F.J.M. Meiland

The emotional impact of psychiatric symptoms in dementia on partner caregivers: do caregiver, patient, and situation characteristics make a difference?

This study aims to investigate the emotional impact of psychiatric symptoms of patients with dementia on their caregiving partners, and to explore if caregiver, patient, and situation factors predict this emotional impact on caregivers. A cross-sectional design was used. Partners of patients with slight to moderately severe dementia who live in the community (n = 85) were interviewed. In a subgroup (n = 58) potential predictors of emotional impact of psychiatric symptoms on caregivers were studied. Agitation, irritability, apathy, and disinhibition produced the highest mean emotional impact scores in caregivers. Besides the neuropsychiatric symptoms themselves, the emotional impact of these symptoms on caregivers was predicted by sense of competence, degree of care needed by the patient, and financial expenditure due to the caregiving situation. The emotional impact of psychiatric symptoms on caregivers is predicted by several patient, caregiver, and situation factors. Interventions aimed at decreasing the experienced burden of caregivers should therefore not only focus on the psychiatric symptoms of the patient, but also on the sense of competence of the caregiver and the financial burden due to the caregiving situation.

Implementatie en (kosten-)effectiviteit van casemanagement voor mensen met dementie en hun mantelzorgers: resultaten van de COMPAS-studie

BACKGROUNDnDifferent forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form.nnnAIM OF STUDYnEvaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation.nnnMETHODSnA mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs).nnnRESULTSnOutcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group.nnnCONCLUSIONnThe integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

Zelf dementie ervaren: Ontwikkeling en evaluatie van de Into D’mentia simulator

BACKGROUNDnMost persons with dementia in the Netherlands live at home, where they are cared for by informal carers such as family members or friends, who offer this care unpaid. Their care-task poses a high burden on these informal carers, increasing the risk of health problems and social isolation. Many informal carers indicate they want more information on the behaviour of those they care for.nnnAIMnTo develop and evaluate Into Dmentia, a simulation set in a living kitchen in which visitors experience a day in the life of someone with dementia. During this day, modern techniques such as sensors and projections, simulate the limitations of having dementia. This intervention is evaluated on usefulness and user friendliness, and on its effect on empathy, attitudes towards dementia, coping, carer burden, person-centered care capabilities and care satisfaction.nnnRESEARCHnNine informal carers and 23 care professionals took part in the research into the Into Dmentia simulation. Before and after their visit, they filled in several questionnaires, with, among others, their opinion on the usefulness and user friendliness of this experience.nnnRESULTSnParticipants found Into Dmentia a highly useful and user friendly development. They indicated that the simulation offered good insight in the life of someone with dementia, and that they could offer better care thanks to this experience. Participants also indicated that they often thought back on their experiences in the simulation, in order to better understand the behaviour of people with dementia.nnnCONCLUSIONnInto Dmentia offers a unique, accessible way to experience the limitations dementia has on daily life. Users indicate that it is a useful and user friendly innovation. Into Dmentia appears to be a suitable method to support informal and professional caregivers.

[Experiencing dementia: evaluation of Into D'mentia].

BACKGROUNDnMost persons with dementia in the Netherlands live at home, where they are cared for by informal carers such as family members or friends, who offer this care unpaid. Their care-task poses a high burden on these informal carers, increasing the risk of health problems and social isolation. Many informal carers indicate they want more information on the behaviour of those they care for.nnnAIMnTo develop and evaluate Into Dmentia, a simulation set in a living kitchen in which visitors experience a day in the life of someone with dementia. During this day, modern techniques such as sensors and projections, simulate the limitations of having dementia. This intervention is evaluated on usefulness and user friendliness, and on its effect on empathy, attitudes towards dementia, coping, carer burden, person-centered care capabilities and care satisfaction.nnnRESEARCHnNine informal carers and 23 care professionals took part in the research into the Into Dmentia simulation. Before and after their visit, they filled in several questionnaires, with, among others, their opinion on the usefulness and user friendliness of this experience.nnnRESULTSnParticipants found Into Dmentia a highly useful and user friendly development. They indicated that the simulation offered good insight in the life of someone with dementia, and that they could offer better care thanks to this experience. Participants also indicated that they often thought back on their experiences in the simulation, in order to better understand the behaviour of people with dementia.nnnCONCLUSIONnInto Dmentia offers a unique, accessible way to experience the limitations dementia has on daily life. Users indicate that it is a useful and user friendly innovation. Into Dmentia appears to be a suitable method to support informal and professional caregivers.

Nooit meer dwalen met slimme zolen

SamenvattingEen speciale inlegzool met gps maakt het mogelijk ouderen met dementie die weglopen of verdwalen eenvoudig te volgen en snel op te sporen via smartphone, tablet of computer.

P403: Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

Towards personalized integrated dementia care: a qualitative study into the implementation of diierent models of case management. Towards personalized integrated dementia care: a qualitative study into the implementation of diierent models of case management. Abstract Background: The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions.

Gecombineerde ondersteuning in Ontmoetingscentra voor mensen met dementie en hun mantelzorgers vergeleken met reguliere dagbehandeling

SummaryBackground: A previous study in Amsterdam showed that combined family support in the Meeting Centres Support Programme, in which persons with dementia patients and their carers are both supported by one professional staff, is more effective in influencing behaviour problems and mood of dementia patients living in the community than non-integrated support, such as day care only. A multi-centre implementation study tests if similar effects are achieved in other regions of The Netherlands.Methods: A pretest-posttest control group design was applied. 112 dementia patients who visited psychogeriatric day care in eight community centres across the country and in three nursing homes, and their carers participated in the study. The patients in the experimental group (n=89) received support from the Meeting Centres Support Programme together with their carers, while the control group (n=23) received day care only. Behaviour problems (aggressive behaviour, inactivity, non-social behaviour) and mood (dissatisfaction, depressive behaviour) were assessed using standardized observation scales. Quality of life was assessed by interviewing the patients.Results: After 7 months the Meeting Centres Support Programme, compared to regular day care, showed a moderately positive effect on the degree of total behaviour problems (effect size=0.52), especially on inactivity (effect size=0.37) and non-social behaviour (effect size=0.60), a large effect on depressive behaviour (effect size=0.92) and a moderate effect on self-esteem (effect size=0.43).Conclusions: The Meeting Centres Support Programme proves to be more effective than regular day care in influencing behaviour problems, especially inactivity and non-social behaviour, and depressed mood. Participation in the programme also seems to have a positive effect on self-esteem, an important aspect of quality of life. These findings surpass the results of the Amsterdam study and confirm the surplus value of the Meeting Centres Support Programme as compared to regular day care for people with mild to severe dementia.SamenvattingAchtergrond: Eerder onderzoek in Amsterdam toonde aan dat geïntegreerde ondersteuning in Ontmoetingscentra, waar mensen met dementie en hun mantelzorgers beiden ondersteuning ontvangen van één professioneel team, meer effect heeft op gedragsproblemen en de stemming van thuiswonende mensen met dementie dan niet-geïntegreerde ondersteuning, zoals reguliere dagbehandeling. In een multi-centre studie is onderzocht of vergelijkbare effecten worden bereikt in andere Nederlandse regios.Methode: Er werd een pretest-posttest controlegroepdesign gehanteerd. 112 mensen met dementie die de dagsociëteit van acht ontmoetingscentra in verschillende regios en drie dagbehandelingen in verpleeghuizen bezochten, en hun mantelzorgers, namen aan het onderzoek deel. In de experimentele groep (n=89) ontvingen de mensen met dementie samen met hun mantelzorger ondersteuning volgens het model van de Ontmoetingscentra, terwijl de controlegroep (n=23) alleen dagbehandeling ontving. Gedragsproblemen (agressief gedrag, inactiviteit, niet-sociaal gedrag) en stemming (ontevredenheid, depressief gedrag) werden beoordeeld aan de hand van gestandaardiseerde observatieschalen. De kwaliteit van leven werd beoordeeld door middel van interviews met de patiënten.Resultaten: geïntegreerde ondersteuning toont vergeleken met reguliere dagbehandeling een gematigd positief effect op gedragsproblemen (effectgrootte=0.52), met name op inactiviteit (effectgrootte=0.37) en niet-sociaal gedrag (effectgrootte=0.60); een groot positief effect op depressief gedrag (effectgrootte= 0.92) en een positief effect op zelfwaardering (effectgrootte=0.43).Over het geheel genomen overstijgen de effecten van deze multicentre studie de resultaten van de eerdere Amsterdamse studie en bewijzen de meerwaarde van de ontmoetingscentra ten opzichte van reguliere dagbehandeling, althans voor wat betreft de doelgroep mensen met een lichte tot matig ernstige dementie en mantelzorgers