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Gillis K, van Diermen L, Lahaye H, De Witte M, De Wit Y, Roelant E, Lips D, Zhiri A, Hockley J, Van Bogaert P. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 2023; 14:1083-1096. [PMID: 37405630 DOI: 10.1007/s41999-023-00825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. METHODS A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. RESULTS Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). CONCLUSION Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. TRIAL REGISTRY Trial registration number B300201942084 (18/11/2019).
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Affiliation(s)
- Katrin Gillis
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Hilde Lahaye
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
| | - Marianne De Witte
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Yentl De Wit
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Ella Roelant
- Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium
| | - Dirk Lips
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Abdesselam Zhiri
- R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium
- Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium
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2
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Cesana BM, Poptsi E, Tsolaki M, Bergh S, Ciccone A, Cognat E, Fabbo A, Fascendini S, Frisoni GB, Frölich L, Jori MC, Mecocci P, Merlo P, Peters O, Defanti CA. A Confirmatory and an Exploratory Factor Analysis of the Cohen-Mansfield Agitation Inventory (CMAI) in a European Case Series of Patients with Dementia: Results from the RECage Study. Brain Sci 2023; 13:1025. [PMID: 37508955 PMCID: PMC10376951 DOI: 10.3390/brainsci13071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items. METHODS Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study. RESULTS The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprised Physically Aggressive behavior, Verbally Aggressive behavior, Physically non-aggressive behavior, and Physically and verbally aggressive behavior. CONCLUSIONS A new grouping of all items according to a clinical criterion is proposed, allowing for a more sensible evaluation of the symptoms leading to better differentiation.
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Affiliation(s)
- Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy
| | - Eleni Poptsi
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, Faculty of Philosophy, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece
- 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, 2313 Ottestad, Norway
- Norwegian National Centre for Aging and Health, Sykehuset i Vestfold, 3103 Tønsberg, Norway
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, 46100 Mantua, Italy
| | - Emmanuel Cognat
- Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, 75010 Paris, France
| | - Andrea Fabbo
- Geriatric Service-Cognitive Disorders and Dementia, Department of Primary Care, Local Health Authority of Modena (AUSL), 41124 Modena, Italy
| | | | - Giovanni B Frisoni
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | | | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
- Division of Clinical Geriatrics, NVS Department, Karolinska Institutet Stockholm, 17177 Stockholm, Sweden
| | - Paola Merlo
- Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 12203 Berlin, Germany
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3
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Al Ghassani A, Rababa M. The Relationship between Size of Core Network and Frequency of Contacts with Agitation and Positive Affect in Older Adults with Dementia. Dement Geriatr Cogn Disord 2022; 50:498-506. [PMID: 34518451 DOI: 10.1159/000518715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have explored the associations of agitation symptoms among older adults with core network size and with frequency of contact with core network care providers. The present study aimed to investigate the associations of agitation and affect among older adult people with dementia (PWD) with core network size and frequency of contact with core network care providers. METHODS A convenience sample of 98 Omani older adult PWD residing in their homes was recruited. Most of the participants (63.3%) were female, and the mean age of the participants was 80 years (standard deviation = 9.0). A total of 77 participants suffered from severe dementia, while the remaining 21 had mild to moderate dementia levels. Valid and reliable instruments completed by either the participating PWD or their caregivers were used to measure the study variables. RESULTS The main hypothesis of the study was not supported, whereby core network size and frequency of contact with the core network were not found to be significantly associated with activities of daily living (ADL) and instrumental ADL (IADL) core networks or agitation and affect. Further, the findings indicated no significant associations between core network size or closeness between PWD and their IADL and ADL caregivers and the amount of ADL and IADL care provided. The level of care provided by the caregivers and the participants' frequency of contact with the core network remained consistent throughout the progress of the dementia patients' conditions. DISCUSSION/CONCLUSION The findings of this study are incongruent with the findings of studies conducted in Western countries, which have reported that older adults prefer to have meaningful interactions with small, close social networks as opposed to large networks. Our findings may be explained by the strong cultural values in Oman which place great emphasis on caring for elderly family members. It is essential to understand these relationships in order to develop effective home care interventions for older adult PWD in Oman.
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Affiliation(s)
- Amal Al Ghassani
- Community and Mental Health Department, Oman College of Health Sciences, Muscat, Oman
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan,
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Kohnen RF, Lavrijsen J, Akkermans R, Gerritsen D, Koopmans R. The prevalence and determinants of inappropriate sexual behaviour in people with acquired brain injury in nursing homes. J Adv Nurs 2021; 77:3058-3072. [PMID: 33634494 PMCID: PMC8248184 DOI: 10.1111/jan.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS Establishing the prevalence of inappropriate sexual behaviour, concurrent challenging behaviours and the determinants of inappropriate sexual behaviour among patients with acquired brain injury ≤65 years of age in Dutch nursing homes. DESIGN Cross-sectional, observational study in acquired brain injury special care units spreads throughout the country. METHODS Nursing homes were recruited through the national expertise network for patients with severe acquired brain injury, regional brain injury teams and by searching the Internet. Patient characteristics were collected through digital questionnaires. Inappropriate sexual behaviour was assessed with the St. Andrews Sexual Behaviour Assessment, concurrent challenging behaviours with the NeuroPsychiatric Inventory-Nursing Home Version and the Cohen-Mansfield Agitation Inventory, cognition with the Mini-Mental State Examination and activities of daily living with the Disability Rating Scale. Psychotropic drug use was retrieved from the electronic prescription system. Associations between determinants and inappropriate sexual behaviour were examined using multilevel multivariate linear regression model analyses. Data collection started in June 2017 and ended in April 2019. RESULTS Of the 118 included patients, 38.1% had one or more inappropriate sexual behaviours. Verbal comments (30.1%) and non-contact behaviour (24.8%) were the most prevalent types of inappropriate sexual behaviour. Less severe behaviours were more common than more severe behaviours. The most frequent concurrent challenging behaviours were agitation, aggression and hyperactivity. Physical aggression was associated with more inappropriate sexual behaviour. Being married and pain were associated with less inappropriate sexual behaviour. CONCLUSION Inappropriate sexual behaviour is prevalent in patients with acquired brain injury ≤65 years of age residing in nursing homes. IMPACT Inappropriate sexual behaviour may have impact not only on the patients themselves but also on nursing staff. Insight into the magnitude, severity, course and concurrent challenging behaviours, sexuality and quality of life could give direction to the kind of interventions and education that is needed. The ultimate goal is to develop appropriate care for this vulnerable group of patients, specifically psychosocial interventions and appropriate use of psychotropic drugs.
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Affiliation(s)
- Roy F. Kohnen
- Vivent, Rosmalen and LivioEnschedethe Netherlands
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Jan Lavrijsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Reinier Akkermans
- Radboud University Medical CenterRadboud Institute for Health SciencesScientific Institute for Quality of CareNijmegenthe Netherlands
| | - Debby Gerritsen
- Department of Primary and Community CareRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterDe Waalboog“Joachim and Anna”Centre for Specialized Geriatric CareNijmegenthe Netherlands
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Clinical impact of antipsychotic and benzodiazepine reduction: findings from a multicomponent psychotropic reduction program within long-term aged care. Int Psychogeriatr 2021; 33:587-599. [PMID: 32618535 DOI: 10.1017/s1041610220000940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore the relationships between dose changes to antipsychotic and/or benzodiazepine medications and resident outcomes, including variations in neuropsychiatric symptoms, quality of life (QoL), and social withdrawal, within a multicomponent, interdisciplinary antipsychotic and benzodiazepine dose reduction program. DESIGN Prospective, observational, longitudinal study. INTERVENTION The Reducing Use of Sedatives (RedUSe) project involved 150 Australian Long-Term Care Facilities (LTCFs) incorporating auditing and benchmarking of prescribing, education, and multidisciplinary sedative reviews. SETTING A convenience sample of LTCFs (n = 28) involved in RedUSe between January 2015 and March 2016. PARTICIPANTS Permanent residents (n = 206) of LTCFs involved in RedUSe taking an antipsychotic and/or benzodiazepine daily. Residents were excluded if they had a severe psychiatric condition where antipsychotic therapy should generally be maintained long-term (e.g., bipolar disorder, schizophrenia) or were considered end-stage palliative. MEASUREMENTS Neuropsychiatric symptoms (Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory (CMAI)), QoL (Assessment of Quality of Life-4D), and social withdrawal (Multidimensional Observation Scale for Elderly Subjects-withdrawal subscale) were measured at baseline and 4 months where nursing staff completed psychometric tests as proxy raters. RESULTS There was no evidence that psychometric measures were worsened following dose reductions. In fact, dose reduction was associated with small, albeit non-statistically significant, improvements in behavior, particularly less physically non-aggressive behavior with both drug groups (-0.36 points per 10% reduction in antipsychotic dose, -0.17 per 10% reduction in benzodiazepine dose) and verbally agitated behavior with benzodiazepine reduction (-0.16 per 10% dose reduction), as measured with the CMAI. Furthermore, antipsychotic reduction was associated with non-statistically significant improvements in QoL and social withdrawal. CONCLUSIONS Antipsychotic and benzodiazepine dose reduction in LTCFs was not associated with deterioration in neuropsychiatric symptoms, QoL, or social withdrawal. Trends toward improved agitation with antipsychotic and benzodiazepine dose reduction require further evaluation in larger, prospective, controlled studies.
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van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Psychiatric and behavioral problems and well-being in gerontopsychiatric nursing home residents. Aging Ment Health 2021; 25:277-285. [PMID: 31847540 DOI: 10.1080/13607863.2019.1695738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Gerontopsychiatric nursing home residents are residents with a chronic mental condition (not dementia), in combination with one or more physical disorders. Psychiatric and behavioral problems are common within this population. The objective of this study is to examine these behaviors and their relationship to the level of both observed and self-rated well-being in the gerontopsychiatric population. METHOD Both gerontopsychiatric residents, and their primary formal caregiver in several nursing homes in The Netherlands were asked to participate in a structured interview concerning psychiatric and behavioral problems and resident well-being. Psychiatric and behavioral problems were measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cohen Mansfield Agitation Index (CMAI). Well-being was measured through the self-rated Laurens Well-being Inventory for Gerontopsychiatry (LWIG), and the observer rated Laurens Well-being Observations for Gerontopsychiatry (LWOG). RESULTS A total of 126 residents participated in the study with ages varying from 42 to 90. Different types of chronic mental disorders such as schizophrenia spectrum disorder, bipolar disorders and personality disorders were prevalent in the population. Most psychiatric and behavioral problems are associated with lower observed and self-rated well-being. For irritability and affective problem behaviors the relationship with well-being was the most evident. CONCLUSION In daily care practice the relationship between well-being and psychiatric and behavioral problems should be taken into account in care planning and treatment. To further explore the direction and details of this relationship, more research is needed.
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Affiliation(s)
- Elja van der Wolf
- Laurens, Residential Care Center 'De Oudelandse Hof', Berkel en Rodenrijs, The Netherlands.,Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Susan A H van Hooren
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands.,Faculty of Healthcare, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Research Centre for the Arts Therapies, KenVaK, Heerlen, The Netherlands
| | - Wim Waterink
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
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7
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Ruthirakuhan M, Herrmann N, Andreazza AC, Verhoeff NPLG, Gallagher D, Black SE, Kiss A, Lanctôt KL. 24S-Hydroxycholesterol Is Associated with Agitation Severity in Patients with Moderate-to-Severe Alzheimer's Disease: Analyses from a Clinical Trial with Nabilone. J Alzheimers Dis 2020; 71:21-31. [PMID: 31322567 PMCID: PMC6839471 DOI: 10.3233/jad-190202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Agitation is a prevalent and difficult-to-treat symptom of Alzheimer’s disease (AD). The endocannabinoid system (ECS) has been a target of interest for the treatment of agitation. However, ECS signaling may interact with AD-related changes in brain cholesterol metabolism. Elevated brain cholesterol, reflected by reduced serum 24-S-hydroxycholesterol (24S-OHC), is associated with reduced membrane fluidity, preventing ligand binding to cannabinoid receptor 1. Objective: To assess whether 24S-OHC was associated with agitation severity and response to nabilone. Methods: 24S-OHC was collected from AD patients enrolled in a clinical trial on nabilone at the start and end of each phase. This allowed for the cross-sectional and longitudinal investigation between 24S-OHC and agitation (Cohen Mansfield Agitation Inventory, CMAI). Post-hoc analyses included adjustments for baseline standardized Mini-Mental Status Exam (sMMSE), and analyses with CMAI subtotals consistent with the International Psychogeriatric Association (IPA) definition for agitation (physical aggression and nonaggression, and verbal aggression). Results: 24S-OHC was not associated with CMAI scores cross-sectionally or longitudinally, before and after adjusting for baseline sMMSE. However, 24S-OHC was associated with greater CMAI IPA scores at baseline (F(1,36) = 4.95, p = 0.03). In the placebo phase only, lower 24S-OHC at baseline was associated with increases in CMAI IPA scores (b = –35.2, 95% CI –65.6 to –5.0, p = 0.02), and decreases in 24S-OHC were associated with increases in CMAI IPA scores (b = –20.94, 95% CI –57.9 to –4.01, p = 0.03). Conclusion: 24S-OHC was associated with agitation severity cross-sectionally, and longitudinally in patients with AD. However, 24S-OHC did not predict treatment response, and does not change over time with nabilone.
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Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ana C Andreazza
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Damien Gallagher
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada
| | - Alex Kiss
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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8
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Kohnen RF, Lavrijsen JCM, Akkermans RP, Gerritsen DL, Koopmans RTCM. The Prevalence and Determinants of Neuropsychiatric Symptoms in People With Acquired Brain Injury in Nursing Homes. J Am Med Dir Assoc 2020; 21:1643-1650. [PMID: 32859514 DOI: 10.1016/j.jamda.2020.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Establishing the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes. DESIGN Cross-sectional, observational study. SETTING AND PARTICIPANTS Patients 18-65 years old with ABI in special care units in Dutch nursing homes. METHODS Nursing homes were recruited through the national expertise network for patients with severe ABI, regional brain injury teams, and by searching the Internet. Patient characteristics were collected through digital questionnaires. NPS were assessed with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI), cognition with the Mini-Mental State Examination, and activities of daily living with the Disability Rating Scale. Psychotropic drug use (PDU) was retrieved from the electronic prescription system. Individual NPS were clustered. Associations between determinants and NPS were examined using multilevel multivariate linear regression models. RESULTS In a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% 1 or more agitated behaviors. The most common NPS were agitation, in particular aberrant motor behavior (24.6%), repetitious sentences/questions (35.5%), and constant requests for attention (34.6%), verbal (33.6%) and physical (50.5%) aggression, and irritability (28.0%). Male patients were more likely to display hyperactivity. Being married was associated with less verbally agitated behavior and pain was associated with a higher CMAI total score. PDU increased the likelihood of a higher NPI-NH total score. CONCLUSIONS AND IMPLICATIONS NPS are common in patients with ABI ≤65 years of age residing in nursing homes. This is a first step to fill in the knowledge gap concerning NPS in this population. An increasing number of patients with severe ABI may survive the acute phase and will reside many years in nursing homes. It is important to shed more light on these NPS, with regard to course, magnitude, and severity, to ultimately develop appropriate care for this vulnerable group of patients.
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Affiliation(s)
- Roy F Kohnen
- Vivent, Rosmalen and Livio, Enschede, the Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Scientific Institute for Quality of Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, De Waalboog, "Joachim and Anna", Centre for Specialized Geriatric Care, Radboud University Medical Center, Nijmegen, the Netherlands
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9
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Ruthirakuhan M, Herrmann N, Andreazza AC, Verhoeff NPLG, Gallagher D, Black SE, Kiss A, Lanctôt KL. Agitation, Oxidative Stress, and Cytokines in Alzheimer Disease: Biomarker Analyses From a Clinical Trial With Nabilone for Agitation. J Geriatr Psychiatry Neurol 2020; 33:175-184. [PMID: 31547752 DOI: 10.1177/0891988719874118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The endocannabinoid system has been a target of interest for agitation in Alzheimer disease (AD) because of potential behavioral effects and its potential impact on mechanisms implicated in AD such as oxidative stress (OS) and neuroinflammation. We explored whether serum markers of OS and neuroinflammation were associated with response to the cannabinoid nabilone in agitated patients with AD (N = 38). All participants were enrolled in a 14-week, double-blind, cross-over trial comparing nabilone to placebo (6 weeks each) with a 1-week washout between phases. Samples were collected at the start and end of each phase. The cross-sectional relationship agitation (Cohen Mansfield Agitation Inventory) and OS and inflammatory markers were investigated to select markers of interest. Significant markers were then explored for their relationship with response. The OS marker, 4-hydroxynonenal (4-HNE; F1, 35 = 6.41, P = .016), and the proinflammatory cytokine, tumor necrosis factor-α (TNF-α; F1, 29 = 3.97, P = .06), were associated with agitation severity, and TNF-α remained significantly associated (F2, 25 = 3.69, P = .04) after adjustment for cognition. In the placebo phase, lower baseline 4-HNE was associated with decreases in agitation severity only (b = 0.01, P = .01), while lower baseline TNF-α was associated with decreases in agitation severity in the nabilone phase only (b = 1.14, P = .045). Changes in 4-HNE were not associated with changes in agitation severity in either phase. In the nabilone phase, lower baseline TNF-α was associated with decreases in agitation severity (b = 1.14, P = .045), and decreases in TNF-α were associated with decreases in agitation severity (b = 1.12, P = .006). These findings suggest that OS and neuroinflammation may be associated with agitation severity, while nabilone may have anti-inflammatory effects.
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Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ana C Andreazza
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nicolaas Paul L G Verhoeff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Baycrest Health Science Centre, Toronto, Ontario, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Alex Kiss
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing Behavioral Symptoms of Dementia Through STAR-VA Implementation: Do Outcomes Vary by Behavior Type? Am J Alzheimers Dis Other Demen 2020; 35:1533317520911577. [PMID: 32237994 PMCID: PMC10623909 DOI: 10.1177/1533317520911577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). METHODS Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). RESULTS Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. CONCLUSIONS STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.
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Affiliation(s)
- Jenefer M. Jedele
- Serious Mental Illness Treatment Resource Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Kim Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, Department of Veterans Affairs, Batavia, NY, USA
| | - Brian M. Ludwin
- New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
- VA Boston Healthcare System, Department of Veterans Affairs, Brockton, MA, USA
| | - Michele J. Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA
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11
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Groot Kormelinck CM, van Teunenbroek CF, Kollen BJ, Reitsma M, Gerritsen DL, Smalbrugge M, Zuidema SU. Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial. BMC Psychiatry 2019; 19:298. [PMID: 31606036 PMCID: PMC6790012 DOI: 10.1186/s12888-019-2291-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation. METHODS We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews. DISCUSSION We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation. TRIAL REGISTRATION NTR5872 , registered on July 2, 2016.
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Affiliation(s)
- Claudia M. Groot Kormelinck
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Charlotte F. van Teunenbroek
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Boudewijn J. Kollen
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Margreet Reitsma
- grid.438099.fVilans, (Center of Expertise for Long-term Care), PO Box 8228, 3503 RE Utrecht, The Netherlands
| | - Debby L. Gerritsen
- 0000 0004 0444 9382grid.10417.33Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, location VUmc/Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Sytse U. Zuidema
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
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12
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Gillis K, Lahaye H, Dom S, Lips D, Arnouts H, Van Bogaert P. A person-centred team approach targeting agitated and aggressive behaviour amongst nursing home residents with dementia using the Senses Framework. Int J Older People Nurs 2019; 14:e12269. [PMID: 31469240 DOI: 10.1111/opn.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/25/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The increase in agitated or aggressive behaviour amongst nursing home residents with dementia is a challenging problem. Such behaviour causes stress for both resident and caregiver. Many non-pharmacological interventions have been studied, but these interventions disregard the resident's unfulfilled needs and are executed by a single, designated caregiver. This study tests a non-pharmacological intervention, applied by the entire team and based on the resident's underlying needs. DESIGN A pretest and post-test interventional study design was used, in which 65 residents with dementia who expressed agitated or aggressive behaviour. Data were collected from December 2016 until March 2017. METHODS The ABC method and the Senses Framework were used to assign residents to either therapeutic touch, group music sessions or a meaningful individual activity. All staff members applied the interventions. Data were collected by use of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI). RESULTS The frequency of aggression, loss of decorum, depression and the severity of aggression decreased for all three interventions. However, the overall severity of fear also increased. The overall prevalence of agitated of residents decreased for the therapeutic touch, group music sessions and individual activities. CONCLUSIONS This study shows the possibilities of designing individualised interventions on the Senses Framework and the ABC method for addressing agitated and aggressive behaviour amongst nursing home residents with dementia. The framework presented in this study should be further explored. IMPLICATIONS FOR PRACTICE A team-based approach is effective to reduce agitated or aggressive behaviour amongst nursing home residents.
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Affiliation(s)
- Katrin Gillis
- Odisee University College, Sint-Niklaas, Belgium.,Curando VZW, Ruiselede, Belgium
| | - Hilde Lahaye
- Odisee University College, Sint-Niklaas, Belgium.,VZW Woonzorg Samen Ouder, Sint-Niklaas, Belgium
| | - Stijn Dom
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
| | | | - Heidi Arnouts
- Odisee University College, Sint-Niklaas, Belgium.,Department of Engineering Management, Antwerp University, Antwerp, Belgium
| | - Peter Van Bogaert
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
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13
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Mulders AJ, Zuidema SU, Leeuwis R, Bor H, Verhey FR, Koopmans RT. Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with young-onset dementia. Int J Geriatr Psychiatry 2019; 34:1185-1193. [PMID: 30968446 PMCID: PMC6767580 DOI: 10.1002/gps.5116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Ans J.M.J. Mulders
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public HealthRadboud University Nijmegen Medical CentreNijmegenThe Netherlands,Archipel Care Group, LandrijtCentre for Specialized CareEindhovenThe Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Renée Leeuwis
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public HealthRadboud University Nijmegen Medical CentreNijmegenThe Netherlands,De Waalboog, “Joachim en Anna,” Centre for Specialized Geriatric CareNijmegenThe Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public HealthRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Psychology/MUMCSchool for Mental Health and Neuroscience (MHeNS)/Alzheimer Centre LimburgMaastrichtThe Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public HealthRadboud University Nijmegen Medical CentreNijmegenThe Netherlands,De Waalboog, “Joachim en Anna,” Centre for Specialized Geriatric CareNijmegenThe Netherlands,Radboudumc Alzheimer CentreNijmegenThe Netherlands
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14
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Borsje P, Lucassen PLBJ, Bor H, Wetzels RB, Pot AM, Koopmans RTCM. The course of neuropsychiatric symptoms in patients with dementia in primary care. Fam Pract 2019; 36:437-444. [PMID: 30517631 DOI: 10.1093/fampra/cmy117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services. OBJECTIVES To investigate the course of NPS in people with dementia in primary care. METHODS Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS. RESULTS The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome. CONCLUSIONS GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Thebe, Region South-East, Goirle, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland B Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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15
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Appelhof B, Bakker C, de Vugt ME, van Duinen-van den IJssel JCL, Zwijsen SA, Smalbrugge M, Teerenstra S, Verhey FRJ, Zuidema SU, Koopmans RTCM. Effects of a Multidisciplinary Intervention on the Presence of Neuropsychiatric Symptoms and Psychotropic Drug Use in Nursing Home Residents WithYoung-Onset Dementia: Behavior and Evolution of Young-Onset Dementia Part 2 (BEYOND-II) Study. Am J Geriatr Psychiatry 2019; 27:581-589. [PMID: 30799167 DOI: 10.1016/j.jagp.2018.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The effect of an intervention on neuropsychiatric symptoms (NPS), particularly agitation and aggression, and psychotropic drug use (PDU) in institutionalized people with young-onset dementia (YOD) was evaluated. METHODS A randomized controlled trial was conducted using a stepped wedge design. Thirteen YOD special care units were randomly assigned to three groups, which received the intervention at different time points. Four assessments took place every 6 months during a period of 18 months. Two hundred seventy-four people with YOD who resided in YOD special care units participated, of whom 131 took part in all assessments. The intervention consisted of an educational program combined with a care program, which structured the multidisciplinary process of managing NPS. The care program included the following five steps: evaluation of psychotropic drug prescription, detection, analysis, treatment, and evaluation of treatment of NPS. The Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version were used to assess NPS. Data on PDU were retrieved from residents' medical files. Multilevel models were used to evaluate the effect of the intervention, which accounted for clustering of measurements in clients within units. RESULTS No significant differences were found in agitation, aggression, other NPS, or PDU after crossing over to the intervention condition. CONCLUSION We found no evidence that the intervention for management of NPS in nursing home residents with YOD was more effective in reducing agitation, aggression, other NPS, or PDU compared with care as usual.
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Affiliation(s)
- Britt Appelhof
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Knowledge Center for Specialized Care (BA), Landrijt Archipel, Eindhoven, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Send correspondence and reprint requests to Britt Appelhof, M.Sc., Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands..
| | - Christian Bakker
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Center for Specialized Care in Young-Onset Dementia (CB), Florence Mariahoeve, The Hague
| | - Marjolein E de Vugt
- Alzheimer Center Limburg (MEV, FRJV), School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeannette C L van Duinen-van den IJssel
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands
| | - Sandra A Zwijsen
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute (SAZ, MS), VU University Medical Center, Amsterdam
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute (SAZ, MS), VU University Medical Center, Amsterdam
| | - Steven Teerenstra
- Department of Health Evidence (ST), Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg (MEV, FRJV), School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine (SUZ), University Medical Center Groningen, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; De Waalboog "Joachim en Anna" Center for Specialized Geriatric Care (RTCMK), Nijmegen, The Netherlands
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16
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Bayram S, Usta E, Altınbaş-Akkaş Ö, Şık T. [The Determination of Agitation Behaviors among the Elderly People Receiving Long-Term Institutional Care and the Influencing Factors]. Florence Nightingale Hemsire Derg 2019; 27:173-187. [PMID: 34267972 PMCID: PMC8127599 DOI: 10.26650/fnjn18075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 11/20/2022] Open
Abstract
AIM Agitation is common among elderly people staying at nursing homes. It is a significant problem particularly for patients with dementia. This study aims to determine the agitation behaviors of elderly people receiving long-term institutional care in a city and influencing factors. METHOD The population of this descriptive and analytical study consisted of elderly individuals in three institutional care centers. 178 elderly individuals aged 60 and above were taken into the sample group. Approval was taken from them and their relatives. The study data were collected between September-November 2018 using the socio-demographic question form, the Cohen-Mansfield Agitation Inventory (CMAI), the Mini-Cog Brief Cognitive Assessment Form, the Barthel Index for Activities of Daily Living (ADL) and the Lawton&Brody Instrumental Activities of Daily Living Scale (IADL). RESULTS The mean age of the participants was 75.58±8.77 and 56.7% were males. The duration of stay at the institution was 23.48±24.46 months. Although 50.6% of the participants had psychiatric diagnoses. The mean score for the CMAI for the patients with dementia was 46.26±15.10, which was significantly higher than those without dementia (Z=-2.132, p=0.033). CONCLUSIONS The results show agitation is high among patients with dementia and cognitive impairment affects agitation significantly.
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Affiliation(s)
- Serap Bayram
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
| | - Esra Usta
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
| | | | - Tuğçe Şık
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
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17
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Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer's disease: Study protocol for a cross-over randomized controlled trial. Contemp Clin Trials Commun 2019; 15:100385. [PMID: 31338476 PMCID: PMC6627000 DOI: 10.1016/j.conctc.2019.100385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/03/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5-2 mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs. Clinical trials number NCT02351882.
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Key Words
- AD, Alzheimer's disease
- Agitation
- Alzheimer's disease
- CB, cannabinoids
- CB1, cannabinoid receptor 1
- CB2, cannabinoid receptor 2
- CGIC, Clinician's Global Impression of Change
- CMAI, Cohen Mansfield Agitation Inventory
- Cannabinoid
- Clinical trial
- EC50, half maximal effective concentration
- FDA, Food and Drug Administration
- IPA, International Psychogeriatric Association
- LTC, long-term care
- MAR, Medication Administration Record
- MNA-SF, Mini-Nutritional Assessment-Short form
- NPI-NH, Neuropsychiatric Inventory-Nursing home version
- NPS, neuropsychiatric symptoms
- Neuropsychiatric symptoms
- PAINAD, Pain Assessment in Advanced AD
- RCT, randomized controlled trial
- SIB, Severe Impairment Battery
- THC, tetrahydrocannabinol
- sMMSE, standardized Mini-Mental Status Examination
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18
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Appelhof B, Bakker C, Van Duinen-van Den IJssel JCL, Zwijsen SA, Smalbrugge M, Verhey FRJ, de Vugt ME, Zuidema SU, Koopmans RTCM. Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia. Aging Ment Health 2019; 23:581-586. [PMID: 29424552 DOI: 10.1080/13607863.2018.1428935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aims of the current study are (1) to explore the differences in neuropsychiatric symptoms (NPS) between young-onset dementia (YOD) and late-onset dementia (LOD), and (2) to investigate whether the possible differences can be attributed to differences in dementia subtype, gender, psychotropic drug use (PDU), or dementia severity. METHOD Three hundred and eighty-six nursing home (NH) residents with YOD and 350 with LOD were included. Multilevel modeling was used to compare NPS between the groups . Furthermore, dementia subtype, gender, PDU, and dementia severity were added to the crude multilevel models to investigate whether the possible differences in NPS could be attributed to these characteristics. RESULTS Higher levels of apathy were found in NH residents with YOD. After the characteristics were added to the models, also lower levels of verbally agitated behaviors were found in YOD . CONCLUSION We recommend that special attention be paid to interventions targeting apathy in YOD. Although no differences in other NPS were found, the PDU rates were higher in YOD, suggesting that the threshold for the use of PDU in the management of NPS is lower. This underscores the need for appropriate attention to non-pharmacological interventions for the management of NPS in YOD.
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Affiliation(s)
- Britt Appelhof
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,b Archipel, Landrijt , Knowledge Center For Specialized Care , Eindhoven , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands
| | - Christian Bakker
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands.,d Florence, Mariahoeve , Center for Specialized Care in Young-Onset Dementia , The Hague , the Netherlands
| | - Jeannette C L Van Duinen-van Den IJssel
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands
| | - Sandra A Zwijsen
- e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research , VU Medical Centre , Amsterdam , the Netherlands
| | - Martin Smalbrugge
- e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research , VU Medical Centre , Amsterdam , the Netherlands
| | - Frans R J Verhey
- f School For Mental Health and Neuroscience , Alzheimer Center Limburg , Maastricht University Medical Center , Maastricht , the Netherlands
| | - Marjolein E de Vugt
- f School For Mental Health and Neuroscience , Alzheimer Center Limburg , Maastricht University Medical Center , Maastricht , the Netherlands
| | - Sytse U Zuidema
- g Department of General Practice , University of Groningen , University Medical Center Groningen , Groningen , the Netherlands
| | - Raymond T C M Koopmans
- a Department of Primary and Community Care , Center for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen , Medical Centre , Nijmegen , the Netherlands.,c Radboud Alzheimer Center , Nijmegen , The Netherlands.,h De Waalboog 'Joachim en Anna' , Center for Specialized Geriatric Care , Nijmegen , the Netherlands
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19
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Margenfeld F, Klocke C, Joos S. Manual massage for persons living with dementia: A systematic review and meta-analysis. Int J Nurs Stud 2019; 96:132-142. [PMID: 30679034 DOI: 10.1016/j.ijnurstu.2018.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/21/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of persons living with dementia will increase. So far, pharmacological management is limited because of small effect sizes and side effects of the drugs. Therefore, it is important to assess non-pharmacological treatment options such as massage, which have nearly no side effects and are easy for caregivers to apply. OBJECTIVES To conduct a systematic review with meta-analysis, aiming to pool the evidence for the efficacy of manual massage for persons living with dementia. DESIGN A systematic review and meta-analysis. DATA SOURCES EMBASE, Medline, PubMed, PSYinfo, BIOSIS, EBM, PSYCINDEX, Osteopathic Research Web, and OSTMED.DR were searched, regardless of publication year, through August 2017. REVIEW METHODS Randomized controlled trials (RCTs) evaluating manual massage in patients with dementia with or without using (aromatic) oil were included. The intervention of the control group had to guarantee no physical contact between caregiver and patient. Only studies assessing behavioural and psychological symptoms of dementia, cognitive abilities or depressive symptoms with validated instruments were included. Two reviewers independently extracted data and assessed risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. Continuous outcomes are given as standardized mean difference (SMD), with 95% confidence intervals (CI) if different scaling of outcome measurement was used, and as mean difference (MD), with 95% confidence intervals (CI) for identical scaling. Data were pooled using the random-effects model. Sensitivity analysis considered type of massage, oil and outcome. Funnel plots were performed. RESULTS Eleven RCTs, with a total of 825 persons living with dementia, were eligible for qualitative synthesis and nine for quantitative synthesis. Two studies, with a total of 95 participants, had a high risk of bias. A pooled analysis of the mean change showed a benefit of manual massage compared to the control group using the Cohen Mansfield Agitation Inventory (SMD = -0.56, 95% CI [-0.95, -0.17], P = 0.005), which included six studies with 395 participants, and using the Cornell Scale of Depression in Dementia (MD = -6.14 [-8.66, -3.61], P < 0.00001), which included three studies with 193 participants. No significant effect could be demonstrated using the Neuropsychiatric Inventory and Mini Mental State Examination. Subgroup analysis of 'acupressure' did not show significant group differences. CONCLUSIONS Manual massage may serve as a non-pharmacological strategy to improve behavioural and psychological symptoms in persons living with dementia. Thus, healthcare professionals and family caregivers should be encouraged to apply massage to their patients and relatives. More research is needed, however, to provide clearer recommendations with respect to frequency and types of massage.
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Affiliation(s)
- Felix Margenfeld
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
| | - Carina Klocke
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
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Gerritsen DL, Koopmans RTCM, Walravens V, van Vliet D. Using Video Feedback at Home in Dementia Care: A Feasibility Study. Am J Alzheimers Dis Other Demen 2018; 34:153-162. [PMID: 30352521 PMCID: PMC6463273 DOI: 10.1177/1533317518808021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Video feedback at home (VFH) aims to improve the well-being of informal caregivers and persons with dementia by training the caregiver to communicate successfully. This feasibility study had 2 aims: (1) to investigate possible effects regarding VFH, caregiver self-efficacy and the burden experienced, and the frequency of challenging behavior in persons with dementia, and (2) to perform a process evaluation of barriers and facilitators regarding the use of VFH. The respondents were caregivers of home-dwelling persons with dementia participating in VHF (N = 10), a group of caregivers who declined participating in VFH (N = 18), stakeholders (N = 6), and field experts (N = 55). The assessments performed were Positive and Negative Affect Scales, Cohen-Mansfield Agitation Inventory, Sense of Competence Scale, semistructured interviews, and questionnaires. Results demonstrated that caregivers were satisfied with VFH and that various (sub)scores on questionnaires improved. Caregivers mentioned a reluctance toward being filmed and both caregivers and referrers were unfamiliar with VFH. Recommendations have been made for health-care professionals and researchers to overcome these barriers.
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Affiliation(s)
- Debby L Gerritsen
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,3 Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,4 Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Veerle Walravens
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
| | - Deliane van Vliet
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
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21
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Smeets CHW, Gerritsen DL, Zuidema SU, Teerenstra S, van der Spek K, Smalbrugge M, Koopmans RTCM. Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging Ment Health 2018; 22:1239-1246. [PMID: 28726490 DOI: 10.1080/13607863.2017.1348469] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine psychotropic drug prescription rates in nursing home residents with dementia and to identify associations with the so far understudied psychosocial non-resident-related factors. METHOD A cross-sectional, observational, exploratory design as part of PROPER I (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia). Participants were 559 nursing home residents with dementia, 25 physicians, and 112 nurses in the Netherlands. Psychotropic drug prescription, non-resident-related and known resident-related variables were measured to operationalize the themes of our previous qualitative analysis. RESULTS Fifty-six percent of residents were prescribed any psychotropic drug, 25% antipsychotics, 29% antidepressants, 15% anxiolytics, and 13% hypnotics, with large differences between the units. Multivariate multilevel regression analyses revealed that antipsychotic prescription was less likely with higher physicians' availability (odds ratio 0.96, 95% confidence interval 0.93-1.00) and that antidepressant prescription was more likely with higher satisfaction of nurses on resident contact (odds ratio 1.50, 95% confidence interval 1.00-2.25). Resident-related factors explained 6%-15% of the variance, resident- and non-resident-related factors together 8%-17%. CONCLUSION Prescription rates for antipsychotics are similar compared to other countries, and relatively low for antidepressants, anxiolytics, and hypnotics. Our findings indicate that improvement of prescribing could provisionally best be targeted at resident-related factors.
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Affiliation(s)
- Claudia H W Smeets
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Debby L Gerritsen
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Sytse U Zuidema
- c Department of General Practice, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Steven Teerenstra
- d Section Biostatistics, Department of Health Evidence, Radboud Institute for Health Sciences , Radboud university medical center , Nijmegen , The Netherlands
| | - Klaas van der Spek
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Martin Smalbrugge
- e Department of General Practice and Elderly Care Medicine/ EMGO+ Institute for Health and Care Research , VU Medical Center , Amsterdam , The Netherlands
| | - Raymond T C M Koopmans
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands.,f Joachim en Anna, Center for Specialized Geriatric Care , Nijmegen , The Netherlands
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22
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Huang HL, Shyu YIL, Hsu WC. Agitated behaviors among elderly people with dementia living in their home in Taiwan. Clin Interv Aging 2018; 13:1193-1199. [PMID: 29988711 PMCID: PMC6029592 DOI: 10.2147/cia.s160243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background/aims Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted. Patients and methods Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure. Results Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors. Conclusion The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations.
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Affiliation(s)
- Huei-Ling Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yea-Ing L Shyu
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, .,School of Nursing, College of Medicine & Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, .,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
| | - Wen-Chuin Hsu
- Chang Gung Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
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23
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Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia. Int Psychogeriatr 2018; 30:547-556. [PMID: 28931452 DOI: 10.1017/s1041610217001958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia. METHODS In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics. RESULTS The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxiolytics, and 76 hypnotics. It was found that older patients and more severe aggression, agitation, apathy, and depression were associated with more appropriate prescriptions. Additionally, less appropriate prescriptions were found to be associated with more severe anxiety, dementia diagnoses other than Alzheimer dementia, more physician time available per patient, more patients per physician, more years of experience of the physician, and higher nurse's workload. CONCLUSIONS The association of more pronounced NPS with more appropriate PD prescriptions implies that physicians should pay more attention to the appropriateness of PD prescriptions when NPS are less manifest. Non-patient-related factors are also associated with the appropriateness of PD prescriptions. However, especially considering that some of these findings are counter-intuitive, more research on the topic is recommended.
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Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study: an intervention study aimed at improvement in the management of neuropsychiatric symptoms in institutionalized people with young onset dementia. Int Psychogeriatr 2018; 30:437-446. [PMID: 28595662 DOI: 10.1017/s1041610217000941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Both neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) are common in institutionalized People with Young Onset Dementia (PwYOD) and can produce negative outcomes such as reduced quality of life and high workload. In community-dwelling PwYOD, NPS are found to be associated with unmet care needs. This emphasizes the importance of a care program for the management of NPS in institutionalized PwYOD that also addresses unmet care needs and PDU. The objectives of the Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study are to develop a care program for the management of NPS in institutionalized PwYOD and to evaluate its effectiveness. METHODS The care program consists of an educational program combined with an intervention to manage NPS with the following five steps: the evaluation of psychotropic drug prescription, detection, analysis (including the detection of unmet needs), treatment and the evaluation of NPS. A stepped wedge design will be used to evaluate its effectiveness. The primary outcomes are agitation and aggression and other NPS. The secondary outcomes are PDU, quality of life, the workload of nursing staff and job satisfaction. Additionally, a process analysis and a cost-consequence analysis will be conducted. CONCLUSIONS The study protocol of the Beyond-II study describes the development, implementation and evaluation of a care program for the management of NPS in institutionalized PwYOD. This care program provides a structured method for the management of NPS, in which unmet needs and PDU are also addressed.
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25
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Zimmerman S, van der Steen JT. It's Not a Small World After All. J Am Med Dir Assoc 2018; 19:187-189. [PMID: 29477772 DOI: 10.1016/j.jamda.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Jenny T van der Steen
- Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands; Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
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26
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Collet J, de Vugt ME, Verhey FRJ, Engelen NJJA, Schols JMGA. Characteristics of double care demanding patients in a mental health care setting and a nursing home setting: results from the SpeCIMeN study. Aging Ment Health 2018; 22:33-39. [PMID: 27367644 DOI: 10.1080/13607863.2016.1202891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Older patients suffering from a combination of psychiatric disorders and physical illnesses and/or dementia are called Double Care Demanding patients (DCDs). Special wards for DCDs within Dutch nursing homes (NHs) and mental health care institutions (MHCIs) offer a unique opportunity to obtain insight into the characteristics and needs of this challenging population. METHODS This observational cross-sectional study collected data from 163 DCDs admitted to either a NH or a MHCI providing specialized care for DCDs. Similarities and differences between both DCD groups are described. RESULTS Neuropsychiatric symptoms were highly prevalent in all DCDs but significantly more in MHCI-DCDs. Cognitive disorders were far more present in NH-DCDs, while MHCI-DCDs often suffered from multiple psychiatric disorders. The severity of comorbidities and care dependency were equally high among all DCDs. NH-DCDs expressed more satisfaction in overall quality of life. CONCLUSIONS The institutionalized elderly DCD population is very heterogeneous. Specific care arrangements are necessary because the severity of a patient's physical illness and the level of functional impairment seem to be equally important as the patient's behavioural, psychiatric and social problems. Further research should assess the adequacy of the setting assignment and the professional skills needed to provide adequate care for elderly DCDs.
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Affiliation(s)
- Janine Collet
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands.,c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Marjolein E de Vugt
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Frans R J Verhey
- b Department of Psychiatry and Psychology, School of Mental Health and Neuroscience , Maastricht University Medical Centre+, Alzheimer Centre Limburg , Maastricht , The Netherlands
| | - Noud J J A Engelen
- c Department of Elderly , Mondriaan Mental Health Care , Heerlen , The Netherlands
| | - Jos M G A Schols
- a Department of Family Medicine/Elderly Care Medicine and Department Health Services Research, School for Public Health and Primary Care (CAPHRI) , Maastricht University , Maastricht , The Netherlands
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Kromhout M, Numans M, Achterberg W. Reducing behavioral symptoms in older patients with dementia by regulating caffeine consumption: Two single-subject trials. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Factors associated with aggressive behavior between residents and staff in nursing homes. Geriatr Nurs 2017; 38:398-405. [DOI: 10.1016/j.gerinurse.2017.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
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29
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Gender differences in clusters of NPS in Dutch nursing homes - a factor analysis. Int Psychogeriatr 2016; 28:1989-1999. [PMID: 27572478 DOI: 10.1017/s1041610216001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have a high prevalence among patients with dementia, up to 80%. NPS can be grouped by type and stage of dementia. However, NPS have not previously been grouped by gender. Our objective was to investigate whether NPS cluster differently in men or women in the nursing home patients. METHODS Factor analysis to assess the clustering of items in the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing home version (NPI-NH) into components, for both scales and for gender. Differences in symptom clustering between male and female patients were assessed using a three-step procedure: (1) identifying a gender specific distinctive item, (2) describe the correlation between the distinctive item with any other item in this cluster, (3) testing whether the correlation between a distinctive item and any other item in the cluster (which is present in both sexes) is different for males and females using a general linear model. RESULTS Our database consisted of 1,609 patients. There were five male and three female clusters for NPI-NH and eight male and seven female clusters for CMAI. There were three distinctive items in the NPI-NH and ten in the CMAI. CONCLUSIONS There are other clusters of NPS in males and females. Our analysis revealed more significant relations in female than male patients. This might have an implication on the clinical course.
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Construct validity and internal consistency of the neuropsychiatric inventory - nursing home (NPI-NH) in German nursing homes. Int Psychogeriatr 2016; 28:1017-27. [PMID: 26739512 DOI: 10.1017/s1041610215002343] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Neuropsychiatric Inventory (NPI) is one of the most popular and frequently used instruments for assessing so-called challenging behavior in individuals with dementia in research practice. However, no information is available regarding the factor structure of the German version of the Neuropsychiatric Inventory - Nursing Home (NPI-NH). The aim of this study was to evaluate the factor structure (an aspect of construct validity) and internal consistency of the NPI-NH for two different stages of dementia severity in a large German nursing home population. METHODS A total of 784 residents with dementia from 40 nursing homes in three studies was included in a secondary data analysis. Principal component analysis (PCA) using an orthogonal rotational procedure (with varimax rotation) was used to evaluate the factor structure of the NPI. Cronbach's α was used to assess the stability of the scale. RESULTS The factors agitation & restless behavior, psychosis, and mood were identified (with factor loading > 0.4 explaining 50% of the variance). The factors showed a moderate internal consistency of 0.55 and 0.68 (Cronbach's α). CONCLUSIONS The results show the acceptable factor structure of the NPI for a German population in nursing homes and confirm the results of studies from other countries. The three identified factors appear to be robust over the various stages of dementia severity. The results also support the hypothesis that the NPI-NH can be subdivided into multiple domains.
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Mulders AJ, Fick IW, Bor H, Verhey FR, Zuidema SU, Koopmans RT. Prevalence and Correlates of Neuropsychiatric Symptoms in Nursing Home Patients With Young-Onset Dementia: The BEYOnD Study. J Am Med Dir Assoc 2016; 17:495-500. [DOI: 10.1016/j.jamda.2016.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/26/2022]
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Van Vracem M, Spruytte N, Declercq A, Van Audenhove C. [Nighttime restlessness in people with dementia in residential care: an explorative field study]. Tijdschr Gerontol Geriatr 2016; 47:78-85. [PMID: 26886877 DOI: 10.1007/s12439-016-0167-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nighttime restlessness in dementia is an underestimated problem. Although little is known about the prevalence and not every person with dementia struggles with it, nighttime restlessness puts a heavy burden on the persons themselves and their caregivers.This field study explores nighttime restlessness in nursing homes based on two research questions: (1) What is nighttime restlessness according to professional caregivers? and (2) How is nighttime restlessness managed?Data were collected through diaries, interviews with caregivers and one night of observation in eight nursing homes.Wandering and screaming seem to be the most prevalent nighttime agitated behaviours. Caregivers identify many possible causes, but spatial and sensory factors, such as light or noise, were rarely mentioned spontaneously. The observations highlighted that a lot of light and noise is prominent and this might be causing nighttime restlessness.Caregivers try several strategies: for example talking with the resident, put on a light and apply medication or physical restraints.The management of nighttime restlessness requires a holistic approach. Caregivers' attention for and efforts to ameliorate the spatial and sensory environment in the management of nighttime restlessness are limited.
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Affiliation(s)
- M Van Vracem
- LUCAS KU Leuven, Katholieke Universiteit Leuven, Minderbroedersstraat 8, postbus 5310, 3000, Leuven, België.
| | - N Spruytte
- LUCAS KU Leuven, Katholieke Universiteit Leuven, Minderbroedersstraat 8, postbus 5310, 3000, Leuven, België
| | - A Declercq
- LUCAS KU Leuven, Katholieke Universiteit Leuven, Minderbroedersstraat 8, postbus 5310, 3000, Leuven, België
| | - C Van Audenhove
- LUCAS KU Leuven, Katholieke Universiteit Leuven, Minderbroedersstraat 8, postbus 5310, 3000, Leuven, België
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Pieper MJC, Francke AL, van der Steen JT, Scherder EJA, Twisk JWR, Kovach CR, Achterberg WP. Effects of a Stepwise Multidisciplinary Intervention for Challenging Behavior in Advanced Dementia: A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:261-9. [DOI: 10.1111/jgs.13868] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Marjoleine J. C. Pieper
- Emgo Institute for Health and Care Research; Amsterdam The Netherlands
- Department of General Practice and Elderly Care Medicine; VU University Medical Center Amsterdam; Amsterdam The Netherlands
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
| | - Anneke L. Francke
- Emgo Institute for Health and Care Research; Amsterdam The Netherlands
- Netherlands Institute for Health Services Research; Utrecht The Netherlands
| | - Jenny T. van der Steen
- Emgo Institute for Health and Care Research; Amsterdam The Netherlands
- Department of General Practice and Elderly Care Medicine; VU University Medical Center Amsterdam; Amsterdam The Netherlands
| | - Erik J. A. Scherder
- Department of Clinical Neuropsychology; VU University Amsterdam; Amsterdam The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics; VU University Medical Center Amsterdam; Amsterdam the Netherlands
| | | | - Wilco P. Achterberg
- Emgo Institute for Health and Care Research; Amsterdam The Netherlands
- Department of Public Health and Primary Care; Leiden University Medical Center; Leiden The Netherlands
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Sprangers S, Dijkstra K, Romijn-Luijten A. Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides. Clin Interv Aging 2015; 10:311-9. [PMID: 25653513 PMCID: PMC4309793 DOI: 10.2147/cia.s73053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.
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Affiliation(s)
- Suzan Sprangers
- Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Katinka Dijkstra
- Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna Romijn-Luijten
- Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Hazelhof TJGM, Gerritsen DL, Schoonhoven L, Koopmans RTCM. "The educating nursing staff effectively (TENSE) study": design of a cluster randomized controlled trial. BMC Nurs 2014; 13:46. [PMID: 25606022 PMCID: PMC4299299 DOI: 10.1186/s12912-014-0046-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 12/03/2014] [Indexed: 12/31/2022] Open
Abstract
Background Challenging behavior exhibited by people with dementia can have adverse outcomes, like stress, low morale, low work satisfaction and absenteeism for nursing staff in long-term care settings. Training nursing staff to manage challenging behavior may reduce its impact. Although much of the research into training nursing staff shows methodological limitations, several studies find some effect of training programs on knowledge about and on management of challenging behavior. Effects on stress or burnout are almost not found. Methods/Design The TENSE-study is a randomized controlled study on 18 nursing home units (9 control, 9 intervention) investigating the effects of a continuous educational program for nursing staff about managing challenging behavior. Nursing staff of intervention units receive the program, nursing staff of control units do not and continue usual care. The primary outcome is stress experienced by nursing staff (N = 135). Secondary outcomes are: emotional workload, work satisfaction, stress reactions at work and knowledge about challenging behaviour of nursing staff; and frequency of challenging behavior, quality of life and social engagement of residents (N = 135). Because there are many unknown factors influencing the effect of the training, a process evaluation to evaluate sampling-, implementation- and intervention quality as well as barriers and facilitators to implementation will also be included in the analysis. Nursing staff could not be blinded to the intervention, but were blinded for the outcomes. Discussion Strengths of this study are the (good) description of the intervention complemented by a process evaluation and the tailoring of the intervention to the wishes and needs of the nursing homes at any moment during the study. Sustaining the effects of the intervention by using follow up sessions is another strength. Possible drawbacks may be dropout because of the frailty of the elderly population and because nursing staff might move to another job during the study. Trial registration NTR (Dutch Trial Registration) number NTR3620
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Affiliation(s)
- Theo J G M Hazelhof
- Vitalis WoonZorggroep Eindhoven, Eindhoven, the Netherlands ; Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands ; Faculty of Health Science, University of Southampton, Southampton, UK
| | - Raymond T C M Koopmans
- Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands ; Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
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van der Putten MJG, Wetzels RB, Bor H, Zuidema SU, Koopmans RTCM. Antipsychotic drug prescription rates among Dutch nursing homes: the influence of patient characteristics and the dementia special care unit. Aging Ment Health 2014; 18:828-32. [PMID: 24506695 DOI: 10.1080/13607863.2014.884537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics. METHOD As part of the Waalbed-II study, the data on antipsychotic drug use in 290 patients were collected and the Global Deterioration Scale (GDS) stage, type of dementia and behaviour (Cohen-Mansfield Agitation Inventory (CMAI)) were measured in 14 SCUs in nine nursing homes. A multilevel logistic regression model was used to assess the difference in antipsychotic drug prescription rates between dementia SCUs adjusted for age, gender, GDS stage, type of dementia and CMAI factor scores. RESULTS Two hundred and ninety residents met the inclusion criteria. Thirty-two per cent were prescribed an antipsychotic drug. Antipsychotic drugs were more often prescribed in patients with physically aggressive and non-aggressive behaviour and in patients with mixed dementia (vascular/Alzheimer's) than in patients with other types of dementia. Antipsychotic drug prescriptions significantly differed among the dementia SCUs. The odds of antipsychotic drug use for patients in the SCU with the highest prevalence of drug use were 2.76 (95% confidence interval (CI) 1.14-6.69) times as high as for the SCU with the lowest prevalence of drug use, taking the patient characteristics into account. CONCLUSION Antipsychotic drug use in nursing home residents with dementia is not only predicted by the type of dementia and patient behaviour, but it is independently associated with the dementia SCU at which the patient resides. This result indicates that antipsychotic drugs are not only prescribed for their clinical indications (agitation/aggression) but are associated with environmental factors that may reflect a specific nursing home prescribing culture.
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Affiliation(s)
- M J G van der Putten
- a Department of Primary and Community Care, Centre for Family Medicine, Elderly Care Medicine and Public Health , Medical Centre, Radboud University Nijmegen , Nijmegen , The Netherlands
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Effects of small-scale, home-like facilities in dementia care on residents' behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study. Int Psychogeriatr 2014; 26:657-68. [PMID: 24411467 DOI: 10.1017/s1041610213002512] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs. METHODS A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e., small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents' medical records. RESULTS In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found. CONCLUSIONS This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents' outcomes.
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Borsje P, Wetzels RB, Lucassen PLBJ, Pot AM, Koopmans RTCM. Neuropsychiatric symptoms in patients with dementia in primary care: a study protocol. BMC Geriatr 2014; 14:32. [PMID: 24628730 PMCID: PMC3995579 DOI: 10.1186/1471-2318-14-32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/11/2014] [Indexed: 12/05/2022] Open
Abstract
Background Neuropsychiatric symptoms (NPS) frequently occur in patients with dementia. To date, prospective studies on the course of NPS have been conducted in patients with dementia in clinical centers or psychiatric services. The primary goal of this study is to investigate the course of NPS in patients with dementia and caregiver distress in primary care. We also aim to detect determinants of both the course of NPS in patients with dementia and informal caregiver distress in primary care. Methods/design This is a prospective observational study on the course of NPS in patients with dementia in primary care. Thirty-seven general practitioners (GPs) in 18 general practices were selected based on their interest in participating in this study. We will retrieve electronic medical files of patients with dementia from these general practices. Patients and caregivers will be followed for 18 months during the period January 2012 to December 2013. Patient characteristics will be collected at baseline. Time to death or institutionalization will be measured. Co-morbidity will be assessed using the Charlson index. Psychotropic drug use and primary and secondary outcome measures will be measured at 3 assessments, baseline, 9 and 18 months. The primary outcome measures are the Neuropsychiatric Inventory score for patients with dementia and the Sense of Competence score for informal caregivers. In addition to descriptive analyses frequency parameters will be computed. Univariate analysis will be performed to identify determinants of the course of NPS and informal caregiver distress. All determinants will then be tested in a multivariate regression analysis to determine their unique contribution to the course of NPS and caregiver distress. Discussion The results of this study will provide data on the course of NPS, which is clinically important for prognosis. The data will help GPs and other professionals in planning follow-up visits and in the timing for offering psycho-education, psychosocial interventions and the provision of care. In addition, these data will enlarge health professionals’ awareness of NPS in their patients with dementia.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Radboud university medical centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Smeets CHW, Smalbrugge M, Gerritsen DL, Nelissen-Vrancken MHJMG, Wetzels RB, van der Spek K, Zuidema SU, Koopmans RTCM. Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry 2013; 13:280. [PMID: 24180295 PMCID: PMC3840636 DOI: 10.1186/1471-244x-13-280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia. METHODS/DESIGN The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out. DISCUSSION This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR3569.
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Affiliation(s)
- Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O Box 7057, 1007, MB Amsterdam, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 196, 9700, AD Groningen, the Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
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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] [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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Whall AL, Kim H, Colling KB, Hong GR, DeCicco B, Antonakos C. Measurement of aggressive behaviors in dementia: comparison of the physical aggression subscales of the Cohen-Mansfield Agitation Inventory and the Ryden Aggression Scale. Res Gerontol Nurs 2013; 6:171-7. [PMID: 23550812 DOI: 10.3928/19404921-20130321-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
One of the central issues in the development of research-based interventions for aggressive behavior (AB) in late-stage dementia is the provision of precise measurement of the major dependent variable, in this case, AB levels. To advance the nursing goal of evidence-based practice, this article presents the characteristics of two research instruments: the Cohen-Mansfield Agitation Inventory (CMAI) aggressive behavior subscale (CMAI-ABS) and the Ryden Aggression Scale (RAS) physically aggressive behavior subscale (RAS-PABS). A total of 282 shower bath events (which are most associated with AB) were observed for 107 nursing home residents with dementia in nine randomly selected nursing homes. Then, we compared the psychometric properties of the CMAI-ABS and the RAS-PABS. Moderate to substantial agreements between the two instruments were identified using Cohen's Kappa. A similar percentage of AB was found on both subscales. Similar items on both subscales, such as hitting and pushing, were moderately correlated. Overall, the study results support that the CMAI-ABS and RAS-PABS measure a single but multifaceted construct-physically aggressive behavior in dementia.
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Affiliation(s)
- Ann L Whall
- Oakland University, School of Nursing, Rochester, MI 48309, USA.
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Young HM, Sikma SK, Reinhard SC, McCormick WC, Cartwright JC. Strategies to promote safe medication administration in assisted living settings. Res Gerontol Nurs 2013; 6:161-70. [PMID: 23350535 DOI: 10.3928/19404921-20130122-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
Abstract
Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA.
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Abstract
BACKGROUND The purpose of this study was to investigate the relationship between dementia severity, age, gender, and prescription of psychotropics, and syndromes of agitation and depression in a sample of nursing home residents with dementia. METHODS The Cohen-Mansfield Agitation Inventory (CMAI) was administered to residents with dementia (N = 304) of 18 nursing homes. Agitation symptoms were clustered using factorial analysis. Depression was estimated using the Dementia Mood Assessment Scale (DMAS). Dementia severity was assessed categorically using predefined cut-off scores derived from the Mini-Mental State Examination (MMSE). The relationship between agitation and its sub-syndromes, depression, and dementia severity was calculated using χ 2-statistics. Linear regression analyses were used to calculate the effect of dementia severity and psychotropic prescriptions on agitation and depression, controlling for age and gender. RESULTS Increasing stages of dementia severity were associated with higher risk for physically aggressive (p < 0.001) and non-aggressive (p < 0.01) behaviors, verbally agitated behavior (p < 0.05), and depression (p < 0.001). Depressive symptoms were associated with physically aggressive (p < 0.001) and verbally agitated (p < 0.05) behaviors, beyond the effects of dementia severity. Prescription of antipsychotics was correlated with depression and all agitation sub-syndromes except hiding and hoarding. CONCLUSIONS Dementia severity is a predictor for agitation and depression. Beyond that, depression increased with dementia severity, and the severity of depression was associated with both physically and verbally aggressive behaviors, indicating that, in advanced stages of dementia, depression in some patients might underlie aggressive behavior.
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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] [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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Abstract
BACKGROUND The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications. METHODS This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either "present" or "absent". RESULTS The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants. CONCLUSIONS PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.
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Bhat R, Rockwood K. Psychiatric complications of dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:398-407. [PMID: 21835103 DOI: 10.1177/070674371105600703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our paper describes the neuropsychiatric signs and symptoms of late-life disorders of cognitive impairment. Late-life cognitive disorders are associated with psychiatric symptoms in various ways-from apparent risk factors to pathognomonic features of particular dementias. They contribute greatly to the burden of illness, both in people with dementia, and in those who care for them. Here we consider specific dementia symptoms in relation to dementing illnesses and to the stages of dementia. Recognizing that no one drug is likely to successfully treat all dementia symptoms, we argue for a syndromic approach, which can lead to appropriately targeted therapy.
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Affiliation(s)
- Ravi Bhat
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria, Australia
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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] [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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Thissen AJC, Ekkerink JLP, Mahler MM, Kuin Y, Wetzels RB, Gerritsen DL. [Premorbid personality and aggressive behavior: a study with residents of psychogeriatric nursing homes]. Tijdschr Gerontol Geriatr 2010; 41:116-125. [PMID: 20593739 DOI: 10.1007/bf03096193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
From experimental research it appears that personality plays a role in causes and onset of aggressive behavior in adults. However, studies about the influence of premorbid personality on aggressive behavior of older persons with dementia show contradictory results. In this study we gathered data on personality and behavior of 166 residents of psychogeriatric nursing homes. Nursing staff filled out the Cohen-Mansfield Agitation Inventory (Dutch version, CMAI-D). Proxy family members completed the Hetero Anamnestic Personality questionnaire (HAP). Results showed that on the CMAI-D aggression could be distinguished from other forms of agitation. Four subscales of the HAP showed significant positive correlations with aggression as measured with the CMAI-D. These subscales were: Antagonism, Whimsical and impulsive behavior, Rigid behavior, and Being vulnerable in social interactions. Although the influence of personality decreased with increasing cognitive impairment, it was still present in stage 6 of the Reisberg Global Deterioration Scale. In depth analysis items of the HAP revealed a first profile of the aggression prone personality.
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Affiliation(s)
- A J C Thissen
- Barendse & Thissen, psychologenpraktijk te Schijndel.
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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] [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] [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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