Myrra Vernooij-Dassen

Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.

Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. Design Cost effectiveness study alongside a single blind randomised controlled trial. Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes. Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers. Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures. Results The intervention cost €1183 (£848,

Effectiveness of Nonpharmacological Interventions in Delaying the Institutionalization of Patients with Dementia: A Meta‐Analysis

1738) (95% confidence interval €1128 (£808,

Psychosocial interventions for dementia patients in long-term care

1657) to €1239 (£888,

How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver? A case study

1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279,

Involving people with dementia in the development of supportive IT applications: A systematic review

2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9). Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.

Unbearable suffering of patients with a request for euthanasia or physician‐assisted suicide: an integrative review

Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta‐analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta‐analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta‐analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43–0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07–2.81, P=.04). A meta‐analysis of the best‐quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43–0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=–0.35– 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net‐benefit or cost‐effectiveness analysis.

Needs in Early Onset Dementia: A Qualitative Case From the NeedYD Study

BACKGROUND Psychosocial interventions in long-term care have the potential to improve the quality of care and quality of life of persons with dementia. Our aim is to explore the evidence and consensus on psychosocial interventions for persons with dementia in long-term care. METHODS This study comprises an appraisal of research reviews and of European, U.S. and Canadian dementia guidelines. RESULTS Twenty-eight reviews related to long-term care psychosocial interventions were selected. Behavioral management techniques (such as behavior therapy), cognitive stimulation, and physical activities (such as walking) were shown positively to affect behavior or physical condition, or to reduce depression. There are many other promising interventions, but methodological weaknesses did not allow conclusions to be drawn. The consensus presented in the guidelines emphasized the importance of care tailored to the needs and capabilities of persons with dementia and consideration of the individuals life context. CONCLUSIONS Long-term care offers the possibility for planned care through individualized care plans, and consideration of the needs of persons with dementia and the individual life context. While using recommendations based on evidence and consensus is important to shape future long-term care, further well-designed research is needed on psychosocial interventions in long-term care to strengthen the evidence base for such care.

Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers

Objective: To enhance insight into the process of occupational therapy (OT) and the changes after OT, in an older patient with mild dementia and his primary caregiver. Design and setting: Case study: content analysis of an OT patient record. Intervention: System-based OT at home using a guideline focusing on both patients performance in daily activities and caregivers cognition on patient behaviour and caregiver role and focusing on adaptation of the physical environment. Measures: Triangulation of results of qualitative content analysis and quantitative description using the following measures: Brief Cognitive Rating Scale (BCRS), Assessment of Motor and Process Skills (AMPS), Interview of Deterioration in Daily Activities in Dementia (IDDD), Canadian Occupational Performance Measurement (COPM), Dementia Quality of Life Instrument (DQOL), Sense of Competence Scale (SCQ) and the Mastery Scale. Results: The global categories derived from content analysis were: daily performance and communication. The specific categories were the patient with dementia, his or her caregiver and the occupational therapist. Important themes derived from content analysis were: patients capacity for pleasure, autonomy and appreciation in performing daily activities and caregivers competence. Patients changes reported after OT: more initiative, autonomy and pleasure in performing daily activities, increase of quality of life; caregivers changes reported after OT: improved communication and supervision skills, changed cognition on patient behaviour and caregiver role, improved sense of competence. The quantitative results showed an improved daily performance (e.g. initiative, motor and process skills, need for assistance) and quality of life of the patient and improved sense of competence, quality of life and mastery of the situation of the caregiver after OT intervention. Thus the results of the qualitative content analysis were supported by the quantitative results. Additionally, based on the results of the content analysis an exploratory and system-based model has been developed connecting OT diagnosis and OT treatment at home for patients with dementia and their primary caregivers. Conclusion: This case study provides information on how occupational therapy can improve the daily performance, communication, sense of competence and quality of life of an older patient with dementia and his or her primary caregiver. A combination of education, setting feasible goals, using adaptations in physical environment, training compensatory skills, training supervision skills, and changing dysfunctional cognitions on patient behaviour and caregiver role seemed to be successful. A randomized controlled trial must provide information on the effects of OT at home for older patients with dementia and their primary caregivers.

The key actor: a qualitative study of patient participation in the handover process in Europe

BACKGROUND Involving people with dementia in research is not self-evident. Inclusion of people with dementia in the development process of user-friendly, supportive IT applications may be especially useful to improve the quality of these applications and may be beneficial to the person with dementia. The aim of this study was to gain insight into the involvement of people with dementia in developing supportive IT applications. The focus of involvement was on phase, methods, role and impact on the quality of the IT application and on the person with dementia. METHOD A systematic search was undertaken using Cochrane Library, PubMED, PsycInfo, EMBASE, and CINAHL. Publications were selected using the following inclusion criteria: publications had to address a development process of an IT application involving people with dementia. The BMJ checklist was used to assess the quality of the included publications. RESULTS Twenty-six publications relating to 15 IT programs met the inclusion criteria. People with dementia were mainly involved in the exploratory and technical development phases. The methods most frequently used to involve the participants were interviews, observations and usability try-outs. In most studies, participants were objects of study and informants. People with dementia provided useful feedback and gave valuable recommendations for researchers and designers regarding the development of user-friendly, supportive, IT applications. Involvement in all phases may have empowering effects on people with dementia. CONCLUSION To develop valuable, user-friendly, supportive IT applications that increase the quality of life of people with dementia involvement in all phases of the development process is of great importance.

Research protocol of the NeedYD-study (Needs in Young onset Dementia): a prospective cohort study on the needs and course of early onset dementia.

Purpose: In the legal performance of the euthanasia procedure, unbearable suffering, one of the requirements of due care, is difficult to assess. Evaluation of the current knowledge of unbearable suffering is needed in the ongoing debate about the conditions on which EAS can be approved.