approaches (dementia care mapping).
13. integrate person centred care for older people with mental health challenges (depression, personality disorders, self-neglect etc).

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Curricular information is subject to change

Learning Outcomes:

On completion the candidate will be able to demonstrate:

• the ability to understand normal processes of age related changes in cognition versus pathological changes due to disease processes.
• the capacity to critically understand dementia in older people: process, progress and associated co-morbidities.
• an appraisal of complementary therapies for people with dementia.
• a comprehensive understanding of staff responsibilities related to capacity
• the ability to articulate understandings of common mental health challenges in older populations
• the capacity to identify appropriate care delivery pathways in cognitive impairment and mental health issues in older people.
• the ability to apply skills to nursing older people using appropriate best practice, critical knowledge transfer

Indicative Module Content:

Dementia: An Introduction
Caring for caregivers
Dementia: Behavioural & psychological symptoms
Dementia: Pain Assessment in older people with dementia
Dementia: communication and changing relationships
Mental Health in older People
Care strategies for older people with cognition challenges
Legislation and policy related to decision making capacity


Student Effort Hours: 
Student Effort Type Hours
Lectures

30

Autonomous Student Learning

145

Online Learning

13

Total

188

Approaches to Teaching and Learning:
Students are presented with topics within lectures. Their active input based on experience is required. They use case based learning embedded in reflective practice, applying evidence based knowledge to practice. This improves skills and competencies. 
Requirements, Exclusions and Recommendations
Learning Requirements:

Complete Level 8 modules or APEL


Module Requisites and Incompatibles
Equivalents:
Cognit & Mental Health in Old (NMHS41980)


 
Assessment Strategy  
Description Timing Open Book Exam Component Scale Must Pass Component % of Final Grade
Assignment: Case based Coursework (End of Trimester) n/a Graded No

80

Presentation: Project Week 6 n/a Graded No

20


Carry forward of passed components
Yes
 
Resit In Terminal Exam
Summer No
Please see Student Jargon Buster for more information about remediation types and timing. 
Feedback Strategy/Strategies

• Feedback individually to students, post-assessment
• Group/class feedback, post-assessment

How will my Feedback be Delivered?

Students receive immediate general feedback on the presentation. Individual meetings with the student are then facilitated to discuss the individual grade. For the assignment, this is end of term. Students will access the grad via the provisional exam grades, but will be offered a meeting to discuss grades. All students who fail any competent will be offered additional meetings

Albers,G.,Van den Block,L., Vander Stichele, R (2014) The burden of caring for people with dementia at the end of life in nursing homes : a post death study among nursing staff . International Journal of Older People Nursing , 9 , 106-117.
Ampe, S., Sevenants,A.,Smets,T.,Decelercq,A., Van Audenhove,C. (2016) Advance care planning for nursing home residents with dementia: policy vs practice. Journal of Advanced Nursing, 72 ( 3) 569-581.
Austin, W.,Goble,Eand Strang,V. et al ( 2009) Supporting relationships between family and staff in continuing care settings . Journal of Family Nursing 15 (3)360-383
Atkinson,R 9 1998) The life story interview . Sage Publications Thousand Oaks Ca
Belanger, F.,Rodriguez,C. and Groleau,D. (2011) Shared decision making in palliative care: a systematic mixed studies review using narrative synthesis. Palliative Medicine 25 (3) , 242-261
Bauer,M.(2006) Collaboration and control : nurses’ construction of the role of family in nursing home care. Journal of Advanced Nursing 54 (1), 45-52
Bauer , M. ( 2007) Staff-family relationships in nursing home care : a typology of challenging behaviours. International Journal of older people Nursing 2 (3), 213-218.
Bauer, M. and Nay, R. ( 2010) Improving family-staff relationships in assisted living facilities: the views of family. Journal of Advanced nursing 67 (6) 1232-1241.
Beck , I., Tornquist, A. and Edberg, AK. ( 2012) Nurse assistants experience of an intervention focused on a palliative care approach for older people in residential care .International Journal of Older People Nursing , 9, 141-150
Beck , I., Jakobsson,U. and Edberg, A.K. ( 2014) Applying a palliative care approach in residential care: effects on nurse assistants’ experiences of care provision and caring climate. Scandinavian Journal of caring science . 28 (4) 830-841.
Biondo,P.D., Lee,L.D.,Davison,S.N and Simon,J.E ( 2016) How Healthcare Systems evaluate their advance care planning initiatives: results form a systematic review . Palliative Medicine 30 (8) 720-729
Benner, P., Hooper-Kyriakidis, P., Stannard,D. ( 1999) Thinking in action and reasoning in transition : an overview. In : Stannard , D ( ED) Clinical wisdom and interventions in acute critical care : A thinking in action approach . WB Saunders , Philadelphia, PA.
Brown, G ( 2011) Are our wishes respected at the end of life ? a systematic review of research evidence . www.compassionindying.org.uk/sites/default/files/systematicreviewsummary pdf
Brown-Wilson ( 2008) Using relationships to develop practice that values the contribution of older people , families and staff . International Journal of Older People Nursing , 3, 274-277.
Broderick,M.C , Coffey , A. ( 2013 ) Person-centred care in nursing documentation. International Journal of older person nursing, 8 , 309-318.
Brazil, K., Brink,P., Kaasalainen,S., Kelly,M.L, and McAiney, C ( 2012) Knowledge and perceived competence among nurses caring for dying in long term care homes. International Journal of Palliative Nursing, 18 (2) 771-83.
Buckley, C and McCarthy , G ( 2009) An exploration of connectedness as perceived by older adults in a long term setting in Ireland . Geriatric Nursing 30 , 390-396.

Bottrell, M.,O’Sullivan,J.,Robbins,M., Mitty,E. ,and Mezey,M. (2001) Transferring dying NH residents to the hospital: DON perspectives on the nurses’ role in transfer decisions. Geriatric nursing 22 (6) 313-317.
Buckley,C. ,McCormack, B. and Ryan,A ( 2013) Valuing narrative in the care of older people: a framework of narrative practice for older people adult residential care settings. Journal of Clinical nursing , 23, 2565-2577.

Casey,D, Murphy,K, Ni Leime,A, Larkin,P, Payne, S., Froggatt, K. and O’shea (2011) Dying well : factors that influence the provision of good end of life care for older people in acute and long stay settings in Ireland. Journal of clinical nursing , 20 , 1824-1833.

, CD., Griffith,J. and Arcand, M ( 2005) Decision making at the end of life in dementia : how family care givers perceive their interaction with health care providers in long term care settings . Journal of applied Gerontology 24 (3)231-47.
Connor,S. and Bermedo,M.S (eds) (2014) Global Atlas of Palliative Care at the end of life . World Health Organisation and worldwide palliative care alliance, Geneva and London.

Cooney,A.,Dowling,M. , Gannn,M.E, Dempsey,L and Murphy,K ( 2013) Exploration of the meaning of connectedness for older people in long term care in context of their quality of life : a review and Commentary. International Journal of Older People nursing
Davies , S . and Nolan,M. ( 2006) Making it better: self-perceived roles of family care givers of older people in care homes: a qualitative study. International Journal of nursing studies 43, 281-291
Dempsey, D( 2013) Advance care planning for people with dementia benefits and challenges . International Journal of Palliative nursing 19 (5) 227-234
Department of Health ( 2008) End of life care Strategy Promoting high quality care for all adults at the end of lfie.
Detering , K.M., Hancock,A.D., Reade,M.C., AND Silvester , W. (2010) The impact of advance care planning on end of life care in elderly patients: randomised control trail. BMJ 340, c1345.
Doi:10.1136/bmj.c1345
Dasekin,R.,Moyle,W . and Creedy,D. ( 2009) Aged Care nurses knowledge of nursing documentation : an Australian perspective. Journal of Clinical nursing, 18 , 2087-2095
Donald, F.Martin-Misener, R., Carter,N. et al (2013) A systematic review of the effectiveness of advance practice nurses in long term care. Journal of advanced nursing 60 ( 10) 2148-61.
Dyason,C. Simon,J. and Wityk,MTL ( 2015) Advance care planning discussions among residents of long termcare and designated assisted living : experiences from Calgary Alberta. BMJ Supportive palliative care 5, 48-53.
Fromberg Gorlen, T. , Gorlen, T. ,Asbjoern- Neergaard, M ( 2013) Death in nursing homes : a Danish qualitative study . International Journal of palliative nursing 19 (5) 236-242
Foyle, I( 2010) Telling stories in cancer and palliative care education: enigmatic , infinite mystery or trusted teaching techniques. In Illuminating the delivery of cancer and palliative care Education . Foyle, L. and Hosted, J (eds) Ratcliffe Publications, Oxford, pp, 39-54.
Frahm, KA.,Brown,LM.,Gibson, M. ( 2011) The importance of end of life care in nursing home settings is not diminished by disaster. Omega 9Westport ) 64 (20 143-55
Gott, M., Seymour,J., Ingleton,C., Gardiner, C. and Bellamy, G. ( 2012) That’s part pf everybody’s job; the perceptions of health care staff in England and New Zealand on the meaning and remit of palliative care . Palliative medicine 26 (3)232-41
Haesler,E.,Bauer,M.,Nay,R . ( 2007) Staff-family relationships in the care of older people : a report on a systematic review. Research in Nursing and Health 30 , 385-398.
Hall , S., Petkova,H. Tsouros, AD, Constantini,M, Higginson IJ (2011) (eds ) Palliative care for older people: better practices. Copenhagen, WHO.
Hansen, L. , Archbold,PG., Stewart, B et al (2005) Family caregivers making life- sustaining treatment decisions : factors associated with role strain and ease. Journal of Gerontological nursing 31 (11) 28-35
Happ, MB, Capezuti,E., Strumpf,NE. et al ( 2002) Advance care planning and end of life care for hospitalised nursing home residents. Journal of American Geriatric society 50 (5) 829-35.

Hockley , J., Dewar,B.and Watson, J. ( 2005 ) Promoting end of life care in nursing homes using an
integrated care pathway for the last days of life . Journal of Research in nursing , 10 , 135-152.
Hertogh,C ( 2006) Advance care planning and the relevance of a palliative approach in dementia. Age Ageing 35 ( 6): 553-5
Heath, H , (2010) The Role of the registered nurse in residential care settings for older people in Ireland. The All Ireland Gerontological Nurses Association . Ireland.
Hov, R.,Athlin,E. and Hedelin,B. ( 2009) Being a nurse in NH for patients on the edge of life. Scanandinavian Journal of Caring Sciences 23, 651-659.
Hutt, E.,Ruscin,J.M, Linnebur, S.A. et al (2011) A multifaceted intervention to implement guidelines did not affect hospitalisation rates for nursing home acquired pneumonia . Journal of American medical directors’ association 12 (7) 499-507.
Irish Hospice Foundation ( 2016) IHF perspectives 4 : A perspective on Advance planning for end of lfie , Dublin.
Gaffney, M (2011) Flourishing . Penguin books , London.
Goodman, C., Amador,S.,Elmore,N. Machen,I andMatie E (2013) Preferences and priorities for ongoing and end of life care : a qualitative study of older people with dementia resident in care homes. International Journal of Nursing studies 50 , 1639-1647.
Hamric,AB., Spross,JA. , Hanson,C ( 2009) Advanced Practice in Nursing : an integrative approach. Elsevier Saunders, Missouri
Health Service Exceutive (2014) Palliative care needs assessment guidelines.
Heidegger, M ( 1962) Being and Time. Blackwell Publishers , Oxford.
Hockley, J ( 2014)Learning , support and communication for staff in care homes: outcomes of reflective debriefing groups in two care homes to enhance end of life care . International Journal of older people nursing 9 , 118-130.
Hogsnes, L. Danielson, E., Norbegh,K.G., and Melin-Johansson, C. ( 2016) Healthcare professionals’ documentation in nursing homes when caring for dementia at the end of life – a retrospective records review. Journal of Clinical Nursing, 25, 1663-1673.
Health information and Quality Authority ( 2016 ) National Standards for residential care settings for older people in Ireland. HIQA , Dublin.
Koppitz, A., Bosshard, G., Kipfer,S., and Imhol, L. ( 2016) Decision making in caring for people with dementia at the end of life in nursing homes. International journal of palliative nursing 22 (2) 68-75.
Lane, H., Philip,J. (2015) Managing expectations: providing palliative care in aged care facilities . Austrailian Journal on Aging 34 ( 2) 76-81
Lagind,B., Ford,R. , Bauer,M. and Nay,R ( 2015) A meta synthesis of factors that influence nursinghome staff decisions to transfer residents to hospital . Journal of advanced nursing 71 ( 10) 2224-2236.
Lloyd,A., Kendall,M. ,Carduff,E., Cavers, D . , Kimbell,B. and Murray,S. (2016) Why do older people get less palliative care than younger people. European Journal of Palliative Care , 23 (3) 132-137
Lopez,R . (2009) Decision making for the acutely ill residents: nurses in the middle. Journal of
advanced nursing 65( 5) 1001-1009
Lester, P.E.,Stefanacci, R.G, Feurerman, M ( 2016) Prevalence and description of palliative care in S nursing homes: a descriptive study. American Journal of Hospice and palliative medicine 33 (2) 171-177
Mc Carthy, J. , Donnelly, M. Dooley,D , Campbell,L, Smith , D ( 2010) An introduction to the ethical framework for end of life care . Irish Hospice Foundation , Dublin
McCormack, B. (2004) Person Centeredness in gerontological nursing: an overview of the literature. Journal of Clinical nursing , 13 (3A), 31-38.
Mc Cormack,B and McCance,T ( 2016) Person Centred Practice in Nursing and Health Care : Theory and Practice. Wiley Blackwell .
McCloskey ,RM ( 2011) A qualitative study on the transfer of residents between a NH and emergency department . JAGS 59 , 717-724
McCance, T. and McCormack, B. ( 2016) The person- centred practice framework. In Mc Cormack,B and McCance,T(eds) Person Centred Practice in Nursing and Health Care : Theory and Practice. Wiley Blackwell .
Mathie,E. , Goodman,C., Crang, C. et al ( 2011) An uncertain future : the unchanging views of nursing home residents about living and dying. Palliative Medicine 26 (5): 734-743
Mackay , S ( 2005) Phenomenological nursing research : methodological insights derived from Heideggars interpretative phenomenology . International Journal of Nursing Studies,
Michell , G., Mcgreevy,J., Preshaw, D.HL, Agnelli,j AND Diamond , M ( 2016) Care home managers knowledge of palliative care : a Northern Irish Study. International Journal of Palliative nursing 22 (5) 230-234
Miller, S. , Lima,J. and Thompson, (2015) End of life in nursing homes with greater versus less palliative care knowledge and practice. International Journal of Palliative nursing 18 (6) 527-34.
Mitchel , G., Nicholson, C. McDonald, K. and Bucetti,A. ( 2011) Enhancing palliative care in rural austrailia : the residential aged care setting . Australian Journal of Primary Health 17 , 95-101
Murphy, K. O’Shea,E and Cooney,A ( 2007) Quality of life for older people living in long stay settings in Ireland . Journal of Clinical nursing 16 , 2167-2177.
Nolan, M., Davies,S. Brown, J.Wilkinson, A. Warnes, T. McKee,K., Flannery, J. and Stasi, K. ( 2008) The role of education and training in achieving change in care homes: a literature review. Journal of Research in Nursing 13 , 411-433
Nursing and Midwifery Council ( 2010) Record Keeping : Guidelines for Nurses and Midwives.Nursing and Midwifery Council, London.
O’Connor, M ( 2009) Decrepit Death as a discourse of death in older age: implications for policy. International journal of older people nursing 4, 263-271.
Phelan, A . and McCormack, B ( 2014) Exploring nursing expertise in residential care for older people in Ireland. Nursing Home Ireland , AIGNA .
Paans,W.,Sermeus,W., Nieweg,R. and Van der Schans, C. ( 2010) D-Catch Instrument: development and psychometric testing of a measurement instrument for nursing documentation in hospitals. Journal of advanced nursing , 66, 1388-1400.
Phillips, J. , Davidson,P., Jackson,M. et al ( 2006) Residential aged care : the last frontier for palliative care. Journal of advanced nursing 55 (4) 416-424.
Pleschberger , S ( 2007) Dignity and the challenge of dying in nursing homes : the residents view. Age and Ageing , 36 (2) ; 197-202.
Ramsbottom,K. and Kelley , M.L., (2014) Developing strategies to improve advance care planning in longt term care homes : giving voice to residents and their family members. International Journal of Palliaitve care 2015 , article ID 358457. Doi:10.1155/2014/358457.
Robinson,L.,Dickinson,C.,Rousseau,N., Beyer,F., Clarke,A.,Hughes,J.,Howel,D. and Exley,C. (2012) A systematic review of effectiveness of advance care planning interventions for people with cognitive impairments and dementia . Age and ageing 41 (2) 263 -269
Robinson , L., Dickinson,C., Bamford,C., Exley,C. Hughes , J. ( 2011) Advance care planning in dementia: great in theory, a challenge in practice. BMJ Supportive Palliative care 1 (1) 82
Ryan, A. , McKenna, H ( 2015) It’s the little things that count ‘ . Families experience of roles , relationships and quality of care in rural nursing homes. International Journal of older people nursing 10 , 38-47

Seymour,J and Gott , M. ( 2011) The challenges of health technology for ageing and dying . In Gott, M and Ingleton,C ( eds) Living with ageing and dying palliative and end of life care for older people . Oxford: Oxford university press. 42-51.
Shanley, C., Whitmore, E., Conforti,D., et al ( 2011) Decisions about transferring NH residents to hospital: highlighting the roles of advance care planning and support from local hospital and community health services. Journal of clinical nursing 20 ( 19-20) 2897-2906.
Silvester, W.,Fullam,RS.,Parslow,RA. Et al ( 2013 ) The quality of advance care planning policy and practice in residential aged care facilities in Australia .BMJ Supportive Palliative care 3 , 349-357
Stevens, I., Whyte,F. ( 2011) Advance care planning will it work in diseases other than cancer ? European Journal palliative care 18 (6) 280-4.
Stone,L. Kinley,J andHockley,J. ( 2013) Advance care planning in care homes : the experience of staff , residents and family members. International Journal of Palliative nursing . 19 : 550-557.
Slater , L ( 2006) Person centeredness : a concept analysis . Contemporary nurse , 23, 135-144
Trotta, R.I. ( 2007) Quality of death : a dimensional analysis of palliative care in the nursing home. Journal of Palliiative medicine, 10 , 1116-1127

Vandervoort, A., Van den Block, L. Van der Steen, J.T., Vander Stichele , R., Bilsen,J. and Deliens,L. ( 2012) Advance Directives and physicians orders in nursing home residents with dementia in flanders, Belguim: prevalence and associated outcomes . International Psychogeriatric 24 ( 7) 1133-1143
Van Riet Paap, J. Mariani, E . , Chattar, R. et al ( 2015) Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals. BMC palliative care 14, 56 -61
Vandervoort,A.,Houttekier, D., Van den Block , L., Van der Steen, J.T., Vander Stichele, R. and Deliens, L. ( 2014) Advance care planning and physicians orders in nursing homes residents with dementia : a nationwide retrospective study among professional care givers and relatives . Journal of pain and Symptom management , 47 (2) 245-256.
WHO (2011) Palliative Care for older people : Better practices ( Hall , S. Petkova,H., Tsourous , AD, Costantini M and Higginson,IJ (eds) World Health Organisation Copenhagen.
Wilson , O. , Avalos,G. and Dowling, M. ( 2016) Knowledge of palliative care and attitudes towards nursing the dying patient . British Journal of Nursing , 25 ( 11) 600-604.
Name Role
Dr Aoife Claire MacCormac Lecturer / Co-Lecturer
Mrs Anita Duffy Tutor