Reviewing the definition of crisis in dementia care

Abstract

Background: Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice.

Methods: We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings.

Results: Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia.

Conclusions: This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.

Figure 1

Literature search.

Figure 2

Operational framework for crisis and retrieving a new equilibrium in dementia care. The figure represents the full process of crisis in dementia. Dynamic proportions within circles represent the burden and time input for the different perspectives potentially involved. The proportions change to represent the individual situation in a crisis process. Stressor(s) can be psychological, medical, social or environmental change that causes a shift in an individual’s homeostasis. The imbalance represents the resulting state of fragility from the severe breakdown in homeostasis. Immediate decisions aim to regain homeostasis. Resolution equals equilibrium, otherwise the crisis is unresolved.