R.M. Dröes

A review of psychosocial models in psychogeriatrics: Implications for care and research

Based on an examination of the relevant literature, this article presents a survey of psychosocial models used in the psychogeriatric field. Models with a multidimensional approach to behavior problems in dementia and a focus on the individual were selected. The utility of these psychosocial models as a theoretical framework for emotion-oriented care for people with dementia, especially Alzheimer disease, is examined. In addition to describing the models, this article also reports on the target group for which these models were developed, the degree to which they have been operationalized for psychogeriatrics, and the degree to which they have been subjected to empirical testing. This study shows that all psychosocial models described may be called emotion-oriented, although they also contain, in varying degrees, elements from the consequences model. It was found that the models are used not only as a theoretical framework for research, but also in the provision of care. Despite the fact that most models have been used in the psychogeriatric field, therefore proving their practicability for psychogeriatric practice, only one of the models described has been tested empirically so far. The theoretical validity of the models in question is, therefore, not yet clear.

Does theatre improve the quality of life of people with dementia

BACKGROUNDnA new communication method, the Veder method, has recently been developed. Caregivers are trained to apply this method in a group activity (living-room theatre activity) for people with dementia in which theatrical stimuli are used in combination with proven emotion-oriented care methods. The aim of this exploratory study was to evaluate the added value of the Veder method group activity compared to a regular reminiscence group activity and to investigate whether professional carers can achieve the same effects with the Veder method as professional actors.nnnMETHODSnA quasi-experimental three-group design was used. Experimental group 1 (E1; n = 65) joined a living-room theatre activity offered by trained professional caregivers. Experimental group 2 (E2; n = 31) joined a living-room theatre activity offered by professional actors. The control group (n = 55) received a usual reminiscence group activity. Behavior, mood and aspects of quality of life were measured using standardized observation scales at three points in time: (T1) pretest; (T2) during the intervention and; (T3) post-test, two hours after the intervention.nnnRESULTSnDuring the intervention, significant differences were found in favor of the group that was offered a living-room theatre activity by actors (E2) on different aspects of behavior, mood and quality of life. At post-test, people in E2 were more alert compared to the control group. Moreover, they recalled more memories and showed less socially isolated behavior compared to the control group.nnnCONCLUSIONnThis exploratory study shows that the Veder method has some clear positive effects on behavior and mood of people with dementia when applied by professional actors.

THE DESIGN OF A LARGE-SCALE EXPERIMENTAL STUDY INTO THE EFFECT OF EMOTION-ORIENTED CARE ON DEMENTED ELDERLY AND PROFESSIONAL CARERS IN NURSING HOMES

Summary The design and organization of a large-scale experimental study on the effect of emotion-oriented care is described. The research project aims to investigate the effect and the cost-effectiveness of emotion-oriented care on demented elderly residents of nursing homes and their professional carers. Besides an evaluation of the effect and costs of emotion-oriented care, the project intends to describe the implementation process of the intervention itself, including the educational courses for the nurses and on-the-job training. Emotion-oriented care as applied in this study is based mainly on the validation approach of N. Feil, developed in the seventies and eighties, but also utilizes insights from other approaches in psychogeriatrics, such as: reality orientation training, reminiscence and sensory stimulation. The study started in April 1996, and data are being collected during 1997. The processing of data and analysis will take place in 1998, and the results will be available during the spring of 1999.

Self report on quality of life in dementia with modified COOP/WONCA charts

This study investigates whether a modified version of the COOP/WONCA charts is suitable to assess quality of life (QOL) in persons with dementia in nursing homes. A group of 112 institutionalized persons with moderate to severe dementia were approached for an interview. Twenty-two were observed not to be communicative, leaving 90. Sixty-seven persons were able to answer four out of six questions adequately (interviewable). Inter-observer reliability (n=38) was excellent (weighted kappa 0.90 to 0.97). Test-retest reliability (n=34; one week interval) ranged from poor for Daily and Social Activities and for the QOL charts, to moderate for Feelings and Pain, and satisfactory for Physical Functioning (weighted kappa 0.23 to 0.67). Interviewability was associated with severity of the dementia and communication ability. Support for convergent validity was found in medium-sized Spearman correlations between the COOP/WONCA charts and related variables. Support for discriminant validity was found in the absence of association between the Ccharts and non-related variables. The modified COOP/WONCA charts can be used to assess QOL in 60% of people with dementia in nursing homes but further modification is needed. Severe cognitive impairment and communication disabilities proved limiting factors for the use of the instrument. Although the illustrations on the charts appeared not to be helpful, the written response options in addition to verbal presentation proved useful during the administration of the charts.

The implementation of integrated emotion-oriented care: Did it actually change the attitude, skills and time spent of trained caregivers?:

Background: Successful implementation is a vital precondition for investigating the outcome of care innovation. This study concerned the evaluation of the implementation of integrated emotion-oriented care (IEOC) in psychogeriatric nursing home wards. The main question was whether the trained caregivers actually applied the knowledge and techniques of IEOC during their daily work. Methods: The study was conducted within the framework of a randomized clinical trial into the effectiveness of IEOC in 16 wards. Preceding the experimental period, staff from 16 wards were educated and trained to work with a standardized care plan, resulting in a similar level of quality of care at the start of the trial. On the experimental wards IEOC was then implemented by training on the job in addition to training courses for personnel. To examine the implementation effectiveness, a self-report questionnaire, ‘Emotion-oriented Skills in the Interaction with Elderly People with Dementia’, was administered at baseline and after 7 months to a sample of caregivers from the experimental and the control wards. In addition, participant observation was conducted on four experimental and four control wards, and time spent by care personnel on different type of care tasks was registered. Results: The implementation of IEOC resulted in increased emotion-oriented skills and more knowledge of the residents among the caregivers. Providing IEOC was not more time consuming for the caregivers than providing usual care. Conclusion: This study shows that the implementation of IEOC was effective. It is recommended that in intervention studies the correct application of a new intervention or care approach is examined before jumping to conclusions about the effectiveness of the intervention or care approach itself.

The rosetta project

To support the growing number of community-dwelling persons with dementia, alternative solutions, such as assistive technologies, are needed. In the European Rosetta Project, three separate ICT systems were improved, integrated, and evaluated with the objective to create one modular system that helps community-dwelling people with mild cognitive impairment (MCI) and dementia in different stages of the disease to retain their autonomy and quality of life that postpones institutional care and that supports the carers. The Rosetta system integrates the systems Elderly Day Navigator (EDN), Early Detection System (EDS), and Unattended Autonomous Surveillance-Advanced Awareness and Prevention System (UAS-AAPS). EDN supports persons in daily functioning in the areas of memory, social contact, daily activities, and safety; EDS monitors daily behavior and timely detects changes in functioning; and UAS-AAPS automatically detects emergency situations (like falls) and generates alarms to carers. The development of the system took place in close cooperation with persons with severe cognitive impairments/dementia, informal and professional carers, and dementia experts. The final prototype was tested in a controlled field trial with persons with severe cognitive impairments or dementia in three countries. The results from the evaluation study show that participants positively valued the usefulness of the system, but that the user-friendliness could be improved. Though there were no statistically significant effects on outcome measures in this explorative small-scale trial, participants indicated that the Rosetta system changed their lives in some ways, for instance, by structuring the day and by improving feelings of safety and security. Participants had no ethical concerns regarding the (visibility and application of) sensors and cameras. Future implementation of the Rosetta system may (cost-)effectively support the growing number of community-dwelling persons with dementia during the mild and more severe stages of the disease.

Casemanagement bij beginnende dementie

Samenvattingxa0Jansen APD, Van Hout HPJ, Nijpels G, Rijmen F, Dröes RM, Pot AM, Schellevis FG, Stalman WAB, Van Marwijk HWJ. Casemanagement bij beginnende dementie. Huisarts Wet 2011;55(2):58–63.DoelMen neemt algemeen aan dat vroegtijdige diagnose en casemanagement leiden tot betere zorg voor thuiswonende ouderen met dementie, vooral doordat de mantelzorger betere ondersteuning krijgt. Dat klinkt plausibel, maar het is niet bewezen. In een gerandomiseerd gecontroleerd klinisch onderzoek (RCT) gingen wij na of ouderen met de eerste symptomen van cognitieve achteruitgang en hun mantelzorgers daadwerkelijk beter af zijn met casemanagement dan met de gebruikelijke zorg die de huisarts biedt.MethodeDe deelnemers aan ons onderzoek waren 99 patiënten uit Westfriese huisartsenpraktijken, met hun belangrijkste mantelzorger. De patiënten waren 65 jaar of ouder, woonden thuis en hadden symptomen van cognitieve achteruitgang. Wij randomiseerden de koppels in een groep die casemanagement kreeg en een groep die de gebruikelijke huisartsenzorg ontving, en maten bij de mantelzorgers de ervaren competentie, zorgbelasting, kwaliteit van leven en mate van somberheid. De patiënten ondervroegen we over hun ervaren kwaliteit van leven. Dit deden we op drie meetmomenten: voorafgaand aan de randomisatie, na zes en na twaalf maanden.ResultatenWe vonden geen verschillen tussen de interventie- en de controlegroep.ConclusieWij hebben de meerwaarde van casemanagement vooralsnog niet kunnen aantonen, maar op basis van deze ene RCT is het nog te vroeg voor een definitief oordeel. Daarvoor is meer onderzoek nodig.

Theatraal communiceren in de zorg: De effectiviteit van de Veder Contact Methode

SamenvattingStichting Theater Veder maakt al jaren school met een benadering die belevingsgerichte zorgmethoden in het contact met mensen met dementie combineert met theatrale elementen. De nieuwste vorm hiervan, de Veder Contact Methode, is nu onderzocht op effectiviteit en op de duurzaamheid van invoering in zorginstellingen.

Does working with the Veder Contact Method influence the job satisfaction of caregivers? A non-randomized controlled trial in nursing homes for people with dementia

BACKGROUNDnPerson-centered care interventions can improve the quality of life and decrease behavioral problems of people with dementia. Although not convincingly proven, person-centered care interventions may benefit the caregivers as well. This study aims to gain insight into how working with the Veder Contact Method (VCM) - a new person-centered care method - influences the job satisfaction of caregivers.nnnMETHODSnWithin a quasi-experimental study, the job satisfaction of caregivers of six experimental wards (n = 75) was compared with caregivers of six control wards (n = 36) that applied Care-As-Usual. The Leiden Quality of Work Questionnaire (LQWQ) was filled in by caregivers in both conditions. Additionally, on the experimental wards, qualitative research, i.e. focus groups with 42 caregivers and interviews with 11 managers, was conducted to obtain a deeper understanding of the influence of applying VCM on caregivers job satisfaction. The transcripts were analyzed using deductive analysis.nnnRESULTSnNo quantitatively significant differences were found on the subscales of the LQWQ: work and time pressure, job satisfaction, autonomous decision making, social support from colleagues, and social support from supervisors. From the qualitative research, some caregivers and managers reported that implementing VCM contributed to their job satisfaction and that applying VCM supported handling difficult behavior and depressed mood of residents and contributed to team building.nnnCONCLUSIONSnNo significant effects on job satisfaction were demonstrated. Qualitative findings indicate that VCM positively influences the daily work performances of nursing home caregivers. The relation between the experience of offering quality care and job satisfaction of caregivers needs further investigation.

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.