La "towel bath" può ridurre l'aggressività in pazienti affetti da demenza? Risultati di un trial crossover

Autori

  • Roberta Lodini ASST Santi Paolo e Carlo, Milano
  • Stefano Terzoni ASST Santi Paolo e Carlo, Milano
  • Agostino D'Antuono ASST Santi Paolo e Carlo, Milano
  • Elena Sala ASST Santi Paolo e Carlo, Milano
  • Giancarlo Celeri ASST Santi Paolo e Carlo, Milano
  • Mauro Parozzi ASST Santi Paolo e Carlo, Milano https://orcid.org/0000-0003-4164-2790
  • Paolo Ferrara ASST Santi Paolo e Carlo, Milano https://orcid.org/0000-0001-5366-4132
  • Laura DiPrisco ASST Santi Paolo e Carlo, Milano https://orcid.org/0000-0003-1355-2480
  • Lara Carelli ASST Santi Paolo e Carlo, Milano https://orcid.org/0000-0001-6945-4877
  • Giada Cocciolo LMU Klinikum Grosshadern, Munich, Germania

DOI:

https://doi.org/10.54103/dn/17511

Parole chiave:

demenza, towel bath, nursing, aggressività

Abstract

INTRODUZIONE:
Il bagno è una delle attività più intime durante le quali le persone affette da demenza vengono assistite. La letteratura suggerisce che il 20-40% dei pazienti con deterioramento cognitivo, ricoverati in strutture a lungo termine, può reagire con comportamenti aggressivi.

OBIETTIVI:
valutare l'efficacia della tecnica del bagno con asciugamano nel ridurre l'agitazione, l'aggressività e il disagio dei pazienti con demenza ricoverati in casa di cura.

MATERIALI E METODI:
È stato condotto uno studio crossover intenzionale; è stato arruolato un campione di pazienti con demenza. I comportamenti aggressivi sono stati valutati utilizzando la versione italiana del Care Recipient Behavior Assessment (CAREBA- ita).

RISULTATI:
Sono stati arruolati 71 residenti. La tecnica del bagno con l'asciugamano ha mostrato una riduzione degli episodi di aggressività e del tempo di esecuzione della procedura con una differenza statisticamente significativa (p < 0,05).

CONCLUSIONI:
La tecnica Towel bath fornisce una valida alternativa al bagno tradizionale per ridurre l'aggressività nei pazienti con demenza.

Riferimenti bibliografici

Savva GM, Zaccai J, Matthews FE, Davidson JE, McKeith I, Brayne C, et al. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry. 2009 Mar 1;194(3):212–9.

Geda YE, Schneider LS, Gitlin LN, Miller DS, Smith GS, Bell J, et al. Neuropsychiatric symptoms in Alzheimer’s disease: Past progress and anticipation of the future. Alzheimers Dement. 2013 Sep;9(5):602–8.

Ismail Z, Smith EE, Geda Y, Sultzer D, Brodaty H, Smith G, et al. Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016 Feb;12(2):195–202.

Desai AK, Schwartz L, Grossberg GT. Behavioral Disturbance in Dementia. Curr Psychiatry Rep. 2012 Aug;14(4):298–309.

Skovdahl K, Kihlgren AL, Kihlgren M. Dementia and aggressiveness: stimulated recall interviews with caregivers after video-recorded interactions. J Clin Nurs. 2004 May;13(4):515–25.

Cheng S-T. Dementia Caregiver Burden: a Research Update and Critical Analysis. Curr Psychiatry Rep [Internet]. 2017 Sep [cited 2017 Oct 29];19(9). Available from: http://link.springer.com/10.1007/s11920-017-0818-2

Cohen-Mansfield J, Parpura-Gill A. Bathing: A framework for intervention focusing on psychosocial, architectural and human factors considerations. Arch Gerontol Geriatr. 2007 Sep;45(2):121–35.

Cheever KH, Smeltzer SC, Brenda G. Infermieristica medico-chirurgica. 1 1. Milano: CEA; 2010.

Bulechek GM, editor. Nursing interventions classification (NIC). 6. ed. St. Louis, Mo: Mosby/Elsevier; 2013. 608 p.

Sloane PD, Hoeffer B, Mitchell CM, McKenzie DA, Barrick AL, Rader J, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. J Am Geriatr Soc. 2004 Nov;52(11):1795–804.

Gozalo P, Prakash S, Qato DM, Sloane PD, Mor V. Effect of the Bathing Without a Battle Training Intervention on Bathing-Associated Physical and Verbal Outcomes in Nursing Home Residents with Dementia: A Randomized Crossover Diffusion Study. J Am Geriatr Soc. 2014 May;62(5):797–804.

Rasin J, Barrick AL. Bathing Patients with Dementia: Concentrating on the patient’s needs rather than merely the task. 2014 Mar;AJN, American Journal of Nursing March 2004-Volume 104-Issue 3-pp 30-32.

Hoeffer B, Talerico KA, Rasin J, Mitchell CM, Stewart BJ, McKenzie D, et al. Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving. The Gerontologist. 2006 Aug;46(4):524–32.

Boustani M, Zimmerman S, Williams CS, Gruber-Baldini AL, Watson L, Reed PS, et al. Characteristics associated with behavioral symptoms related to dementia in long-term care residents. The Gerontologist. 2005 Oct;45 Spec No 1(1):56–61.

Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012 Sep;169(9):946–53.

Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M, Meyer G, et al. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med. 2015 Apr;6(2):134–50.

Cammisuli DM, Danti S, Bosinelli F, Cipriani G. Non-pharmacological interventions for people with Alzheimer’s Disease: A critical review of the scientific literature from the last ten years. Eur Geriatr Med. 2016 Feb;7(1):57–64.

Mann E, Köpke S, Haastert B, Pitkälä K, Meyer G. Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatr [Internet]. 2009 Dec [cited 2017 Oct 29];9(1). Available from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-9-18

Schneider LS, Tariot PN, Dagerman KS, Davis SM, Hsiao JK, Ismail MS, et al. Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease. N Engl J Med. 2006 Oct 12;355(15):1525–38.

Richter T, Mann E, Meyer G, Haastert B, Köpke S. Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts. J Am Med Dir Assoc. 2012 Feb;13(2):187.e7-187.e13.

Alexopoulos GS, Streim J, Carpenter D, Docherty JP, Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients. Using antipsychotic agents in older patients. J Clin Psychiatry. 2004;65 Suppl 2:5-99; discussion 100-102; quiz 103-104.

Daiello LA. Atypical antipsychotics for the treatment of dementia-related behaviors: an update. Med Health R I. 2007 Jun;90(6):191–4.

Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Donepezil and Memantine for Moderate-to-Severe Alzheimer’s Disease. N Engl J Med. 2012 Mar 8;366(10):893–903.

Brauer R, Smeeth L, Anaya-Izquierdo K, Timmis A, Denaxas SC, Farrington CP, et al. Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study. Eur Heart J. 2015 Apr 21;36(16):984–92.

Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007 Oct;62(10):1172–81.

Bierman EJM, Comijs HC, Gundy CM, Sonnenberg C, Jonker C, Beekman ATF. The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent? Int J Geriatr Psychiatry. 2007 Dec;22(12):1194–200.

Ballard C, Creese B, Corbett A, Aarsland D. Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opin Drug Saf. 2011 Jan;10(1):35–43.

Kales HC, Kim HM, Zivin K, Valenstein M, Seyfried LS, Chiang C, et al. Risk of mortality among individual antipsychotics in patients with dementia. Am J Psychiatry. 2012 Jan;169(1):71–9.

Nielsen R-E, Lolk A, M Rodrigo-Domingo null, Valentin J-B, Andersen K. Antipsychotic treatment effects on cardiovascular, cancer, infection, and intentional self-harm as cause of death in patients with Alzheimer’s dementia. Eur Psychiatry J Assoc Eur Psychiatr. 2017 May;42:14–23.

Maher AR, Maglione M, Bagley S, Suttorp M, Hu J-H, Ewing B, et al. Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults: A Systematic Review and Meta-analysis. JAMA. 2011 Sep 28;306(12):1359.

APA Work Group on Alzheimer’s Disease and other Dementias, Rabins PV, Blacker D, Rovner BW, Rummans T, Schneider LS, et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry. 2007 Dec;164(12 Suppl):5–56.

Mitka M. CMS seeks to reduce antipsychotic use in nursing home residents with dementia. JAMA. 2012 Jul 11;308(2):119, 121.

Jutkowitz E, Brasure M, Fuchs E, Shippee T, Kane RA, Fink HA, et al. Care-Delivery Interventions to Manage Agitation and Aggression in Dementia Nursing Home and Assisted Living Residents: A Systematic Review and Meta-analysis. J Am Geriatr Soc. 2016 Mar;64(3):477–88.

Brasure M, Jutkowitz E, Fuchs E, Nelson VA, Kane RA, Shippee T, et al. Nonpharmacologic Interventions for Agitation and Aggression in Dementia [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 [cited 2017 Mar 6]. (AHRQ Comparative Effectiveness Reviews). Available from: http://www.ncbi.nlm.nih.gov/books/NBK356163/

Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry. 2014 Dec 1;205(6):436–42.

Millan-Calenti JC, Lorenzo-López L, Alonso-Búa B, de Labra Pinedo C, González-Abraldes I, Maseda A. Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions. Clin Interv Aging. 2016 Feb;175.

Viggo Hansen N, Jørgensen T, Ørtenblad L. Massage and touch for dementia. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004989.

Holmes C, Hopkins V, Hensford C, MacLaughlin V, Wilkinson D, Rosenvinge H. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Int J Geriatr Psychiatry. 2002 Apr;17(4):305–8.

Fu C-Y, Moyle W, Cooke M. A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia. BMC Complement Altern Med [Internet]. 2013 Dec [cited 2017 Oct 29];13(1). Available from: http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-13-165

Hsu MH, Flowerdew R, Parker M, Fachner J, Odell-Miller H. Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study. BMC Geriatr. 2015 Jul 18;15:84.

Fakhoury N, Wilhelm N, Sobota KF, Kroustos KR. Impact of Music Therapy on Dementia Behaviors: A Literature Review. Consult Pharm J Am Soc Consult Pharm. 2017 Oct 1;32(10):623–8.

Preuss U, Wong J, Koller G. Treatment of behavioral and psychological symptoms of dementia: a systematic review. Psychiatr Pol. 2016;50(4):679–715.

Cohen-Mansfield J, Mintzer JE. Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia. Alzheimer Dis Assoc Disord. 2005 Mar;19(1):37–40.

Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc. 2010 Aug;58(8):1465–74.

The University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research. Bathing Without a Battle Creating a Better Bathing Experience for Persons with Alzheimer’s Disease and Related Dementias [Internet]. Available from: http://bathingwithoutabattle.unc.edu/bathing-techniques

Martin LS, Morden P, McDowell C. Using the towel bath to give tender care in dementia: a case example. Perspect Gerontol Nurs Assoc Can. 1999;23(1):8–11.

Flori L. Donʼt throw in the towel: Tips for bathing a patient who has dementia. Nursing (Lond). 2007 Jul;37(7):22–3.

Castello M, Ferrara P, Destrebecq A, Terzoni S. The perception of clinical risk among students of different health professions: a multicentre study. Br J Nurs. 2019; 28(3),193-197. doi: 10.12968/bjon.2019.28.3.193. PMID: 30746967.

Lazzari T, Terzoni S, Destrebecq A, Meani L, Bonetti L, Ferrara P. Moral distress in correctional nurses: A national survey. Nurs Ethics. 2020 Feb;27(1):40-52. doi: 10.1177/0969733019834976. Epub 2019 Apr 9.

Pubblicato

2022-07-29 — Aggiornato il 2022-08-01

Versioni

Come citare

Lodini, R., Terzoni, S., D’Antuono, A., Sala, E., Celeri, G., Parozzi, M., Ferrara, P., DiPrisco, L., Carelli, L., & Cocciolo, G. (2022). La "towel bath" può ridurre l’aggressività in pazienti affetti da demenza? Risultati di un trial crossover. Dissertation Nursing, 1(1), 64–77. https://doi.org/10.54103/dn/17511 (Original work published 29 luglio 2022)
Ricevuto 2022-03-17
Accettato 2022-07-21
Pubblicato 2022-08-01