Project summary
RSL Care RDNS (Bolton Clarke Research Institute) in partnership with Queensland University of Technology has been awarded an ARIIA grant for their ‘Reducing need-driven dementia-compromised behaviour by addressing constipation – developing and preparing the translation of best-practice through co-design’ project.
This innovative one-year applied research project addresses the ‘dementia’ and ‘restorative care, reablement and rehabilitation’ priorities and will fill the evidence gap of how to best manage a commonly overlooked health issue associated with need-driven dementia-compromised behaviour, namely constipation.
This project focuses on improving workforce capability and capacity in caring for people living with dementia. The overarching aim is to co-design the development and translation of an evidence-based multi-component nursing and care staff intervention to prevent constipation in people with dementia in Residential Aged Care (RAC). Objectives include 1) synthesising available scientific evidence and evaluating current practices in RAC and from other specialities and 2) collaborating with key stakeholders (e.g., residents, their family carers, health and care workers) to define best practice on how to best assess and prevent constipation in this vulnerable older population.
Our co-designed Implementation Framework Aged Care (IFAC) will be used to guide the intervention development and its subsequent translation into practice (i.e., Why? What? With whom? By Whom? How?). Co-designed preventative constipation strategies that are relevant and appropriate for residents living with dementia, their family carers, and RAC health and care workers, will ultimately support residents and prevent dementia-compromised behavioural issues associated with constipation.
Project outcomes
Background and Aims
Two‐thirds of people living in Residential Aged Care (RAC) experience constipation. Approximately half of all people living in RAC have a form of cognitive impairment, which makes it difficult for them to recognise and verbalise the need to go to the toilet or autonomously apply common constipation prevention measures. Constipation is defined as infrequent bowel motions or a problem with passing stool. Left unmanaged, constipation can lead to more serious and painful conditions, such as haemorrhoids, faecal impaction, urinary retention, bowel obstruction, and need‐driven behavioural change. The project aimed to co‐design the development, testing and translation of an evidence‐informed multi‐component intervention to prevent constipation in people living with dementia in Residential Aged Care (RAC).
What we did
A 12‐item evidence‐informed care bundle was co‐designed and implemented at one aged care home over six weeks with the mission to help residents living with dementia to have regular and soft‐formed bowel motions. The 12 items in the care bundle included: dietitian consultation; adequate fibre intake; individualised hydration care plan; beverage cart; individualised toileting schedule; assessment and management of constipation risk factors; privacy and dignity when using the toilet; dementia friendly toilet signage; contrasting coloured toilet seat; electronic alerts for abnormal bowel frequency; staff education on bowel health; and constipation prevention information for residents.
Outcomes
The CoCo intervention showed positive results. First, staff reported that residents were eating more, therefore reducing their risk of malnutrition. Second, staff noticed that residents had more regular bowel movements, established a bowel routine, and some residents were able to reduce the use of laxatives. Third, staff reported an increase in hydration in residents as they became aware of the importance of adequate hydration in the prevention of constipation. In addition to improved bowel movements, staff improved their tracking on bowel movements therefore making it easier to monitor and care for their residents. Overall, all care staff reported positive outcomes and appreciation for the CoCo care bundle, with intent to continue use of the bundle.
Impact on aged care and workforce
The care bundle provides a comprehensive intervention to assist RAC staff in preventing constipation in residents living with dementia. People with dementia may find it difficult to articulate pain and/or discomfort related to constipation, therefore sometimes resulting in need‐driven behaviour (e.g., restlessness, agitation). Changed behaviours often create an increased workload for frontline staff. Therefore, preventing constipation in people living with dementia helps also to reducing the pressure on the workforce through reduced workload.
Resources developed
No resources have been published for public access yet as the CoCo intervention is a site‐specific intervention, which should be adapted for each site. The CoCo project team are willing to assist those wishing to implement the care bundle. Please contact Linda Schnitker for further information concerning the CoCo care bundle – lschnitker@boltonclarke.com.au
Next steps
Further work is proposed to observe the implementation and sustainability of the CoCo over a longer period in the participating home and other aged care communities.