Ulla Eloniemi-Sulkava

Effects of supporting community-living demented patients and their caregivers: a randomized trial.

To determine whether community care of demented patients can be prolonged by means of a 2‐year support program based on nurse case management.

Family care as collaboration: effectiveness of a multicomponent support program for elderly couples with dementia. Randomized controlled intervention study.

OBJECTIVES: To determine whether community care of people with dementia can be prolonged with a 2‐year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services.

How do elderly spouse care givers of people with Alzheimer disease experience the disclosure of dementia diagnosis and subsequent care

Objectives: To examine the experiences of spousal care givers of Alzheimer patients to disclosure of dementia diagnosis and subsequent care. Methods: A random sample of 1943 spousal care givers of people receiving medication for Alzheimer disease (AD) was sent a cross-sectional postal survey about their opinions on the disclosure of dementia and follow-up care. A smaller qualitative study (n = 63) included open-ended questions concerning their experiences of the same topics. Results: The response rate for the survey was 77%. Of the respondents, 1214 of 1434 acknowledged themselves as their spouse’s care giver. The mean age of the care givers was 78.2 years, and that of demented spouses, 80.5 years. Of the care givers, 63% were women. The couples had long-lasting marriages (mean 52 years). Of the care givers, 93% reported that dementia had been disclosed openly to their spouse; 97% also preferred that physicians openly inform the patients of the dementia diagnosis, although 55% of their spouses with AD had developed depressive symptoms after the disclosure. Of the care givers, 71% felt they had received sufficient information about dementia. However, only 50% estimated that their spouses’ follow-up care had been well organised. The responses in the qualitative study indicated that many care givers felt grief and anxiety. They also expressed feelings of loneliness and uncertainty about how to deal with follow-up care for dementia. Conclusions: Elderly spousal care givers were quite satisfied with the information given them about dementia. However, the support with regard to the follow-up care of care-giving families failed to meet their needs adequately.

Systematic intervention for supporting community care of elderly people after a delirium episode.

OBJECTIVE To investigate the effects of a systematic intervention with a case manager concept and rehabilitation periods compared to standard aftercare in elderly community-dwelling patients discharged from the hospital after a delirium episode. DESIGN Before/after intervention cohort study with 3-year follow-up. SETTINGS Acute geriatric wards of a city hospital and a private rehabilitation center. SUBJECTS AND METHODS The intervention group consisted of 51 community-dwelling people over 65 years of age without severe underlying disorders, who were consequently admitted as emergency cases to the hospital because of a delirious state or who were delirious immediately after admission. The intervention included continuous support and counseling by a nurse specialist and rehabilitation periods at a rehabilitation center. The control group consisted of 51 age- and gender-matched patients admitted to the same hospital for delirium fulfilling the same inclusion and exclusion criteria during preceding years. The main outcome measures were duration of community care, the use of long-term institutional care, the use of short-term hospitalizations during the follow-up, and the death of the patients. RESULTS Delirium even in the healthy community-dwelling subjects indicated a poor prognosis. After 3 years, 18 patients (35%) from the intervention group and 9 patients (18%) from the controls were in community care. The mean duration of community care was 671 days in the intervention group and 503 days in the control group, p = .025. A reduction of 19 years was achieved in the cumulative time spent in long-term institutionalized care. The use of short-duration hospitalization was similar in both groups. CONCLUSION The institutionalization of elderly patients after a delirious state could be delayed using rehabilitation periods and systematic intervention with the case manager concept.

Nutritional guidance improves nutrient intake and quality of life, and may prevent falls in aged persons with Alzheimer disease living with a spouse (NuAD trial)

ObjectiveThe aim was to examine the effect of tailored nutritional guidance on nutrition, health-related quality of life (HRQoL) and falls in persons with Alzheimer disease (AD).DesignRandomised controlled trial.Setting and ParticipantsPersons with AD living with a spouse.InterventionTailored nutritional guidance with home visits during one year. The control group received a written guide about nutrition in older adults and all community-provided normal care.MeasurementsThe primary outcome measure was weight change, and secondary outcomes included changes in protein and micronutrient intakes from three-day food records, HRQoL (15D) and rate of falls.ResultsOf the participants (n = 78) with AD (mean age 77.4, 69% males), 40% were at risk for malnutrition, 77% received < 1.2 g/bodyweight (kg) of protein at baseline. We found no difference in weight change between the groups. At 12 months, the mean change in protein intake was 0.05 g/bodyweight (kg) (95% CI −0.06 to 0.15) in the intervention group (IG), and −0.06 g/kg (95% CI −0.12 to 0.02) in the control group (CG) (p = 0.031, adjusted for baseline value, age, sex, MMSE and BMI). Participants’ HRQoL improved by 0.006 (95% CI −0.016 to 0.028) in the IG, but declined by −0.036 (95% CI −0.059 to 0.013) in the CG (p = 0.007, adjusted for baseline value, age, sex, MMSE and BMI). Dimensions that differed included mental functioning, breathing, usual activities and depression. The fall rate was 0.55 falls/person per year (95% CI 0.34 to 0.83) in the IG, and 1.39 falls/person per year (95% CI 1.04 to 1.82) in the CG (IRR 0.55; 95% CI 2.16 to 6.46; p < 0.001 adjusted for age, sex and MMSE).ConclusionsTailored nutritional guidance improves nutrition and HRQoL, and may prevent falls among AD people living with a spouse.

DISCLOSURE OF DEMENTIA DIAGNOSIS AND THE NEED FOR ADVANCE CARE PLANNING IN INDIVIDUALS WITH ALZHEIMER'S DISEASE

To the Editor: In a recent article in the Journal of the American Geriatrics Society, Carpenter and colleagues found that disclosure of a dementia diagnosis does not prompt a catastrophic emotional reaction in most people with dementiaFnot even in those who are cognitively only mildly impaired. Companions of these patients also remained stable or even declined in their emotional stress immediately after the disclosure of dementia diagnosis. These findings suggest that physicians can provide a dementia diagnosis to a patient without fear of prompting strong emotional reactions. In our experience, the disclosure of a diagnosis of dementia and adjustment to understanding all dimensions related to this information are a long-term process in which the patient’s feelings develop and change over time. We examined the experiences of spousal caregivers of patients with Alzheimer’s disease (AD) with many comorbidities and disabilities regarding the disclosure of dementia diagnosis and the subsequent need for advance care planning (ACP).

Health-related quality of life as a predictor of mortality in heterogeneous samples of older adults

BackgroundHealth-related quality of life (HRQoL) is associated with survival in older people with multimorbidities and disabilities. However, older people differ in their characteristics, and less is known about whether HRQoL predicts survival in heterogeneous older population samples differing in their functional, cognitive, psychological or social disabilities. The aim of this study was to explore HRQoL in heterogeneous samples of older men and women, and to explore its prognostic significance for mortality.MethodsWe analysed combined individual patient data from eight heterogeneous study samples all of which were assessed with the same methods. We used 15D, a generic, comprehensive instrument for measuring HRQoL, which provides a single index in addition to a profile. Two-year mortality was retrieved from central registers.ResultsHealth-related quality of life measurements with 15D were available for 3153 older adults. The mean HRQoL was highest among older businessmen (0.878) and lowest among nursing home residents (0.601). 15D predicted independently and significantly the 2-year survival in the total sample [hazard ratio (HR)/SD 0.44, 95% CI 0.40–0.48)]. However, 15D did not predict mortality in samples of spousal caregivers, lonely older adults and cardiovascular patients.Conclusions15D captures health and disability factors associated with prognosis whereas in older populations suffering from psychological and social impairments such as caregiver burden or loneliness HRQoL may not reflect their health risks.

Unterstützende Intervention bei dementen Patienten und ihren pflegenden Angehörigen in der Gemeinde

Zusammenfassung: Die Einweisung dementer Patienten in Langzeiteinrichtungen kann mit Hilfe eines Familienpflegekoordinators fur Demenzkranke hinausgezogert werden. Allerdings waren am Ende der Zwei-Jahres-Intervention die Zahlen der institutionalisierten Patienten in der Interventions- und in der Kontrollgruppe ahnlich. Dennoch scheint es nutzlich zu sein, diese Art der intensiven Unterstutzung insbesondere schwer kranken Demenzpatienten und ihren Angehorigen zukommen zu lassen. Auf der Grundlage unserer Erfahrungen schlagen wir vor, dass die Intervention durch einen Familienpflegekoordinator fur Demenzkranke speziell auf solche Patienten abzielen sollte, bei denen die Kontinuitat der Gemeindekrankenpflege problematisch ist.

P365: Tailored nutritional intervention and nurses’ guidance in nutrition improves nutrition among residents with dementia in long-term care

P363 Nutritional guidance improves nutrient intake, quality of life and prevents falls of aged persons with AD living at home: a randomized, controlled trial (NuAD-trial) M.H. Suominen, T.M. Puranen, U. Eloniemi-Sulkava, S.K. Jyvakorpi, H. Kautiainen, U. Siljamaki-Ojansuu, K.H. Pitkala Society for Gerontological Nutrition in Finland, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Central Hospital, Finland, Helsinki, Finland; University of Helsinki, Palmenia Centre for Continuing Education, Helsinki, Finland; Nutrition Unit at Tampere University Hospital, Tampere, Finland