Julia Haberstroh

TANDEM: Communication training for informal caregivers of people with dementia

Objectives: Dementia increasingly diminishes the ability to communicate. We aimed to develop and evaluate a psychosocial intervention program that focuses on communication in dementia care. This was intended to enhance the quality of life (QoL) of people with dementia and to reduce the burden on their informal caregivers. Method: A training program for informal caregivers of people with dementia was developed. The training combines the expertise of geriatric psychiatry, geriatric care, and educational psychology. Caregivers acquire and deepen competencies required to improve communication in dementia care. The training was evaluated with a pre–post-control group design and time-series analyses. Twenty-four informal caregivers participated in the study. Results: The results of the study provide evidence that TANDEM training increases caregivers’ use of strategies that are relevant for communication in dementia care and the care receivers’ QoL. Conclusion: The results of research in this program show the relevance of including caregivers in interventions and the importance of communication for the QoL of people with dementia.

Optimal management of Alzheimer’s disease patients: Clinical guidelines and family advice

Family members provide most of the patient care and administer most of the treatments to patients with Alzheimer’s disease (AD). Family caregivers have an important impact on clinical outcomes, such as quality of life (QoL). As a consequence of this service, family caregivers suffer high rates of psychological and physical illness as well as social and financial burdens. Hence, it is important to involve family caregivers in multimodal treatment settings and provide interventions that are both suitable and specifically tailored to their needs. In recent years, several clinical guidelines have been presented worldwide for evidence-based treatment of AD and other forms of dementia. Most of these guidelines have considered family advice as integral to the optimal clinical management of AD. This article reviews current and internationally relevant guidelines with emphasis on recommendations concerning family advice.

Communication training for family caregivers of dementia patients

ZusammenfassungDas Trainingsprogramm Kommunikations-TAnDem wurde mit der primären Zielsetzung entwickelt, eine Verbesserung der Kommunikationskompetenz pflegender Angehöriger gegenüber Demenzpatienten zu erreichen. Sekundäre Ziele waren eine Steigerung der Lebensqualität der Demenzpatienten sowie eine Reduktion der Belastung der Angehörigen in der häuslichen Pflege. Die Wirksamkeit des Kommunikations-TAnDems wurde in einer kontrollierten Trainingsstudie mit Wartekontrollgruppendesign und Prozesserhebung überprüft, an der eine Stichprobe von 22 pflegenden Angehörigen teilnahm. Die Ergebnisse der Studie belegen Wirkungen für die Variablen „Kommunikationskompetenz“, „Wissen über Kommunikation bei Demenz“, „Lebensqualität der Demenzpatienten“ und „Direkt wahrgenommene Belastung der pflegenden Angehörigen“. Demnach handelt es sich beim Kommunikations-TAnDem um einen Ansatz zur indirekten Förderung von Demenzpatienten durch ein Training der pflegenden Angehörigen. Insgesamt verdeutlichen die Befunde die Notwendigkeit der Einbeziehung der pflegenden Angehörigen in Interventionsprogramme sowie die Bedeutung der Kommunikationskompetenz für das Wohlbefinden der Demenzpatienten und deren Betreuer.SummaryThe program Kommunikations-TAnDem was developed with the primary purpose of increasing the communication competence of family caregivers of dementia patients. Further aims were to reduce the burden of family caregivers and to increase the quality of life of dementia patients. The effectiveness of the Kommunikations-TAnDem was tested in a controlled training study with 22 participants using a waiting-group control design and process measurement. The results of the study verify effects for the variables “Communication competence”, “Caregivers knowledge about communication in dementia”, “Quality of life of dementia patients” and “Directly perceived burden of family caregivers‟. Therefore it can be concluded that the Kommunikations-TAnDem is a method of indirectly supporting dementia patients by training the family caregivers. The results of research in this program underline very clearly the relevance of the inclusion of the family caregivers in intervention programs and the importance of communication competence for the well-being of dementia patients and their caregivers.

Support for families of patients dying with dementia: A qualitative analysis of bereaved family members' experiences and suggestions

OBJECTIVE To explore and document the needs of family caregivers of patients dying with dementia and to identify how healthcare professionals can adequately support them. METHOD We employed a cross-sectional survey containing open-ended questions that were analyzed using qualitative methods. RESULTS Receiving information about the diagnosis and disease trajectory of dementia is essential for the caregiving families of people dying with the disease. However, at present the communication of information offered by professionals is not experienced as satisfying. Further aspects that require improvement concern issues related to time constraints, as well as practical and emotional support from professionals in the care setting. Family members would also like professionals to better assist them during and after the dying process. SIGNIFICANCE OF RESULTS Family members face multiple burdens while caring for their demented relatives and need more professional support during the course of the disease trajectory as well as in the terminal phase.

Development and evaluation of a training program for nursing home professionals to improve communication in dementia care

ZusammenfassungMit dem Ziel, die berufliche Beanspruchung von Altenpflegern zu reduzieren und gleichzeitig die Lebensqualität demenzkranker Bewohner zu steigern, wurde ein Training für Altenpfleger zur Kommunikation in der stationären Dementenbetreuung entwickelt, durchgeführt und evaluiert. Schwerpunkte des Trainings lagen auf Problemen und Strategien in der Kommunikation mit demenzkranken Menschen sowie mit Kollegen. Die Wirksamkeit der Intervention wurde in einer kontrollierten Trainingsstudie mit Wartekontrollgruppendesign und Prozesserhebung überprüft, an der 53 Altenpflegekräfte teilnahmen, die in täglichem Kontakt mit demenzkranken Bewohnern standen. In Prä-Post- und prozessualen Analysen konnte nachgewiesen werden, dass das Training die soziale Kompetenz der Pfleger steigert und deren psychische Beanspruchung reduziert sowie die Lebensqualität der betreuten demenzkranken Bewohner steigert. Die Ergebnisse der Studie weisen darauf hin, dass das Training eine effektive Möglichkeit zur Verbesserung der Situation in der stationären Dementenbetreuung darstellt. Damit die Intervention breit einsetzbar ist, wird derzeit ein Multiplikatorenprogramm entwickelt, das in einer Folgestudie durchgeführt und evaluiert werden soll.AbstractThe purpose of this study was to develop and evaluate a skill training aimed at increasing the social competence of caregivers of nursing home residents suffering from dementia. Herewith, the professional burden and occupational stress of the caregivers should be reduced and the quality of life of dementia patients should be increased. The contents of the training focused on problems and strategies in the communication with dementia patients and the communication with colleagues. The effectiveness of the intervention was tested in a controlled training study using a multiple control group design and process measurement. The participants of the trainings were 53 nursing home professionals, who were in daily contact with residents suffering from dementia. The results of the study verify effects for all relevant variables. The “social competence” of the caregivers increased and their “work stress” decreased while the “quality of life of dementia patients” increased. Therefore it can be concluded that training the social competence of nursing home professionals is a method to indirectly reduce their work stress and support dementia patients. The results of research in this program underline very clearly that the developed training is an effective option to improve the situation of dementia care in nursing homes. To make the intervention widely applicable we are currently developing a “multiplier program“ in a follow-up project.

Evaluation eines Kommunikationstrainings für Altenpfleger in der stationären Betreuung demenzkranker Menschen (Tandem im Pflegeheim)

ZusammenfassungMit dem Ziel, die berufliche Beanspruchung von Altenpflegern zu reduzieren und gleichzeitig die Lebensqualität demenzkranker Bewohner zu steigern, wurde ein Training für Altenpfleger zur Kommunikation in der stationären Dementenbetreuung entwickelt, durchgeführt und evaluiert. Schwerpunkte des Trainings lagen auf Problemen und Strategien in der Kommunikation mit demenzkranken Menschen sowie mit Kollegen. Die Wirksamkeit der Intervention wurde in einer kontrollierten Trainingsstudie mit Wartekontrollgruppendesign und Prozesserhebung überprüft, an der 53 Altenpflegekräfte teilnahmen, die in täglichem Kontakt mit demenzkranken Bewohnern standen. In Prä-Post- und prozessualen Analysen konnte nachgewiesen werden, dass das Training die soziale Kompetenz der Pfleger steigert und deren psychische Beanspruchung reduziert sowie die Lebensqualität der betreuten demenzkranken Bewohner steigert. Die Ergebnisse der Studie weisen darauf hin, dass das Training eine effektive Möglichkeit zur Verbesserung der Situation in der stationären Dementenbetreuung darstellt. Damit die Intervention breit einsetzbar ist, wird derzeit ein Multiplikatorenprogramm entwickelt, das in einer Folgestudie durchgeführt und evaluiert werden soll.AbstractThe purpose of this study was to develop and evaluate a skill training aimed at increasing the social competence of caregivers of nursing home residents suffering from dementia. Herewith, the professional burden and occupational stress of the caregivers should be reduced and the quality of life of dementia patients should be increased. The contents of the training focused on problems and strategies in the communication with dementia patients and the communication with colleagues. The effectiveness of the intervention was tested in a controlled training study using a multiple control group design and process measurement. The participants of the trainings were 53 nursing home professionals, who were in daily contact with residents suffering from dementia. The results of the study verify effects for all relevant variables. The “social competence” of the caregivers increased and their “work stress” decreased while the “quality of life of dementia patients” increased. Therefore it can be concluded that training the social competence of nursing home professionals is a method to indirectly reduce their work stress and support dementia patients. The results of research in this program underline very clearly that the developed training is an effective option to improve the situation of dementia care in nursing homes. To make the intervention widely applicable we are currently developing a “multiplier program“ in a follow-up project.

Need for and challenges facing functional communication as outcome parameter in AD clinical trials.

This paper (1) highlights the relevance of functional communication as an outcome parameter in Alzheimer disease (AD) clinical trials; (2) identifies studies that have reported functional communication outcome measures in AD clinical trials; (3) critically reviews the scales of functional communication used in recent AD clinical trials by summarizing the sources of information, characteristics, and available psychometric data for these scales; and (4) evaluates whether these measures actually or partially assess functional communication. To provide direction for future research and generate suggestions to assist in the development of a valid and reliable functional communication scale for the needs of AD clinical trials, we have included not only functional communication scales, but also related concepts that give thought-provoking impulses for the development of a functional communication scale. As outcome measures for AD clinical trials, the 6 identified papers use 6 different scales, for functional communication and for related concepts. All of the scales appear to have questionable psychometric properties, but still provide a promising basis for the creation of a functional communication scale. We conclude with concrete suggestions on how to combine the advantages of the existing scales for future research aimed at developing a valid and reliable functional communication scale for the needs of AD clinical trials.

Communication trainings for caregivers of dementia patients: tandem project

and delay age-related cognitive decline and various forms of dementia. Previous approaches to cognitive training have generally been fairly focused, and have had difficulty in translating possible gains in cognitive performance on specific tasks to improved functioning in everyday activities. Methods: To address this issue, we developed a Web-based health coaching platform for delivering multiple components of cognitive interventions to the home. The interventions include adaptive cognitive computer games, physical exercise, sleep management, novelty exercises, and socialization. The coaching software uses monitoring data from the home to provide summary reports and automated suggested tailored messages for a coach to send to elderly clients in the home. The participants in the home use a separate system to view their weekly action plan, practice their cognitive exercises, view coaching messages, and use Skype to contact remote family members and friends. Results: We conducted an initial pilot study of this system with 13 cognitively healthy participants in our ORCATECH Living Lab to demonstrate feasibility of this approach. The participants were all over the age of 65 (mean age 76.7 6 8.2 years) and predominantly female (69%). We focused on the cognitive game and novelty exercise protocols for this initial study and found that we were able to keep our participants engaged in performing their tailored interventions over a period of 6 months. However, we also found that we needed to have both online and paper-based tutorials for the adaptive computer games, more positive automated messages generated for the coach, and defined blocks of time for each of the interventions (10-20 weeks maximum). Conclusions: We hypothesize that a continuous, multi-faceted cognitive intervention will more likely transfer to everyday activities and improvements in quality of life. Through this project we hope to provide a robust and scalable platform for testing sustainable cognitive interventions in the home.

Qualifizierungsmaßnahmen zur Steigerung der Lebensqualität demenzkranker Menschen über eine Förderung der Kommunikation und Kooperation in der ambulanten Altenpflege (Quadem)

Im vorliegenden Beitrag wird das innovative Schulungskonzept Quadem vorgestellt. Das Projektvorhaben nutzt zwei wissenschaftlich evaluierte und in der Praxis bewahrte Qualifizierungsmasnahmen: 1. Tandem, Trainings fur familiar, professionell und ehrenamtlich Pflegende zur Steigerung von sozialen Schlusselkompetenzen, insbesondere der Kommunikations- und Kooperationsfahigkeiten sowie 2. THELIA, ein Programm zur Schulung ehrenamtlich und familiar Pflegender, das diese in die Lage versetzt, fur demenzkranke Menschen zentrale Lebensthemen zu erkennen und in die alltagliche Versorgung zu integrieren. Durch die beiden Qualifizierungsmasnahmen soll dazu beigetragen werden, dass die in die Pflege eines Demenzkranken involvierten Personen effektiver zusammenarbeiten und der Individualitat Demenzkranker besser gerecht werden. Entsprechend sollte die von familiar und professionell Pflegenden erlebte Beanspruchung reduziert, das Sinnerleben von familiar, professionell und ehrenamtlich Pflegenden gestarkt und vor alle...

Psychopharmakaverordnung im Altenpflegeheim

ZusammenfassungDer Einsatz von Psychopharmaka im Altenpflegeheim unterliegt aufgrund institutioneller und struktureller Besonderheiten dieses Versorgungsbereiches, aber auch aufgrund der großen Abhängigkeit und Vulnerabilität eines großen Teils der Altenpflegeheimbewohner in besonderer Weise der Gefahr, in inadäquater und missbräuchlicher Weise durchgeführt zu werden. Die Beachtung der ethischen Grundprinzipien des Wohltuns und des Nichtschadendürfens sowie des Respekts vor der Autonomie der Bewohner (bzw. der Patienten) sollte für alle an der Versorgung unmittelbar und mittelbar Beteiligten handlungsleitend sein. Zum Schutz der Heimbewohner, aber auch mit dem Ziel die Versorgungsqualität in diesem Bereich nachprüfbar zu verbessern, werden in diesem Beitrag Kriterien zur Definition einer inadäquaten bzw. adäquaten Anwendung von Psychopharmaka explizit formuliert, sowie deren Implementierung in prozessorientierte Handlungsalgorithmen und Behandlungsleitlinien vorgeschlagen. Darüber hinaus sollen die Möglichkeiten und Grenzen nicht-pharmakologischer, psychologischer Interventionen als Alternative zur Psychopharmakamedikation diskutiert und hinsichtlich ihrer ethischen Implikationen reflektiert werden.AbstractDefinition of the problemNursing home residents are at particular risk of becoming victims of inadequate psychotropic drug use. This is not only due to several institutional and structural characteristics of nursing home care but also because nursing home residents are in a state of dependency which makes them particularly vulnerable.Arguments and conclusionAccordingly, the ethical principles of beneficence, non-maleficence and respect towards the (patients) autonomy should always be considered by all professionals who are directly and indirectly involved in care. To protect nursing home residents against inadequate psychotropic drug use and with the aim of improving the quality of care, we defined explicit criteria which characterize inadequate use. Further, we propose an algorithm to help guide adequate psychotropic drug use within the nursing home environment and suggest the implementation of these guidelines in order to improve nursing home care and prevent inadequate medication. Finally, the potential and limits of nonpharmacological psychological approaches towards behavioural and psychopathological symptoms in elderly demented nursing home residents are discussed with respect to their ethical implications.