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van de Ven G, Draskovic I, Adang EMM, Donders R, Zuidema SU, Koopmans RTCM, Vernooij-Dassen MJFJ. Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial. PLoS One 2013; 8:e67325. [PMID: 23844003 PMCID: PMC3699562 DOI: 10.1371/journal.pone.0067325] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention. METHODS Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents' neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects. RESULTS 34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI -2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects. CONCLUSIONS Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect. TRIAL REGISTRATION Dutch Trials Registry NTR2314.
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Affiliation(s)
- Geertje van de Ven
- Department of Primary and Community Care, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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102
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van de Ven-Vakhteeva J, Bor H, Wetzels RB, Koopmans RTCM, Zuidema SU. The impact of antipsychotics and neuropsychiatric symptoms on the quality of life of people with dementia living in nursing homes. Int J Geriatr Psychiatry 2013; 28:530-8. [PMID: 22886912 DOI: 10.1002/gps.3858] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/25/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to establish whether antipsychotic (AP) use in patients with dementia negatively affects quality of life (QoL) independent of neuropsychiatric symptoms (NPS). METHOD We tested 290 patients with dementia living in nine nursing homes throughout the Netherlands in a longitudinal study. The measurements were repeated every 6 months over 2 years. We studied the change in NPS and AP use and their effect on QoL over time in two separate generalized estimating equations. We assessed QoL and NPS using the Qualidem questionnaire and the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), respectively. RESULTS Antipsychotic prescriptions did not significantly change participant QoL, whereas NPI-NH total score changes consistently predicted changes in QoL. According to the Qualidem, the development of QoL in patients who chronically used APs did not differ from AP-free patients, except on the restless tense behavior subscale. AP-free patients' "restless tense behavior" improved compared with patients who chronically used APs, who showed a slight deterioration in these symptoms; however, this effect did not significantly influence total QoL. CONCLUSION Antipsychotic use does not necessarily have detrimental effects on the QoL of patients with dementia; rather, NPS consistently and negatively affects QoL. The use of APs to treat NPS is justified when used carefully (i.e., their benefits and side effects should be monitored).
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Affiliation(s)
- Julia van de Ven-Vakhteeva
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Center Nijmegen, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands.
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103
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Weerkamp NJ, Zuidema SU, Tissingh G, Poels PJE, Munneke M, Koopmans RTCM, Bloem BR. Motor Profile and Drug Treatment of Nursing Home Residents with Parkinson's Disease. J Am Geriatr Soc 2012; 60:2277-82. [DOI: 10.1111/jgs.12027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nico J. Weerkamp
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
- Department of Neurology; Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Nijmegen the Netherlands
| | - Sytse U. Zuidema
- Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Department of Primary and Community Care; Center for Family Medicine; Geriatric Care and Public Health; Nijmegen the Netherlands
- Radboud University Nijmegen Medical Center; Donders Institute for Brain; Cognition and Behavior; Department of Neurology; Nijmegen the Netherlands
| | - Gerrit Tissingh
- Department of Neurology; Atrium Medical Center; Heerlen the Netherlands
| | - Petra J. E. Poels
- Department of Neurology; Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Nijmegen the Netherlands
| | - Marten Munneke
- Department of Neurology; Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Nijmegen the Netherlands
| | - Raymond T. C. M. Koopmans
- Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Department of Primary and Community Care; Center for Family Medicine; Geriatric Care and Public Health; Nijmegen the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology; Radboud University Nijmegen Medical Center; Nijmegen Center for Evidence Based Practice; Nijmegen the Netherlands
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
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Ruikes FGH, Meys ARM, van de Wetering G, Akkermans RP, van Gaal BGI, Zuidema SU, Schers HJ, van Achterberg T, Koopmans RTCM. The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly. BMC Fam Pract 2012; 13:115. [PMID: 23216685 PMCID: PMC3527269 DOI: 10.1186/1471-2296-13-115] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/29/2012] [Indexed: 12/31/2022]
Abstract
Background With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. Methods/design The CareWell-primary care study includes a (cost-) effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver ‘care as usual’. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients’ and professionals’ approval of the program, and the barriers and facilitators to implementation. Discussion The CareWell-primary care study will provide new insights into the (cost-) effectiveness, feasibility, and barriers and facilitators for implementation of this complex intervention in primary care. Trial registration The CareWell-primary care study is registered in the ClinicalTrials.gov Protocol Registration System: NCT01499797
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Affiliation(s)
- Franca G H Ruikes
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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105
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Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RTCM. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis. BMC Health Serv Res 2012; 12:443. [PMID: 23211058 PMCID: PMC3537742 DOI: 10.1186/1472-6963-12-443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022] Open
Abstract
Background Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. Methods This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Results Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Conclusion Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
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Affiliation(s)
- Bianca I Buijck
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P,O,Box 9101, Nijmegen, 6500 HB, the Netherlands.
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106
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Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RTCM, Geurts ACH. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study. Age Ageing 2012; 41:746-52. [PMID: 22885846 DOI: 10.1093/ageing/afs105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity. DESIGN prospective cohort study with data collection at baseline and at discharge. SETTING fifteen SNFs in the Netherlands. PARTICIPANTS of 378 eligible patients, 186 were included. METHODS multi-disciplinary teams recorded demographic and disease characteristics, as well as functional status, cognitive functioning and multi-morbidity on admission. The study outcomes were discharge to an independent living situation within 1 year of admission and functional status at discharge (Barthel index). RESULTS of the included 186 patients, 175 were followed up. Of these patients, 123 (70%) were successfully discharged. High Berg Balance Scale (BBS) and Star Cancellation test (SCT) scores independently contributed to 48% of the variance of functional status at discharge, while low age, high BBS and SCT scores were independently related to successful discharge, explaining 33% of the variance. Multi-morbidity was not an independent determinant of rehabilitation outcome. CONCLUSION geriatric patients admitted for 'low intensity' rehabilitation in SNFs after stroke appeared to have a fair prognosis for being successfully discharged. Postural control was an important determinant of both outcome measures.
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Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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107
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Robben SH, Huisjes M, van Achterberg T, Zuidema SU, Olde Rikkert MG, Schers HJ, Heinen MM, Melis RJ. Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP). JMIR Res Protoc 2012; 1:e10. [PMID: 23611877 PMCID: PMC3626145 DOI: 10.2196/resprot.1945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/28/2012] [Accepted: 06/26/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. OBJECTIVE To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). METHODS We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. RESULTS We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. CONCLUSIONS This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.
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Affiliation(s)
- Sarah Hm Robben
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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108
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van Kempen JAL, Robben SHM, Zuidema SU, Olde Rikkert MGM, Melis RJF, Schers HJ. Home visits for frail older people: a qualitative study on the needs and preferences of frail older people and their informal caregivers. Br J Gen Pract 2012; 62:e554-60. [PMID: 22867679 PMCID: PMC3404333 DOI: 10.3399/bjgp12x653606] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/08/2012] [Accepted: 03/08/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A number of studies have examined the effects of home visits and showed inconsistent results on physical functioning, institutionalisation, and mortality. Despite continuing interest from professionals in home visits for older people, reports on older people's needs and preferences for such visits are scarce. AIM This qualitative study aims to explore the views and needs of community-dwelling frail older people concerning home visits. DESIGN AND SETTING A qualitative study including interviews with frail older persons and their informal caregivers living in the area of Nijmegen, the Netherlands. METHOD Semi-structured interviews were conducted with frail older people and informal caregivers. A grounded theory approach was used for data-analysis. RESULTS Eleven frail older people and 11 informal caregivers were included. Most participants emphasised the importance of home visits for frail older people. They felt that it would give older people the personal attention they used to receive from GPs but miss nowadays. Most stated that this would give them more trust in GPs. Participants stated that trust is one of the most important factors in a good patient-professional relationship. Further, participants preferred home visits to focus on the psychosocial context of the patient. They stated that more knowledge of the psychosocial context and a good patient-professional relationship would enable the professional to provide better and more patient-centred care. CONCLUSION Patients' expectations of home visits are quite different from the actual purpose of home visiting programmes; that is, care and wellbeing versus cure and prevention. This difference may partly explain why the effectiveness of home visits remains controversial. Future studies on home visits should involve patients in the development of home visiting programmes.
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Affiliation(s)
- Janneke A L van Kempen
- Department of geriatric medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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109
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van Kollenburg EGP, Lavrijsen JCM, Verhagen SC, Zuidema SU, Schalkwijk A, Vissers KCP. Prevalence, causes, and treatment of neuropathic pain in Dutch nursing home residents: a retrospective chart review. J Am Geriatr Soc 2012; 60:1418-25. [PMID: 22788732 DOI: 10.1111/j.1532-5415.2012.04078.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the prevalence and causes of neuropathic pain in Dutch nursing home residents; to establish the prevalence of painful and nonpainful diabetic polyneuropathy in a subsample of individuals with diabetes mellitus and central poststroke pain (CPSP) in a subsample of individuals who had a stroke; and to study the prescription of antineuropathic drugs. DESIGN A descriptive, retrospective, cross-sectional study conducted by analyzing medical records. SETTING Data were collected in 12 Dutch nursing homes. PARTICIPANTS The data were derived from the medical records of 497 residents of chronic long-term stay and rehabilitation nursing home units. MEASUREMENTS Four groups were defined: actual (at some time in the previous year) neuropathic pain (ANP), possible neuropathic pain (PNP), neuropathic pain in the past (NPP), and no signs of neuropathic pain (NoNP). RESULTS The prevalence of ANP was 10.9% (95% confidence interval (CI) = 8.4-13.8%) and of PNP was 5.6% (95% CI = 3.9-7.9%). The most common causes were CPSP and phantom limb pain. In the subgroup with diabetes mellitus, 6.3% had nonpainful diabetic polyneuropathy, 0.7% had painful diabetic polyneuropathy, and 0.7% had possible painful diabetic polyneuropathy. In the poststroke subsample, 4.7% were identified as having CPSP, and 5.2% were identified as possibly having CPSP. Within the ANP group, 68.5% of the residents received antineuropathic drugs on the day the medical records were examined; 48.1% used anticonvulsants. CONCLUSION Dutch nursing home residents frequently experience neuropathic pain; therefore, neuropathic pain should receive more attention in frail elderly adults.
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Affiliation(s)
- Esther G P van Kollenburg
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Vijmegen Medical Centre, Nijmegen, the Netherlands.
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110
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Buijck BI, Zuidema SU, Spruit-van Eijk M, Geurts ACH, Koopmans RTCM. Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study. Int J Geriatr Psychiatry 2012; 27:734-41. [PMID: 21932248 DOI: 10.1002/gps.2781] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/11/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the prevalence and course of neuropsychiatric symptoms (NPS) in geriatric patients admitted to skilled nursing facilities (SNFs) for rehabilitation after stroke. METHODS This was a longitudinal multicenter study within 15 SNFs in the Netherlands. NPS were assessed in 145 patients with stroke through the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) with measurements on admission and at discharge. The prevalence and course of NPS were described in terms of cumulative prevalence (symptoms either on admission or at discharge), conversion (only symptoms at discharge), remission (only symptoms on admission), and persistence (symptoms both on admission and at discharge) for patients who were discharged to an independent living situation within one year after admission and patients who had to stay in the SNF for long term care. RESULTS Eighty percent had a first-ever stroke and 74% could be successfully discharged. Overall, the most common NPS were depression (33%), eating changes (18%), night-time disturbances (19%), anxiety (15%), irritability (12%), and disinhibition (12%). One year after admission, the patients who were still in the SNF showed significantly more hallucinations (p = 0.016), delusions (p = 0.016), agitation (p = 0.004), depression (p = 0.000), disinhibition (p = 0.004), irritability (p = 0.018), and night-time disturbances (p = 0.001) than those who had been discharged. DISCUSSION The overall prevalence of NPS in this study was lower than reported by other studies in different settings. There was a high prevalence of NPS in patients that could not be successfully discharged. CONCLUSIONS The findings suggest that NPS should be optimally treated to improve outcome of rehabilitation.
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Affiliation(s)
- Bianca I Buijck
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. .
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111
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Buijck BI, Zuidema SU, Eijk MS, Gerritsen DL, Koopmans RTCM, Linde H, Buijck BI, Eijk MS, Zuidema SU. Erratum. J Am Geriatr Soc 2012. [DOI: 10.1111/j.1532-5415.2012.04095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Bianca I. Buijck
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Sytse U. Zuidema
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Monica S. Eijk
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Debby L. Gerritsen
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Raymond TCM Koopmans
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Harmen Linde
- Rehabilitation; Nijmegen Centre for Evidence Based Practice; Radboud University Nijmegen Medical Centre; Nijmegen
| | | | | | - Sytse U. Zuidema
- General Practice; University Medical Centre Groningen; Groningen; the Netherlands
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Buijck BI, Zuidema SU, van Eijk MS, Gerritsen DL, Koopmans RTCM, Linde H. Determinants of Quality of Life in Older Adults After Lower Limb Amputation and Rehabilitation in Skilled Nursing Facilities. J Am Geriatr Soc 2012; 60:796-8. [DOI: 10.1111/j.1532-5415.2011.03880.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Debby L. Gerritsen
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Raymond TCM Koopmans
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Harmen Linde
- Rehabilitation; Nijmegen Centre for Evidence Based Practice; Radboud University Nijmegen Medical Centre; Nijmegen
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Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RT, Geurts AC. To what extent can multimorbidity be viewed as a determinant of postural control in stroke patients? Arch Phys Med Rehabil 2012; 93:1021-6. [PMID: 22464737 DOI: 10.1016/j.apmr.2012.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the determinants of postural imbalance after stroke in geriatric patients admitted for low-intensity rehabilitation in skilled nursing facilities (SNFs), particularly the role of multimorbidity. DESIGN Cross-sectional study design. SETTING Fifteen SNFs. PARTICIPANTS All patients who were admitted for rehabilitation after stroke in one of the participating SNFs (N=378) were eligible. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Berg Balance Scale (BBS) was selected as a measure of standing balance and the Functional Ambulation Categories (FAC) as a measure of walking balance. RESULTS Multimorbidity was present in 34% of the patients. The patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on both outcome measures. In linear regression analyses, both the BBS and FAC were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively), while proprioception added only to the variance of the FAC. CONCLUSIONS Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs. Muscle strength and the interaction of muscle strength with static sitting balance were important determinants of both standing and walking balance, indicating these factors as essential targets for rehabilitation.
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Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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114
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van de Ven G, Draskovic I, Adang EMM, Donders RART, Post A, Zuidema SU, Koopmans RTCM, Vernooij-Dassen MJFJ. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial. BMC Geriatr 2012; 12:1. [PMID: 22214264 PMCID: PMC3267673 DOI: 10.1186/1471-2318-12-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 01/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. METHODS/DESIGN The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory--Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. DISCUSSION A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. TRIAL REGISTRATION The trial is registered in the Netherlands National Trial Register: NTR2314.
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Affiliation(s)
- Geertje van de Ven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 117 ELG, 6500 HB Nijmegen, The Netherlands
| | - Irena Draskovic
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 117 ELG, 6500 HB Nijmegen, The Netherlands
| | - Eddy MM Adang
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 113 EBH, 6500 HB Nijmegen, The Netherlands
| | - Rogier ART Donders
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 113 EBH, 6500 HB Nijmegen, The Netherlands
| | - Aukje Post
- Dementia-care mapping, The Netherlands, De Friese Wouden, P.O. Box 215, 9250 AE Burgum, The Netherlands
| | - Sytse U Zuidema
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 117 ELG, 6500 HB Nijmegen, The Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 117 ELG, 6500 HB Nijmegen, The Netherlands
| | - Myrra JFJ Vernooij-Dassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 117 ELG, 6500 HB Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands
- Kalorama Foundation, Postbus 85, 6573 ZH Beek-Ubbergen, The Netherlands
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Eijk MSV, van der Linde H, Buijck BI, Zuidema SU, Koopmans RTCM. Geriatric rehabilitation of lower limb amputees: a multicenter study. Disabil Rehabil 2011; 34:145-50. [DOI: 10.3109/09638288.2011.591888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Zwijsen SA, Smalbrugge M, Zuidema SU, Koopmans RTCM, Bosmans JE, van Tulder MW, Eefsting JA, Gerritsen DL, Pot AM. Grip on challenging behaviour: a multidisciplinary care programme for managing behavioural problems in nursing home residents with dementia. Study protocol. BMC Health Serv Res 2011; 11:41. [PMID: 21338502 PMCID: PMC3051882 DOI: 10.1186/1472-6963-11-41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/21/2011] [Indexed: 11/25/2022] Open
Abstract
Background Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. Methods/Design The care programme is based on Dutch national guidelines. It will consist of four steps: detection, analysis, treatment and evaluation. A stepped wedge design will be used. A total of 14 dementia special care units will implement the care programme. The primary outcome is behavioural problems. Secondary outcomes will include quality of life, prescription rate of antipsychotics, use of physical restraints and workload and job satisfaction of nursing staff. The effect of the care programme will be estimated using multilevel linear regression analysis. An economic evaluation from a societal perspective will also be carried out. Discussion The care programme is expected to be cost-effective and effective in decreasing behavioural problems, workload of nursing staff and in increasing quality of life of residents. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR 2141
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Affiliation(s)
- Sandra A Zwijsen
- Department of Nursing Home Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
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Zuidema SU, Buursema AL, Gerritsen MGJM, Oosterwal KC, Smits MMM, Koopmans RTCM, de Jonghe JFM. Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and Reliable Change Index of the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. Int J Geriatr Psychiatry 2011; 26:127-34. [PMID: 20690131 DOI: 10.1002/gps.2499] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to estimate inter-observer and test-retest reliability of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI), and to establish their Reliable Change Index (RCI). Reliable Change methodology is a practical method for estimating the least change acquired in outcome measures. METHODS Nursing home physicians and certified nurses assessed 105 patients with dementia (in five nursing homes) at baseline and after 2 weeks. Spearman rank correlations were calculated and Reliable Change Difference Scores (S(diff) (80)). RESULTS NPI-NH inter-observer correlations ranged 0.14-0.70. NPI-NH test-retest correlations ranged 0.23-0.80. CMAI inter-observer correlations ranged -0.10 to 0.72. CMAI test-retest correlations ranged 0.32-1.00 (CMAI total score, ρ=0.89). S(diff) (80) for NPI-NH items ranged 1.7-5.0. A change of 11 points on the NPI-NH total score can be considered a true behavioral change. S(diff) (80) for CMAI total score was 8 and factor analysis based sub-scale scores physically aggressive behavior, physically non-aggressive behavior, and verbally agitated behavior were 3, 6, and 4, respectively. CONCLUSION Reliability estimates and RCI for the NPI-NH were modest, seriously challenging its reliability and sensitivity to change over time. NPI-NH may only be useful for monitoring behavioral changes in individual patients with dementia, when symptoms are moderate to severe, or when effect sizes are large. Reliability of the CMAI was good, supporting its usefulness in clinical practice. Poor inter-observer agreement on behavioral observations poses a real challenge in nursing homes. Reliable scales are needed that include unambiguously formulated items.
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Affiliation(s)
- Sytse U Zuidema
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Koopmans RTCM, Lavrijsen JCM, Zuidema SU. The physician's role in nursing homes: the Dutch solution. ACTA ACUST UNITED AC 2010; 170:1406; author reply 1406-7. [PMID: 20696976 DOI: 10.1001/archinternmed.2010.278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wetzels RB, Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord 2010; 29:189-97. [PMID: 20215750 DOI: 10.1159/000280437] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS The goal of this study is to assess the relationship between quality of life (QoL), neuropsychiatric symptoms (NPS), psychotropic drug use (PDU) and patient characteristics in a large group of nursing home residents with dementia. METHODS This cross-sectional observational study included 288 individuals with dementia who reside in 14 special care units in 9 nursing homes. The following measures were used: the Qualidem scale to assess QoL, the Neuropsychiatric Inventory-Nursing Home version, the Global Deterioration Scale (GDS), the Severe Impairment Battery-short version, an Activities of Daily Living scale and PDU. Associations between QoL and NPS were examined using multivariate linear regression models with corrections for potential covariates. RESULTS The average age of the residents was 84 years (SD = +/-7). Agitation, depression, psychosis, psychomotor agitation and psychotropic drugs were independently associated with poor QoL. In patients with mild to moderately severe dementia (GDS 4-6), NPS, PDU and cognitive impairment explained almost half of the variance in QoL scores. Agitation and depression were particularly strong predictors of poor QoL. In patients with severe dementia (GDS 7), agitation, depression, psychosis and cognitive impairment were associated with poor QoL. CONCLUSIONS NPS, cognition and PDU independently impair QoL for patients in both the moderate and advanced stages of dementia. These results challenge existing pharmacological intervention strategies and highlight the need for psychosocial interventions in the treatment of NPS.
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Affiliation(s)
- R B Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Radboud University Nijmegen, The Netherlands.
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Spruit-van Eijk M, Buijck BI, Zuidema SU, Voncken FLM, Geurts ACH, Koopmans RTCM. Geriatric rehabilitation of stroke patients in nursing homes: a study protocol. BMC Geriatr 2010; 10:15. [PMID: 20346175 PMCID: PMC2858723 DOI: 10.1186/1471-2318-10-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. METHODS/DESIGN This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation.Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation. DISCUSSION This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients.
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Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen- Medical Centre, Geert Grooteplein 21 Nijmegen 6525 EZ, the Netherlands.
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. Int J Geriatr Psychiatry 2010; 25:14-22. [PMID: 19517419 DOI: 10.1002/gps.2292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the influence of environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. METHODS 1289 patients in 56 Dementia Special Care Units (SCUs) in the Netherlands were assessed using the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI). Potential correlates of the neuropsychiatric symptoms studied were gender and age of the patient, dementia severity, psychoactive medication use and environmental correlates such as the number of patients per unit or per living room, staff size/patient ratio, time spent on care activities and presence of a walking circuit. Multilevel logistic regression analysis was used to estimate the relative contribution of the different factors in explaining neuropsychiatric symptoms variability. RESULTS The prevalence of neuropsychiatric symptoms differed between SCUs, also after correcting for patient factors. Patient-related factors explained 7-21% of the total variance of neuropsychiatric symptoms. Intra Class Correlation (the correlation of symptoms of patients within SCUs) ranged from 0.039 (psychosis) to 0.163 (apathy). The variance in SCU symptom prevalence (variance between SCUs) accounted for 3.5-14.8% of the total variance in neuropsychiatric symptoms. In SCUs of which the staff spent more time on care activities did the patients show lower levels of apathy. Other environmental correlates did not predict neuropsychiatric symptoms. CONCLUSION The substantial variation of prevalence rates between SCUs in combination with the clustering of symptoms within SCUs is strong evidence for the environmental contribution to neuropsychiatric symptoms and the multifactorial nature of behaviour in dementia.
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Affiliation(s)
- Sytse U Zuidema
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, the Netherlands.
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. Int J Geriatr Psychiatry 2009; 24:1079-86. [PMID: 19280678 DOI: 10.1002/gps.2225] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of the study was to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. METHODS Neuropsychiatric symptoms were assessed in a large sample of 1319 Dutch nursing home patients using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated using logistic regression analysis and subsequently corrected for possible confounders, such as age, duration of institutionalization and psychoactive medication use. RESULTS While physically aggressive behaviour was more common in patients with very severe cognitive deterioration (GDS stage 7), disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients in GDS stage 5 or 6. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. With respect to other neuropsychiatric symptoms, delusions and depression were also more common in patients in GDS stage 5 and 6, while prevalences of anxiety and apathy further increased in severely demented patients (GDS stage 7). Apathy was more prevalent in male patients, while depression and anxiety were more common in females. CONCLUSION In nursing home patients, neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing (moderately) severe cognitive decline. Only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline. Dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
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Affiliation(s)
- Sytse U Zuidema
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Abstract
BACKGROUND Efficient neuropsychological tests are needed to measure cognitive impairment in moderate to severe dementia. OBJECTIVE To examine construct validity of the Severe Impairment Battery Short Version (SIB-S) in nursing home patients with moderate to severe dementia, and to examine potential floor effects for the SIB-S. METHODS Cross-sectional comparison of cognitive measures, dementia severity and functional dependency. RESULTS A total of 290 patients were included 264 of whom had complete SIB-S protocols. Internal consistency of the SIB-S was very high (Cronbach alpha = 0.97). Principal-component analysis produced three factors, the first of which explained more than 50% of common score variance. Semantic memory items loaded highly on the first factor. Total SIB-S scores were associated with cognitive impairment (SIB-S--Mini Mental State Examination (MMSE) rho = 0.91, p<0.001), and with functional dependency (SIB-S--ADL scale rho = -0.61, p<0.001). SIB-S total scores differentiated between dementia stages as measured with the Global Deterioration Scale (F = 164.6; df 3,260, p<0.001). Comparisons of SIB-S total score variance across patients with moderate to severe dementia and patients with below or above average Mini Mental State Exam scores indicate an absence of large floor effects. CONCLUSION In this first study examining an independently administered SIB-S, the scale proved to be a homogeneous and valid measure of cognitive impairment. The SIB short version can be used to assess moderately to severely demented patients, who may find it difficult to complete traditional, lengthier neuropsychological tests.
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Affiliation(s)
- J F M de Jonghe
- Geriatric Medicine, Medical Center Alkmaar 046, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
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Kat MG, Zuidema SU, van der Ploeg T, Kalisvaart KJ, van Gool WA, Eikelenboom P, de Jonghe JFM. Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms. Int J Geriatr Psychiatry 2008; 23:1014-9. [PMID: 18425989 DOI: 10.1002/gps.2026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. METHODS This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the Netherlands. Nursing home physicians (NHP) noted the primary reasons for psychiatric consultation according to the Neuropsychiatric Inventory items and two extra domains. Patients were subsequently assessed by an old-age psychiatrist. Eligible patients were those that had dementia. Reasons for referral were compared with independent data on prevalence of neuropsychiatric symptoms in nursing home patients with dementia. RESULTS A total of 325/787 (41.3%) patients had dementia. Agitation, disinhibition and aberrant motor behaviour were frequent reasons for referral (>25%). Psychotic symptoms, apathy and eating behaviour changes were infrequent reasons (<10%) for seeking consultation. Agitation and disinhibition were more often primary reasons for consultation than would have been expected based on normative prevalence estimates of these symptoms. In contrast, delusions, euphoria, apathy, irritability and eating behaviour changes were less often reasons for referral compared with prevalence estimates. CONCLUSIONS This study is the first to examine psychiatric consultation for dementia patients in Dutch nursing home. Large differences exist between referral reasons and normative data on symptom prevalence. Specialized mental health service was provided for the agitated and disinhibited patient in particular. Chances are that this is at the expense of the apathetic, retarded and quietly 'not causing any trouble' patient.
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Affiliation(s)
- Martin G Kat
- Medical Center Alkmaar, Department of Geriatric Medicine, Alkmaar, The Netherlands.
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the neuropsychiatric inventory in different stages of dementia. Dement Geriatr Cogn Disord 2007; 24:169-76. [PMID: 17641527 DOI: 10.1159/000105603] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To examine the influence of dementia stage and psychoactive medication use on the factor structure of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) in Dutch nursing home patients. METHODS The NPI-NH was administered to a large sample of 1,437 patients with mild to severe dementia receiving nursing home care. Exploratory factor analysis was used to examine behavioural dimensions underlying neuropsychiatric symptoms indicated by the NPI-NH across dementia stages (as assessed with the Global Deterioration Scale - GDS) and in patients with or without psychoactive medication prescribed. RESULTS In GDS stages 4/5, 6 and 7, a 4- or 5-factor solution was found, with factors referred to as agitation/aggression, depression, psychosis, psychomotor agitation and apathy. These symptom clusters were replicated in the group of drug-naive patients, but only partially in the group of patients on psychoactive medication. CONCLUSION The factor structure of the NPI-NH in nursing home patients is consistent with the clinical taxonomy of symptoms, is relatively stable across dementia stages, and is only moderately influenced by psychoactive medication use. The division of depression and apathy into separate behavioural dimensions - also in patients with severe dementia - may have important therapeutic consequences.
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Affiliation(s)
- Sytse U Zuidema
- Department of Nursing Home Medicine, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM. Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry 2007; 22:632-8. [PMID: 17136713 DOI: 10.1002/gps.1722] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the prevalence of neuropsychiatric symptoms of dementia patients in Dutch nursing homes. METHODS Cross-sectional study in a large sample of 1322 demented patients living in 59 dementia special care units (SCUs) in The Netherlands. Symptoms were observed by licensed vocational nurses during regular care-giving in a 2-week observational period prior to assessment. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory- Nursing home version (NPI-NH; frequency X severity score >/= 4) and the Cohen-Mansfield Agitation Inventory (CMAI; symptoms occurring at least once a week). RESULTS More than 80% of these patients suffered from at least one clinically significant symptom, as defined with the NPI-NH frequency X severity score >/= 4. Measured with the NPH-NH agitation/aggression, apathy and irritability were the most frequently observed behaviors, with prevalences of 30-35%. Using the CMAI, 85% of the patients showed at least one symptom of agitation, of which general restlessness was observed most frequently (44%). Other frequently observed symptoms with prevalence rates of 30% were cursing or verbal aggression, constant request for attention, negativism, repetitious sentences, mannerisms, pacing, and complaining. Physically aggressive symptoms such as hitting, kicking, biting occurred less often (less than 13%). CONCLUSIONS Prevalence rates of neuropsychiatric symptoms in Dutch nursing home patients with dementia residing in SCUs are high, especially agitation and apathy. Insight into the prevalence rates of individual symptoms in patients with dementia has important practical consequences for the accurate planning of staff allotment and stresses the need for patient oriented care.
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory. Dement Geriatr Cogn Disord 2007; 23:35-41. [PMID: 17077631 DOI: 10.1159/000096681] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/AIMS To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. RESULTS A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. CONCLUSION The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.
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Affiliation(s)
- Sytse U Zuidema
- Department of Nursing Home Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Zuidema SU, van Iersel MB, Koopmans RTCM, Verhey FRJ, Olde Rikkert MGM. [Efficacy and adverse reactions of antipsychotics for neuropsychiatric symptoms in dementia: a systematic review]. Ned Tijdschr Geneeskd 2006; 150:1565-73. [PMID: 16886695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To assess the efficacy and adverse reactions of typical and atypical antipsychotics in the treatment of neuropsychiatric symptoms in dementia, and to examine the evidence for the cerebrovascular events warning for atypical antipsychotics. DESIGN Systematic review. METHOD Using Medline, Cinahl, PsyclNFO, Embase and the Cochrane central register of controlled trials (1980-2005), double-blind randomized controlled trials with intention-to-treat analysis were selected, which evaluated efficacy and adverse reactions of antipsychotics in the treatment of neuropsychiatric symptoms in dementia. The studies underwent a standardised validity assessment. RESULTS After screening 950 studies, 14 studies on the effect of haloperidol, risperidone, olanzapine, quetiapine, tiapride, loxapine and perphenazine were selected. In 7 out of 10 studies, haloperidol, risperidone and olanzapine appeared to be more effective than placebo in the treatment of aggression and psychosis. Direct comparison between typical and atypical antipsychotics revealed no statistically significant difference. The most common adverse reactions were extrapyramidal symptoms and somnolence. These adverse reactions were less frequent with low-dose risperidone than with haloperidol or olanzapine, but risperidone and olanzapine were found to be associated with a higher risk of cerebrovascular events in two studies. CONCLUSION The efficacy of typical and atypical antipsychotics is comparable, but only low-dose risperidone seems to be associated with fewer (extrapyramidal) side effects. The adverse reactions are inadequately described in the published data and consequently the warning of an increased risk of mortality could not be confirmed.
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Affiliation(s)
- S U Zuidema
- Universitair Medisch Centrum St. Radboud, Postbus 9101, 6500 HB Nijmegen.
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Zuidema SU, van der Meer MM, Pennings GATC, Koopmans RTCM. [Prevalence of behavioural problems in a group of demented nursing home patients]. Tijdschr Gerontol Geriatr 2006; 37:19-24. [PMID: 16529151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Behavioural problems in dementia are a burden for patients and caregivers and are often the main reason for admission to a nursing home. Research on the prevalence of behavioural problems is scarce. In this study the prevalence of behavioural problems was estimated in nursing home patients with dementia. In 59 demented patients the Neuropsychiatric Inventory (NPI-NH) and the Cohen-Mansfield Agitation Inventory were used to measure behavioural problems over the last two weeks. Behavioural problems were present in about 85% of the study group. Using the NPI-NH aggression/agitation and apathy were present in almost 40% of the patients. Delusions, hallucinations, depression and anxiety were present in 10-15% of the patients. Using the CMAI cursing/verbal aggression, restlessness, complaining, negativism, and mannerisms were prevalent in 30%-50% of the patients. Larger studies on the prevalence of problem behaviour and possibly influencing factors are necessary.
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Affiliation(s)
- S U Zuidema
- Verpleeghuisarts-onderzoeker, Stichting Kalorama, Beek-Ubbergen en afdeling Verpleeghuisgeneeskunde UMC St Radboud, Nijmegen.
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Nijmeijer NM, aan de Stegge BM, Zuidema SU, Sips HJWA, Brouwers PJAM. [Efficacy of agreements within the Enchede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation]. Ned Tijdschr Geneeskd 2005; 149:2344-9. [PMID: 16261715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess the efficacy of agreements within the Enschede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation. DESIGN Prospective, partly retrospective. METHOD All patients who were referred from the stroke unit at Medisch Spectrum Twente to the CVA Rehabilitation Unit (CRU) in the period 1 July 1999-31 July 2003 were included. Referral took place via an active multidisciplinary approach and specific referral agreements. The primary outcome was the number of patients that could be discharged home after rehabilitation. In addition, we assessed the influence on final discharge destination of age, the Barthel and Rankin scores at the time of admission to the CRU and the medical complications during the period of rehabilitation. RESULTS 232 patients were included (133 women and 99 men, mean age 76.4 years). Within 3 months, 63% of the patients were discharged home. After 6 months, 82% had returned home. 8% of the patients died within 6 months and 9% had to stay in a nursing home permanently. Of the patient aged 80 years or older, 75% could return home within 6 months. Patients with poor Barthel and Rankin scores and medical complications had a smaller chance of being discharged home. CONCLUSION Effective referral of patients from the stroke unit to a nursing home for short-term rehabilitation is possible. With adequate patient selection, the use of good referral agreements and multidisciplinary consultations, most patients could finally return home.
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van Iersel MB, Zuidema SU, Koopmans RTCM, Verhey FRJ, Olde Rikkert MGM. Antipsychotics for Behavioural and Psychological Problems in Elderly People with Dementia. Drugs Aging 2005; 22:845-58. [PMID: 16245958 DOI: 10.2165/00002512-200522100-00004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Although antipsychotics are important in the treatment of behavioural and psychological symptoms of dementia (BPSD), they have moderate efficacy and often cause adverse events. Recent safety warnings about increased frequency of cerebrovascular adverse events in elderly patients who use atypical antipsychotics mean that physicians now face a dilemma when weighing the benefits and risks of use of antipsychotics in this patient group. This study systematically reviews the reporting of adverse events of antipsychotics used to treat BPSD in randomised, controlled trials (RCTs). METHODS We searched the MEDLINE, EMBASE, PsychInfo and CINAHL databases (search period 1980 or 1986-April 2005) and the Cochrane controlled trials register (2005) for RCTs that used intention-to-treat analysis to evaluate the efficacy and harms of antipsychotics used to treat BPSD. Two independent reviewers assessed the reporting of adverse events. RESULTS Screening of 930 abstracts identified 12 eligible RCTs (2809 patients). Most participants were elderly people (mean age 80 years) with Alzheimer's, vascular or mixed dementia. Studies lasted from 3 to 16 weeks. Adverse events, though common, were described heterogeneously and incompletely. No RCT fulfilled all Consolidated Standards of Reporting Trials requirements for the reporting of harms. Atypical antipsychotics caused fewer extrapyramidal symptoms and less somnolence than typical antipsychotics, but these differences disappeared when dosages were increased. Only one trial reported cerebrovascular adverse events, with a number needed to harm of 14 (95% CI 8, 41). CONCLUSIONS At lower doses atypical antipsychotics may cause fewer adverse events in the treatment of BPSD, but there is uncertainty about their cerebrovascular safety profile. The RCTs included in this systematic review described adverse events too incompletely and heterogeneously to allow generation of clear treatment recommendations, and they do not provide sufficient evidence to support recent safety warnings. Better reporting on harms in RCTs is needed to enable rational treatment decisions with respect to use of antipsychotics for BPSD.
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Affiliation(s)
- Marianne B van Iersel
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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