Lena Annerstedt

Caregiver's Burden of Patients 3 Years After Stroke Assessed by a Novel Caregiver Burden Scale

OBJECTIVE To assess burden of caregivers to stroke patients three year after primary stroke and to test validity and reliability of a novel caregiver burden scale (CB scale). DESIGN A longitudinal community-based 3-year follow-up study of 35 consecutive primary stoke patients initially admitted to an Acute Medical Unit (mean age 82 yr). The validity of the CB scale was studied in 150 patients (mean age 77 yr): 83 demented outpatients with stroke from a general geriatric day-care unit. Reliability was studied in another 23 outpatients (mean age 72 yr) with stroke from the same unit. METHODS A 22-item CB scale for different types of caregiver burden and scales for neuroticism and extroversion (Eysenck Personality Inventory) and quality of life (11-item scale). Activities of daily life were assessed by a 6-item, scale, initially and 3 years later. OUTCOME MEASURE Reliability and validity of the CB scale. Improvements of activities of daily life of stroke patients. RESULTS Factor analyses of the CB scale gave five indices--general strain, isolation, disappointment, emotional involvement, and environment--having good kappa values, .89 to 1.00 and Cronbachs alpha, .70 to .87, except for environment. A higher burden was related to a closer relationship but not to the living situation. The highest caregiver burden was found among patients showing the greatest improvements of ADL, when divided into tertiles. The patients degree of extroversion and quality of life were negatively correlated to caregiver burden, -.46(p < .05) and .59(p < .01). CONCLUSIONS The CB scale proved to be a valid and reliable instrument to assess caregiver burden. To improve the caregiver situation, individual patient personality characteristics, like extroversion, feeling of quality of life, and progression of the disease, must be considered.

How should a group living unit for demented elderly be designed to decrease psychiatric symptoms

Summary:The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 ± 6 years), 37% with dementia of Alzheimers type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with “disorientation for recent memory” and “lack of vitality,” adjusted for type of dementia (r = −0.13 to −0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.

Development and consequences of group living in Sweden: A new mode of care for the demented elderly

The process of developing a new mode of care for the demented elderly, group living (GL), is evaluated and the consequences discussed. The increasing proportion of very old persons in Sweden means a higher prevalence of dementia. The majority of patients in traditional institutional long term care show cognitive deterioration. An insufficient caring situation, both in quantity and quality has long been observed. This, and a better knowledge and understanding of dementing diseases, their symptoms and consequences, has been the impetus to develop an alternative care model, group living (GL), for well defined groups of demented elderly. The concept of GL discussed here means a setting strictly adapted to the abilities and psychosocial needs of moderately diseased Alzheimer and vascular demented patients. Security, integrity promoting therapy and activation are specially stressed. The importance of informing and educating different kinds of actors simultaneously to structural changes in social and physical patterns within the implementation of the new concept is illustrated.

Group-Living Care: An Alternative for the Demented Elderly

Group-living (GL) care as an alternative to traditional long-term care for elderly demented people is rapidly proliferating across Sweden. In engineering the psychosocial and physical environment according to the competence and needs of moderately and moderately to severely demented patients, therapeutic effects on symptoms can be achieved during a period of the dementing process. The background, implementation and outcome of a concept of GL care developed for patients suffering from dementia of Alzheimer type (DAT), vascular dementia (VD) and mixed DAT and VD is presented as is the role of GL in the total dementia care of a community.

Behavioral Disturbances and Pharmacological Treatment of Patients With Dementia in Family Caregiving: A 2-Year Follow-Up

Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimers dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.