Satisfaction with the care of institutionalized psychogeriatric patients, as reflected by a survey of their relatives

What is desirable care in the opinion of formal and informal caregivers in nursing-home care for patients with dementia?

Aim

To examine care characteristics related to desirable care as reported by formal and informal caregivers in Dutch Psycho‐geriatric nursing homes for patients with dementia.

Design

Qualitative exploratory study.

Methods

The sample consisted of four nursing homes. In each home, semi‐structured interviews were conducted with a manager, a quality advisor or head nurse, a daily care supervisor and an informal caregiver. The findings were analysed by labelling and coding the text fragments.

Results

The 16 semi‐structured interviews contained 60 discussion items. The 16 items that were shared by the four interviewee categories were clustered into the following six major themes: good quality of care; poor quality of care; elements of a vision; extra hands; bureaucracy; and formal caregivers.

Staff Factors Contributing to Family Satisfaction with Long-Term Dementia Care: A Systematic Review of the Literature

OBJECTIVE

The aim of the present review was to critically evaluate empirical evidence regarding staff factors that contribute to families' satisfaction with ongoing care provision for their relatives with dementia in long-term care.

METHODS

Four databases were systematically searched using search terms informed by the aim of the present systematic review. The resulting 14 relevant articles comprised both qualitative and quantitative studies.

RESULTS

The findings highlighted three broad areas relating to staff factors that appeared to contribute to families' satisfaction with care provision: family related factors, relating to staff interaction with families; staffing related factors, focusing on staffing organization and composition; and client related factors, focusing on staff interaction with clients and the quality of care provided.

CONCLUSIONS

The findings have important implications for care staff and managers working in such settings regarding staffing organization, staff training, recruitment and retention. Future research directions are discussed.

CLINICAL IMPLICATIONS

Families want consistent, knowledgeable staff that interact well and respond appropriately to the needs of their relative as well as their own needs as family members. Staff training in such settings should therefore focus not only on staff education but also on the importance of establishing effective relationships with both clients and families.

Measuring family perceived involvement in individualized long-term care

Although family involvement is considered an important aspect of care for residents with dementia in long-term care facilities, measurement is lacking. The purpose of this study is to present a multi-item reliable measurement instrument assessing family perceived involvement. Literature reviews, observations within facilities, iterative consultations with an expert panel and extensive pilot testing of items for family perceived involvement were undertaken, to establish face and content validity. Two scales were developed: family perceived involvement and family assessment of importance of their involvement in individualized care for their resident relative. Strong evidence of face and content validity, internal consistency and test-retest reliability were established for both scales. Short versions of the original scales were derived via factor analysis. These instruments provide researchers and facilities with the ability to measure both degree of family perceived involvement and the importance the family places on that involvement using a relatively brief set of statements.

[Care assessment parameters in an intermediate care unit for patients with dementia]

OBJECTIVE

To evaluate the care outcomes of a psychogeriatric unit.

MATERIAL AND METHODS

A prospective study of 46 patients with dementia consecutively admitted to Psychogeriatric Unit between May and August 2008. The parameters analysed were: a) median Neuropsychiatric Inventory (NPI) on admission, after one week and at discharge, b) percentage of patients coming from home or discharged from the acute hospital, c) percentage of patients coming from the acute hospital with an average stay equal or less than 7 days, d) percentages of falls and physical restraints, and e) destination at discharge. Comparisons between variables were performed using t-test and chi-squared.

RESULTS

There were a statistically significant difference between the median NPI on admittance (37.7) and after a week (13.7) (p<0.001). Half of the patients came from home and the other half from acute hospital, 73.9% of whom had had an average hospital stay equal or less than 7 days. Falls were reported in 19.6% of patients. Physical restraints were used in 43.5% of patients. On admission there was a low level of prescription of long half-life benzodiazepines (6.5%) and typical neuroleptics (2.2%), and 6.7% of patients had no prescription of psychotropic drugs. At discharge psychotropic drugs were not prescribed in 33% of patients. The institutionalisation rate was 43.5%.

CONCLUSIONS

Intermediate Psychogeriatric wards enable behavioural symptoms to be controlled (BPSD) and they probably optimize the use of acute hospitals.

Ratings of symptoms and comfort in dementia patients at the end of life: comparison of nurses and families

After-death reporting by proxies on end-of-life outcomes is used in research and can also be used to target institutions directly to improve practice. We compared the scores of family caregivers and nurses on two End-of-Life in Dementia Scales (EOLD) scales: Symptom Management (SM; range 0-45) over the last 3 months of life and Comfort Assessment in Dying (CAD; range 14-42). Higher scores represent better outcomes. Four Dutch nursing homes retrospectively enrolled 48 decedents with dementia. Total mean scores for family caregivers and nurses were 28.7 (SD 9.6) versus 25.2 (SD 12.7) for the SM and 31.7 (SD 5.5) versus 32.8 (SD 8.2) for the CAD. Mean item scores also did not differ much. Concordance Correlation Coefficients were 0.42 (SM) and 0.04 (CAD). Mean evaluations of end of life with dementia corresponded reasonably well between family and professional caregivers, but correspondence of individual observations was poor to moderate, suggesting serious differences in individual ratings but little systematic difference.

Evaluations of end of life with dementia by families in Dutch and U.S. nursing homes

BACKGROUND

The End-of-Life in Dementia (EOLD) scales comprise the most specific set of instruments developed for evaluations of patients' end of life by their families. It is not known whether the EOLD scales are useful for cross-national comparisons.

METHODS

We used a mortality follow-back design in multi-center studies in the Netherlands (pilot study 2005-2007) and the U.S.A. (1999), and we compared EOLD Satisfaction With Care (SWC; last three months of life), Symptom Management (SM; last three months) and Comfort Assessment in Dying (CAD) scores for 54 Dutch and 76 U.S. nursing home residents.

RESULTS

SWC total scores did not differ significantly between the Dutch and U.S. studies (31.9, SD 4.7 versus 30.4, SD 6.1), but three of ten items were rated more favorable for Dutch residents, as were SM total scores (29.1, SD 9.2 versus 20.4, SD 10.6). CAD total scores did not differ (32.0, SD 5.4 versus 30.5, SD 5.9, respectively), but the "well-being" subscale was rated more favorably for Dutch residents. Results were similar after adjustment for demographics and dementia severity.

CONCLUSION

The Dutch families rated end of life with dementia in nursing homes as somewhat better than did U.S. families. Although differences were small, the observed patterns were consistent. This suggests validity of the SM and CAD to assess differences in quality of dying and possible sensitivity to differences between countries or time frames. Larger, simultaneous, cross-national studies are needed to confirm usefulness of the scales and to detect areas which need improvement in the respective countries.

Outcomes from a program of home care attendance in very frail elderly subjects

This study evaluated various outcomes of home care in a group of 121 chronically ill and frail elderly subjects followed for 24 months, starting from September 2001. The scheduled times of follow up were baseline, 6, 12, and 24 months. Subjects of both sexes were assigned to one of two groups. Control group (CG) (60 subjects: mean age 85.4 years, home care provided by the Social Health Service of the Emilia Romagna Region) and Intervention group (IG) (61 subjects, mean age 82.0 years), for whom the institutional home care was empowered providing a home care attendant. The home care attendant was a person trained in the care of the frail elderly. He/she served from 4 to 24 h daily, according to a program established by a Geriatric Evaluation Unit, considering the needs of the subject and of his/her family members. The cost of the additional home care attendance (HCA) was sponsored (totally or in part), by the "Fondazione del Monte di Bologna e di Ravenna", a non profit foundation. This report takes into consideration the data coming from the first 24 months of follow-up. The two groups were homogenous at baseline. Genetic/molecular pattern including interleukine-1-beta (IL-1b), alfa1-antichimotrypsine (a1ACT), apolipoprotein E4 (APOE4), interleukine-6 (IL-6), tumor necrosis factor-alfa (TNFa), and progression of frailty and disability were considered and discussed. Mortality was lower in the IG than in the CG at 6, 12, and 24 months. Depressive symptoms and disability increased more in IG than in CG; a decrease of the stress of the family members was observed in the IG. The number of drugs used was higher in the CG than in the IG. These outcomes can be related to the additional program of home attendance. The correlation between pro-inflammatory cytokine levels and degree of frailty are observed in both groups without statistically significant difference.