Patricia De Vriendt

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

Background Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL. Methods and findings The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study. Conclusions This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

An explorative study of the relationship between functional and cognitive decline in older persons with mild cognitive impairment and Alzheimer’s disease

Introduction This study explored the relationship between functional decline on three advanced activities of daily living and cognitive decline in elderly persons. The use of everyday technology, driving a vehicle, and performing complex economic activities are advanced activities of daily living domains presumed to be sensitive to early cognitive decline and therefore of interest for the profession of occupational therapy. Method We included 45 persons with mild cognitive impairment, 48 persons with Alzheimer’s disease, and 50 cognitively healthy controls. Functional impairment due to cognitive decline was evaluated by the advanced activities of daily living tool. Cognitive disability indices were computed for the investigated advanced activities of daily living domains and correlated with the Mini Mental State Examination and the Cambridge Examination for Mental Disorders of the Elderly, Cognitive Part. Results The cognitive disability index for performing complex economic activities and the cognitive disability index for the three advanced activities of daily living domains together differed significantly between the three groups. For the whole sample, the advanced activity of daily living cognitive disability indices correlated strongly with the cognitive measures. Within each separate group, few correlations were found. Conclusion This study contributes to the field of knowledge for occupational therapy by emphasizing the value of assessment of advanced activities of daily living in early cognitive decline. For the occupational therapy profession, further research is required in the interaction between functional decline and cognition in early cognitive decline.

How competent are healthcare professionals in working according to a bio-psycho-social model in healthcare? : the current status and validation of a scale

Background Over the past decades, there has been a paradigm shift from a purely biomedical towards a bio-psycho-social (BPS) conception of disability and illness, which has led to a change in contemporary healthcare. However, there seems to be a gap between the rhetoric and reality of working within a BPS model. It is not clear whether healthcare professionals show the necessary skills and competencies to act according to the BPS model. Objective The aim of this study was (1) to develop a scale to monitor the BPS competencies of healthcare professionals, (2) to define its factor-structure, (3) to check internal consistency, (4) test-retest reliability and (5) feasibility. Design and Setting Item derivation for the BPS scale was based on qualitative research with seven multidisciplinary focus groups (n = 58) of both patients and professionals. In a cross-sectional study design, 368 healthcare professionals completed the BPS scale through a digital platform. An exploratory factor analysis was performed to determine underlying dimensions. Statistical coherence was expressed in item-total correlations and in Cronbach’s α coefficient. An intra-class-correlation coefficient was used to rate the test-retest reliability. Results The qualitative study revealed 45 items. The exploratory factor analysis showed five underlying dimensions labelled as: (1) networking, (2) using the expertise of the client, (3) assessment and reporting, (4) professional knowledge and skills and (5) using the environment. The results show a good to strong homogeneity (item-total ranged from 0.59 to 0.79) and a strong internal consistency (Cronbach’s α ranged from 0.75 to 0.82). ICC ranged between 0.82 and 0.93. Conclusion The BPS scale appeared to be a valid and reliable measure to rate the BPS competencies of the healthcare professionals and offers opportunities for an improvement in the healthcare delivery. Further research is necessary to test the construct validity and to detect whether the scale is responsive and able to detect changes over time.

The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition

Abstract Purpose To explore the perspectives of male clients in a neurological rehabilitation setting with regard to the occupational therapy they have received and the client-centred approach. Method This study involved a qualitative research design based on the grounded theory tradition. Individual in-depth interviews were used to collect data. Data were analysed using a constant comparative method. Seven male participants from an inpatient neurological setting were included using a theoretical sampling technique. Results Three themes emerged to describe the approach of the therapists to client-centred practice: (a) a shared biomedical focus as the start of the rehabilitation process, (b) the un-simultaneous shift from a biomedical towards a psycho-social focus and (c) formal versus informal nature of gathering client information. Conclusion A client-centred approach entails a shift from the therapist focussing on recovery from the short-term neurological issues towards the long-term consequences of the disease. According to the client, this shift in reasoning must occur at a specific and highly subjective moment during the rehabilitation process. Identifying this moment could strengthen the client-centred approach. Implications for Rehabilitation Client-centred practice entails a shift from recovering the short-term neurological issues towards the long-term psycho-social consequences of the disease. To be effective in client-centred practice, the clients expect from the professional to be an authority with regard to biomedical issues and to be partner with regard to psycho-social issues. Client-centred practice is most likely to be successful when client is susceptible to discuss his psycho-social issues and finding this moment is a challenge for the professional. Using formal methods for goal setting do not necessarily cover all the information needed for a client-centred therapy programme. Rather, using informal methods could lead to a more valid image of the client.

Active ageing in the nursing home: Could participatory action research provide the answer?

Within the Active Ageing context (WHO), enhancing older peoples’ quality of life by focusing on their participation is essential. Although Active Ageing is relevant in nursing homes, the nursing home residents’ autonomy and participation on organizational level are often restricted. New ways to structurally enhance their participation must be found. This article discusses possible contributions of participatory action research as structural method in a new Active Ageing-envisioned nursing home, enabling residents’ participation and focuses on the practicalities of its implementation process. During an implementation project in the nursing home, participatory action research was introduced in the nursing home as weekly activity where residents assembled to observe the nursing home operation, identify problems and make suggestions for improvement. Based on the researchers’ experiences, implementing participatory action research needs a preparation and adaptation period for the nursing home staff, the participatory action research moderators and the residents to cope with the experienced challenges. Nevertheless, participatory action research appeared feasible and can bring added value to residents’ living conditions. This article contributes to the development of the participatory action research theory and the Active Ageing implementation in nursing home, since it shows the possibilities, challenges and assets of participatory action research towards a more frail population in the nursing home environment. Participatory action research might in turn lead to the realization of Active Ageing nursing home who endeavours to optimize residents’ quality of life.

Quality in dementia care: A cross sectional study on the Bio-Psycho-Social competencies of health care professionals

Objective Professionals in dementia-care ought to be able to work within a Bio-Psycho-Social model. The objectives were to examine whether dementia-care is delivered in a Bio-Psycho-Social way, to explore the influencing factors and to evaluate the factorial validity of the ‘Bio-Psycho-Social-Dementia-Care scale’. Design and setting 413 healthcare-professionals completed the ‘Bio-Psycho-Social-Dementia-Care scale’. Differences between groups (settings, professions, years of experience) were calculated with a student’s t-test and one-way ANOVA. The facture structure of the scale was evaluated using a confirmatory factor analysis. Results The factor-analysis confirmed the 5 subscale-structure (1) networking, (2) using the client’s expertise, (3) assessment and reporting, (4) professional knowledge and skills and (5) using the environment. (No significant differences were found between professionals in residential care and community care for the subscales ‘networking’ and ‘using the client’s expertise’. Professionals in residential care score higher than community care for ‘assessment and reporting’ (p<0,05) and ‘professional knowledge and skills’ (p<0,01) but lower for ‘using the environment’ (p<0,001). The juniors score higher for ‘professional knowledge’ compared to seniors (p<0,01) and the seniors score better for ‘professional experience’ (p<0,01). The Cure and Care disciplines and the Therapy disciplines had higher values in ‘assessment and reporting’ compared to the Social Support disciplines (p<0,001 and p<0.001). The Therapy disciplines scored higher in ‘using professional knowledge and skills’ compared to the Social Support group (p 0.021) and the Cure and Care disciplines (p<0,001). The Social Support disciplines scored higher in ‘using the environment’ compared to the Therapy disciplines (p<0.001) and the Cure and care disciplines (p<0.001). Conclusion The Bio-Psycho-Social-Dementia-scale is a valid tool and offers opportunities not only to rate, but also to improve Bio-Psycho-Social functioning in dementia-care: increase interdisciplinary collaboration, facilitate assessment, combine the strengths of the different professions and install a heterogeneous team with regard to age and experience.

Improving clarity and transparency in cognitive assessment: conversion of the Cambridge Cognition Examination to the International Classification of Functioning, Disability and Health

BackgroundA variety of screening, diagnostic and assessment tools have been developed for use in dementia research and care. However, there is no consensus which tool to use and moreover there is no transparency in communication between countries and disciplines.ObjectiveTo contribute to a more uniform assessment in dementia, the Cambridge Cognition Examination (CAMCOG) was converted to the International Classification of Functioning, Disability and Health (ICF).MethodsIn a qualitative design, CAMCOG-items and –scoring-system were converted to the ICF addressing 3 ICF domains: global and specific mental functions and general tasks and demands. Construct and discriminative validity was checked in a sample of 25 cognitively healthy elderly (CHE), 25 persons with Mild Cognitive Impairment (MCI) and 25 patients with mild Alzheimer’s Disease (mAD).ResultsA significant correlation was observed between CAMCOG/ICF-CAMCOG (r = − 0.987; p < 0.01). The areas under the curve (AUC) of the ICF-CAMCOG were between 0.819 and 0.978; comparable with the original CAMCOG. Only a significant difference between the AUC of the CHE versus MCI (0.911 vs. 0.819; p = 0.0094) was observed in favour of CAMCOG.ConclusionThe clinical use of the ICF-CAMCOG looks promising offering a more detailed and interpretable scoring and may allow for better planning of resources to aid patients with dementia.

A retrospective study of a multicomponent rehabilitation programme for community-dwelling persons with dementia and their caregivers:

Introduction This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia (n = 30) and their caregivers (n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results Eight participants dropped out prematurely. For persons with dementia (n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly (Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers (n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.