[Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital]

Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital Abstract: Background: Demographic change and the accompanying increase in people with dementia and delirium in acute care hospitals pose growing challenges for nurses in acute care wards. Objective: Pilot implementation and evaluation of knowledge gain and implementation of previously defined critical behaviors. Method: Implementation of the training by APNs. Parallel evaluation of the training along the New World Kirkpatrick model using questionnaires and non-participant observation. Analysis of the data using descriptive statistics. Results: The training itself was well evaluated by the participants. It showed an increase in knowledge of the participants in the main topic categories. The targeted critical behaviors were implemented for the most part. There are deficiencies in the mapping of interventions in the nursing care process. Conclusion: The training concept is suitable to give nurses confidence in dealing with people with dementia and delirium. Continuous support in practice is needed to maintain the interventions in the long term and sustainably in everyday life.

[Closing care gaps after hospitalization: Study results [intersec-CM] on discharge and transfer management according to sect. 39 SGB V for people with cognitive impairments associated with dementia]

In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential.

Forest Therapy as a Nature-Based Intervention: An Option for Neurological Rehabilitation?

BACKGROUND

Forest therapy demonstrates positive effects on mood, immune system, stress levels, and general well-being. Studies on depression, stress-related illnesses, sleep disorders, and arterial hypertension have provided evidence-based proof of this.

SUMMARY

The aim of this review was to examine the possible effects of forest therapy with regard to its evidence in the treatment of chronic neurological diseases such as stroke in the rehabilitation phase, Parkinson's disease, dementia, and multiple sclerosis. Therefore, the electronic databases Medline, Scopus, and Cochrane were searched for such clinical trials for the years 1970 to mid-2023 without language restriction. The literature search revealed only few studies with positive indications but too few cases to be able to make generalizable evidence-based statements. In terms of improvement in the Hamilton Depression Scale analysis of two studies in stroke patients showed slight benefits in the forest therapy group (standard mean difference -0.43; 95% CI: -0.76 to -0.10; p < 0.01). One observational study revealed a higher rate of stroke survival in patients living in marked greenness. Few nature-based interventions in dementia patients showed certain benefits in particular details.

KEY MESSAGES

There are no evidence-based results on the benefit of forest therapy for chronic neurological diseases. However, there are hints that forest therapy could have a positive benefit. Therefore, a proposal for forest therapy as a component of multimodal neurological rehabilitation is presented.

Hintergrund

Die Waldtherapie zeigt positive Auswirkungen auf die Stimmung, das Immunsystem, das Stressniveau und das allgemeine Wohlbefinden. Studien zu Depressionen, stressbedingten Erkrankungen, Schlafstörungen und arteriellem Bluthochdruck haben dies evidenzbasiert belegt.

Zusammenfassung

Ziel dieser Übersichtsarbeit war es, die möglichen Wirkungen der Waldtherapie im Hinblick auf ihre Evidenz bei der Behandlung chronischer neurologischer Erkrankungen wie Schlaganfall in der Rehabilitationsphase, Morbus Parkinson, Demenz und Multiple Sklerose zu untersuchen. Dazu wurden die elektronischen Datenbanken Medline, Scopus und Cochrane für die Jahre 1970 bis Mitte 2023 ohne sprachliche Einschränkung nach solchen klinischen Studien durchsucht. Die Literaturrecherche ergab nur wenige Studien mit positiven Indikationen, aber zu wenigen Fällen, um verallgemeinerbare evidenzbasierte Aussagen machen zu können. Im Hinblick auf Verbesserung in der Hamilton Depressionsskala zeigte die Analyse von 2 Studien bei Schlaganfallpatienten leichte Vorteile der Waldtherapiegruppen (Standard Mean Difference −0.43; 95% CI: -0.76- -0,10; p < 0.01). Eine Beobachtungsstudie ergab eine höhere Schlaganfall-Überlebensrate bei Patienten, die in ausgeprägtem Grün leben. Einige naturbasierte Interventionen bei Demenzpatienten zeigten in einzelnen Parametern gewisse Vorteile.

Fazit

Es gibt bis dato keine verallgemeinerbaren evidenzbasierten Ergebnisse zum Nutzen der Waldtherapie bei chronischen neurologischen Erkrankungen. Es gibt jedoch Hinweise, dass die Waldtherapie einen positiven Nutzen haben könnte. Es wird daher ein Vorschlag für eine Waldtherapie als Bestandteil einer multimodalen neurologischen Rehabilitation vorgestellt.

[Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis]

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

[The controversy over early diagnosis of Alzheimer's disease: A literature review of the advantages and disadvantages]

BACKGROUND

The continuum of Alzheimer's disease (AD) comprises three stages: the pre-clinical stage (with few to no subjective symptoms), the prodromal stage (measurable mild cognitive impairment) and the final stage of clinically manifest (AD) dementia. Neuropathological correlates in accordance with these stages have been found with varying frequency. The aim of early AD diagnosis is to determine such correlates in these preclinical and prodromal stages and to determine the probability of the manifestation of a later AD dementia. In this regard, the prognostic validity is of vital importance. From the perspective of those affected, the issue of early diagnosis cannot be reduced to AD, although Alzheimer's dementia is by far the most common form of dementia. The aim of this review is to provide a literature-based overview of the advantages and disadvantages of early AD diagnosis in contrast to other types of dementia. Based on this, recommendations will be formulated for the prioritisation of early diagnostic advantages and disadvantages in the patient counselling situation in clinical practice.

METHODS

Three databases were searched for current reviews addressing the advantages, disadvantages and ethical aspects of early AD diagnosis. The search was limited to current German or English reviews published between January 1, 2018 to November 30, 2022. The systematic search strategy was based on the PICO model and included both a Boolean and a focus-expanding keyword search using previously defined search terms. In addition, snowballing was used as a search strategy. Qualitative synoptic content analysis in accordance with Mayring was used to analyse both advantages and disadvantages. Similar arguments were combined into single statements. The resulting statements were categorized into three main groups: social, individual or clinical aspects. To emphasize the aforementioned aims, arguments were additionally distinguished into "only valid for early AD diagnosis" and "valid for early diagnosis of all types of dementia".

RESULTS

Overall, seven reviews with suitable content were included. Social aspects of early AD diagnosis comprise the protection of the affected person and the society as well as potential stigmatisation of the affected and their family members. Individual arguments range from the right to a "rational suicide", including the avoidance of financial and caregiving burdens on family members, to the right not to know the diagnosis. Clinical arguments include, for example, the scientific research context (facilitating the identification of suitable clinical trial participants) and various negative effects of a false positive or false negative early diagnosis.

CONCLUSION

Early diagnosis of AD as well as of other forms of dementia are characterised by numerous advantages and disadvantages of a social, individual and clinical nature. The decision for or against early diagnosis should always be made by weighing the current advantages against the disadvantages in a specific case. In particular, the desires of the person affected, the validity of the diagnostic procedures available and, above all, the availability of effective preventive or therapeutic measures must be taken into account.

[Support needs of caregivers of people with dementia: An integrative literature review]

Support needs of caregivers of people with dementia: An integrative literature review Abstract: Background: Family caregivers are of great importance in the home care for people with dementia. The care and related stress can have a negative impact on their health. The CSNAT (German: KOMMA) is an approach to support family caregivers in palliative home care that could be used for this group of people. Aim: The aim was to identify support needs for caregivers of people with dementia in the literature and compare these with those that formed the basis for the development of the KOMMA approach. Method: We performed an integrative review. Literature research was conducted in February and March 2021 in the MEDLINE, CINAHL and PsycInfo databases. Relevant studies were identified and assessed using inclusion and exclusion criteria. Using MAXQDA, the data were assigned to categories with a content analytic procedure. Results: 23 studies were included that had been published with peer review procedure. Compared to the KOMMA approach, family caregivers show divergent support needs in the areas of (in)formal assistance, access to knowledge, managing physical and mental health conditions, maintaining the relationship, (temporarily) relinquishing the caregiving role and social integration. Conclusion: The KOMMA tool for identifying support needs cannot be directly adopted for this group of caregivers in its present form. However, given the richness of identified support needs, the development of a person-centered and needs-oriented assessment seems important.

[Qualitätsstandards in der Alterspsychiatrie]

Quality Standards in Old Age Psychiatry Abstract: Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

Specifics of and training needs in the inter-professional home care ofpeople with dementia

Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.

[Scientific evidence and user quality in mobile health applications for people with cognitive impairments and their caregivers]

INTRODUCTION

The range of health-related apps is large, but the scientific evidence for them is uncertain. The aim of this study is to evaluate the methodological quality of German-language mobile health apps for people with dementia and their caregivers.

METHODS

The app search was conducted according to the PRISMA-P guidelines in the application stores (Google Play Store and Apple App Store) using the terms "Demenz", "Alzheimer", "Kognition" and "Kognitive Beeinträchtigung". A systematic literature search with subsequent assessment of the scientific evidence was performed. The user quality assessment was conducted using "The German Version of the Mobile App Rating Scale" (MARS-G).

RESULTS

Scientific studies have been published for only 6 of the 20 apps identified. A total of 13 studies were included in the evaluation, whereby the app itself was the subject of investigation in only two publications. In addition, methodological weaknesses were often observed such as small group sizes, short study duration and / or insufficient comparative treatment. The overall quality of the apps can be rated as acceptable with a mean MARS rating of 3.38. Seven apps were able to achieve a score of over 4.0 and thus a good rating, but just as many apps fell below the acceptable limit of 3.0.

DISCUSSION

The contents of most apps have not been scientifically tested. This identified lack of evidence is consistent with the information in the literature in other indication areas. A systematic and transparent evaluation of health applications is necessary to protect end-users and better support their selection process.

[Quality Standards in Old Age Psychiatry]

Quality Standards in Old Age Psychiatry Abstract. Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements, matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

[Physical Activity and Mental Health in the Elderly]

Physical Activity and Mental Health in the Elderly Abstract. The aging process is closely linked to physiological changes. These physiological changes may lead to an increased vulnerability for developing somatic and mental disorders. Reduced physical activity/sedentary behaviour can enhance this process. In contrast, physical training and sports counteract this process, in particular in the elderly, who may thus gain or maintain a younger biological age. Physical fitness is associated with better mental health in the elderly. Sports and physical activity over the course of life have shown to be of preventive value concerning the development of depression and dementia in old age. Also late-life depression and cognitive impairment (MCI, mild cognitive impairment) can be improved by regular, continuous physical exercise. Some data furthermore suggest that even patients with dementia benefit from physical exercise, especially on behalf of the behavioural and psychic symptoms of dementia (BPSD).

[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]

Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice.

[Task sharing in outpatient dementia care - Focus groups with GPs and nurses]

Task sharing in outpatient dementia care - Focus groups with GPs and nurses Abstract. Background: Caring for people with dementia (PWD) is challenging for the health system and family carers and can only be managed through interprofessional medical and nursing care.

AIM

The AHeaD study investigated attitudes of general practitioners (GPs) and nurses towards the transfer of activities previously performed by GPs to advanced nurses in the outpatient care of PWDs.

METHODS

In four focus group discussions with 10 GPs and 13 nurses, qualitative content analysis was used to investigate attitudes towards the transfer of certain tasks and to identify opportunities and barriers to their introduction.

RESULTS

GPs primarily preferred the transfer of nursing activities such as blood sampling, assessments, their monitoring or follow-up prescriptions for nursing aids. "Classical" medical tasks (e. g. diagnosis of diseases, initial prescription of medication) are still seen in the hands of GPs. Nurses demanded more appreciation and recognition for the relationship between GPs and nurse and criticised the lack of trust and insufficient communication. Both sides pointed to tight time budgets that were hardly oriented towards the actual needs of the PWD.

CONCLUSIONS

The implementation of a redistribution of tasks requires the creation of legal and financial framework conditions, time resources, concrete task descriptions as well as a stronger cooperation between the professional groups involved. Innovative concepts could contribute to the sensible use of the resources GP and nurses and strengthen the care of PWDs.

[Palliative Care in Neurology]

Palliative Care in Neurology Abstract. Neurology as a discipline clearly overlaps with palliative care. Nevertheless, an early integration of palliative care accompanying neurological treatment rarely takes place, and there are still misunderstandings with regard to the timing of the inclusion of palliative care and its role beyond pure end-of-life care and hospice care. A further expansion and use of synergies should become an integral part of both disciplines in the coming years, and training should focus on appropriate training, especially for our young medical colleagues.

[Information needs of family caregivers regarding new technologies for dementia care at home: A qualitative study]

Information needs of family caregivers regarding new technologies for dementia care at home: A qualitative study Abstract. Background: New technologies can support family caregivers in the home care of people with dementia but are unknown to many. To reduce the information deficit, the information needed by caregivers must be determined. Aim: The aim of this study is to investigate the information needs of family caregivers regarding new technologies for dementia care at home, taking into account experiences in past research and future information needs. Methods: Episodic interviews were conducted with eight family caregivers of people with dementia and analyzed according to thematic coding. Results: Caregivers used both media-based and interpersonal channels for technology-related research and made heterogeneous experiences. The researched information content and causes of research varied across respondents. The amount of available online information was a barrier in some cases. With regard to future information needs, the diversity of information channels and the quality of information are of high importance. Conclusions: The individual situation-specific needs of family caregivers must be taken into account in the development of new information and counseling services so that information deficits can be eliminated, and the potential of new technologies can be exploited in the home care of people with dementia. Further research is needed on the information needs of people with dementia.

[Options for using assistive technologies for people with dementia in Switzerland: a qualitative interview study with experts]

BACKGROUND

To overcome challenges in dementia care, technological concepts are considered to have a potential. It is unclear, however, how utilization of assistive technologies in Switzerland could look like and which specific potentials it may offer. Therefore, the aim of the present study is to elaborate options for using assistive technologies in dementia care on the basis of the opinion, experience and knowledge of experts.

METHODS

We chose a qualitative study design. Thematic analysis served to evaluate the expert interviews. To report this study, we followed the Standards for Reporting Qualitative Research (SRQR).

RESULTS

Between November 2018 and May 2019, we interviewed 15 experts. The analysis resulted in three themes, each with three sub-themes: (i) use and potentials of technologies (support in the home care network, promoting a sense of security, facilitating and preserving interaction), (ii) requirements for using technology (structural framework conditions, enhancing quality of life and care, considering individual needs and health situation), and (ii) ethical considerations and technical assets (security and freedom, side effects of telepresence care, caveats and technological optimism).

CONCLUSIONS

To exploit the identified potentials of assistive technologies for people with dementia, it is necessary to fulfil the requirements on a structural level in nursing policy, education and clinical practice. Furthermore, assistive technologies should be applied that have demonstrated effectiveness without unwanted effects. The decision to use assistive technologies should be made on an individual basis. Accordingly, the use of assistive technologies should take into account the needs of the persons involved and be adapted to the state of health of people with dementia.

[Dementia Care Nurse - Feasibility study of outreach assistance for people with dementia and their family carers]

Dementia Care Nurse - Feasibility study of outreach assistance for people with dementia and their family carers Abstract. Background: Case management for dementia is stipulated in the German national dementia strategy. The effectiveness of case management has been investigated many times, yet the results are heterogeneous. On the contrary, the implementation processes of case management concepts have to date rarely been described or evaluated in detail. Aim: The aim of the project was to analyze the implementation of an outreaching assistance for people with dementia and to explore the changes in care, acceptance, and also facilitators and barriers to the implementation. Methods: Between 08 / 2018 and 07 / 2019, outreaching assistance for people with dementia and their family carers was implemented. Quantitative and qualitative data were prospectively collected using semi-standardised interviews in the context of outreach assistance. Results: A total of 113 people with dementia were included in the study, and for the most part family carers could be involved. On average, eight contacts took place over a period of 74 days. The areas of need and support were diverse. The use of support services increased by 19 % after the end of the intervention. Conclusions: The implementation of continuous and processual support for people with dementia and their carers is possible, whereby the structure and procedure should be transparent. A comprehensive orientation and networking is beneficial. The effectiveness of the intervention remains to be investigated in a controlled study.

[What support does a mobile, assistive app provide for informal caregivers? A qualitative analysis of the MoCaB app user experience]

BACKGROUND

In the joint project "Mobile Care Backup" funded by the German Federal Ministry of Education and Research, the smartphone-based app "MoCaB" was developed in close cooperation with informal caregivers. It provides individualized, algorithm-based information and can accompany and support caring relatives in everyday life. After a multi-step development, informal caregivers tested the MoCaB app in a home setting at the end of the research project. The goal was to find out how the test persons evaluate MoCaB and in which form the app can provide support to informal caregivers.

METHODS

Eighteen test persons caring for relatives participated in a four-week test of MoCaB. Guideline-based qualitative interviews to record usage behavior and experiences with the app were conducted after two and four weeks of testing, transcribed and analyzed using qualitative content analysis.

RESULTS

The test persons described the care-related information as helpful. The individualized, algorithm-based mode of information delivery and the exercises provided for family caregivers were generally rated as helpful, but their use depends on the individual usage style. Three dimensions can describe the effects of MoCaB: 1) expansion of care-relevant knowledge, 2) stimulation of self-reflection, and 3) behavior towards the care recipients.

DISCUSSION

With few exceptions, the testing caregivers felt that the MoCaB app was enriching. The support dimensions have an effect at different points in everyday life and vary in intensity, depending on the duration of the existing care activity and the individual preferences of the users.

CONCLUSION

The way in which caregivers used the app was not always consistent with the expected behaviors. This demonstrates the relevance of open-ended, qualitative research methods in the evaluation of health apps.

[Tracking systems in people with dementia in long-term care - Update of an integrative review]

Tracking systems in people with dementia in long-term care - Update of an integrative review Abstract. Background: This article is an update of the article by Hülsken-Giesler et al. (2019) and describes the latest findings on tracking systems in inpatient long-term care.

RESEARCH QUESTION

The research question also follows on from the underlying article and again deals with the application of tracking systems and their consequences for residents and nursing staff.

METHODS

A systematic literature search in the databases MEDLINE via PubMed and CINAHL as well as a hand search for the period starting in August 2017 was performed. The included literature was evaluated by two independent persons regarding content and methodology.

RESULTS

In addition to deductive categories from the underlying work, further inductive categories could be formed and thus ethical and implementation aspects could be included.

CONCLUSION

Since the first analysis, the focus in nursing science studies on the use of tracking systems in inpatient long-term care has shifted to ethical aspects. Also, the successful and long-term integration into care practice is now relevant.

Unmittelbare Reaktionen von Menschen mit Demenz auf individualisierte Musik - Analyse von Verhaltensbeobachtungen im Pflegeheim

Immediate reactions of people with dementia to individualized music - Analysis of behavioral observations in a nursing home Abstract. Background: Due to the increasing prevalence of dementia, there is an urgent need for effective non-pharmacological interventions to improve the quality of life of people with dementia (PwD) and to relieve their carers. Studies show evidence for the benefits of individualized music. However, the immediate reactions to individualized music have not yet been adequately investigated.

AIM

The research objective of the study was the investigation of the immediate effects of an individualized music intervention in a nursing home using a newly developed systematic behavioral observation rating scale.

METHODS

In 153 behavioral observations of 20 PwD, 32 different experiences and behaviors pertaining to 11 categories such as emotional and motor changes which indicate immediate reactions to listening to music were rated.

RESULTS

Participants showed significantly more positive reactions (e. g. joy or relaxation) and less negative reactions immediately after listening to the music compared to before. Moreover, in the course of listening to music, participants showed significantly more positive reactions, most often smiles, movements to music, attentive listening, relaxation and general vigilance / interest / social contact.

CONCLUSIONS

The systematic behavioral observation rating scale proved to be a suitable method for rating the experiences and behaviors of people with dementia. Listening to individualized music seems to be a helpful intervention for PwD in institutional care settings.

Die Lebenssituation von Menschen mit Demenz und pflegenden Angehörigen während der Coronavirus-Pandemie Eine qualitative Studie

The life situation of people with dementia and family carers during the coronavirus pandemic - A qualitative study Abstract. Background: The measures initiated as a result of the coronavirus pandemic have far-reaching consequences for the everyday life of people with dementia and their family carers. Both are usually among those who are the most vulnerable and thus are subject to rigorous restrictions. Their everyday life is made more difficult because care and respite services are currently suspended. In addition, people with dementia have difficulty understanding and implementing the restrictions and hygiene rules.

AIMS

This study aims to describe the current life situation of family carers and people with dementia.

METHODS

For this purpose, 21 telephone interviews with both family carers and people with dementia have been conducted twice during the spring of 2020 and were subsequently evaluated by a content analysis.

RESULTS

The interviewees experienced the situation differently. Especially the social isolation, the higher amount of care, the uncertainty of the situation and the increase in psychological symptoms are described as being stressful. With regard to coping with the situation, discussions are taking place about the support from the social environment, alternative ways of communication, experiences with comparable crises, the stability of formal care and the handling of information.

CONCLUSIONS

Family carers and people with dementia feel stressed due to the coronavirus pandemic, but many of them have coping strategies for this special situation. Informal support is a particularly important support mechanism.

Prioritäten der Pflegeforschung für das Themenfeld "Dementia Care" im deutschsprachigen Raum - Eine Delphi-Studie

Priorities of nursing research in dementia care in German-speaking countries - A Delphi study Abstract. Background and objective: To meet the central needs of people with dementia, their relatives and their caregivers in complex living conditions and care situations, a substantive examination of research priorities is required. The aim of this work was the identification and prioritisation of nursing research topics concerning dementia care in German-speaking countries.

METHODS

To identify existing research agendas in dementia care, we conducted a systematic literature research. As part of a Delphi process, systematically identified dementia care experts from German-speaking countries supplemented research priorities extracted from existing research agendas and assessed their importance. Subsequently, they prioritized topics of particular importance for nursing research.

RESULTS

Fifteen experts supplemented 61 topics previously identified in existing research agendas. They assessed 107 topics in terms of their importance and prioritized 79 topics.

CONCLUSIONS

The research priorities developed are a potential framework for nursing science, health policy and research funding in order to structure research activities. To ensure currency, priorities should be regularly updated and re-opened for discussion.

[Challenges in dementia care at home - The situation at home of a married couple]

Challenges in dementia care at home - The situation at home of a married couple Abstract. Background: People with dementia and their relatives are faced with major challenges due to complex dementia symptoms. Families need information and counselling in order to find adequate dementia care services tailored to their needs.

AIM

This case report's objective is to exemplify the domestic situation of a married couple who is faced with significant challenges within the family and the care system due to the husband's dementia and Parkinson's disease.

METHODS

The Dementia Care Nurse project included case monitoring; by means of different assessments relevant information was recorded and the family's situation described.

RESULTS

The family's problems and their need for support were multifaceted and entailed reimbursement of costs, application for care services as well as management of challenging behaviours and reduction of the caregiver's psychosocial burden.

CONCLUSIONS

The family, particularly the spouse caregiver, was effectively supported in meeting the challenges of dementia, e. g. by drawing on professional services and sorting out entitlement to benefits. From the perspective of the experience in the project, independent counselling structures such as a case management approach are indispenable in order to stabilise the domestic situation.

[The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study]

The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study Abstract. Introduction: To deal with the complexity of the situation of people with dementia in acute hospitals, it is necessary to develop tailored interventions. In doing so, it is important to consider the perspectives of all relevant persons, including health care teams.

AIM

The aim of this study was to explore the situation of people with dementia in three Swiss acute hospitals from the perspective of health care teams.

METHODS

We conducted three focus group interviews with health care teams consisting of medical doctors, nurses and therapists. Data were analysed by means of summarising content analysis according to Mayring.

RESULTS

A total of 20 health professionals took part. Three main categories were identified: "People with dementia confront the hospital system", "The hospital system fails to meet the needs of people with dementia" and "Necessary changes take place in the hospital system". The results show a lack of intention in the hospital system to address the specific needs of people with dementia. Health care teams feel forced to intensify their teamwork. This occurs unsystematically and with little organisational support.

CONCLUSION

It seems of paramount importance to systematically support the teams' initiatives for enhanced teamwork in caring for people with dementia. Teamwork should be considered as a key aspect when developing interventions.

[Counselling approaches to assistive technologies in nursing care for people with dementia - A focus group study with informal carers]

Counselling approaches to assistive technologies in nursing care for people with dementia - A focus group study with informal carers Abstract. Background: Assistive technologies may support caregiving relatives of people with dementia. Presently, counselling and training courses are lacking as well as concrete considerations for didactic and methodical implementation.

AIM

To convey the perspectives of caring relatives on the development of knowledge and competences in assistive technologies.

METHODS

Six interview-guided focus groups with 46 caring relatives of people with dementia were conducted. For analysis the documentary method was applied.

RESULTS

Assistive technologies currently do not seem to play a role in care-relevant information and counselling structures. The early development of competences as part of a guided support process is explicitly requested by caregiving relatives. The respondents favoured to try out assistive technologies, e. g. by moderated test possibilities.

CONCLUSION

The interviewed caregiving relatives consider the existing approaches to get access to assistive technologies as inadequate. Access to knowledge and competence development of caregiving relatives must be more clearly integrated into the design of the care process. Counselling formats focusing on experience, reflection and usage of assistive technologies might be the didactic basis of structured competence achievement for sustainable integration of useful technologies in daily nursing care.

Interne Konsistenz und Konstruktvalidität des demenzspezifischen Lebensqualitätsinstruments QUALIDEM - Eine Sekundärdatenanalyse einer Querschnittserhebung

Internal consistency and construct validity of the Quality of Life measurement in dementia QUALIDEM - a secondary data analysis of cross-sectional data Abstract. Background: Maintaining and improving the Quality of Life (QoL) of people with dementia is the principal aim of nursing and medical care. The QUALIDEM is a theory-based, dementia-specific QoL instrument in the German language. Until now, however, there are hardly any findings on the construct validity.

OBJECTIVE

Evaluation of the item difficulty, internal consistency, discriminant and convergent validity of the German QUALIDEM.

METHOD

The evaluation of the construct validity is based on a Multi-Trait-One-Method approach, using a sample of 167 people with mild to severe dementia and 71 people with very severe dementia.

RESULTS

The correlation between the QUALIDEM subscales and the comparative constructs agitation, depression, anxiety, aberrant motoric behavior, apathy, pain and QoL, measured with the Alzheimer's Disease Related Quality of Life instrument, was confirmed in the expected direction in 82 % of the predefined hypotheses. The correlation coefficients range between 0.04 and -0.60 (discriminant validity) and -0.21 and 0.71 (convergent validity). For the majority of QUALIDEM subscales a good internal consistency could be demonstrated.

CONCLUSION

The results indicate first indications for the construct validity of the QUALIDEM subscales and for the further development of the instrument. In future studies, the validity of the German QUALIDEM should be further investigated.

[Providing knowledge and support for caring relatives with the smartphone - the MoCaB project]

Providing knowledge and support for caring relatives with the smartphone - the MoCaB project Abstract. Background: Caring relatives often have a lack of knowledge of illness and care options. Surveys, as part of the MoCaB (Mobile Care Backup) project, showed that this is often experienced as a burden. Aim: The aim is to support caring relatives by increasing their knowledge. Therefore care-relevant knowledge and instructions for self-care should be provided according to their needs. Methods: The core element of the mobile application, personalized knowledge transfer in dialogue form, will be developed in a participative process with potential users. The relevant evidence-based nursing knowledge was reviewed by experts and written down for the target group. Results: So far, 86 relevant topics have been identified and formulated. First usability tests showed that the content itself, the used expressions and the presentation via the MoCaB app are well received. Outlook: In a next step, the app will be tested in the home setting with caring relatives and, in order to identify any further need and areas for improvement.

Needs of people with dementia and their informal caregivers concerning assistive technologies

Background and objective: Assistive technologies might be a suitable option for supporting people with dementia and their informal caregivers. To avoid "one-fits-all"-solutions and to design useful technologies, it is essential to consider the end-users' needs. The objective of this review was to examine the needs of people with dementia and their informal caregivers with regard to assistive technologies. Methods: We conducted a scoping review based on a comprehensive literature search in databases, handsearching, and free web searching. Additionally, we performed citation tracking of included studies. We included all types of study designs. Two researchers independently selected the studies. The results were thematically categorised by two researchers. Results: The search yielded 7160 references. 18 of 24 included studies were qualitative. The studies had been conducted in 13 different countries, mostly in Europe. The sample size ranged between two and 270 participants. Most of the studies involved people with dementia as well as informal caregivers. The analysis resulted in eleven themes. The themes could be assigned to three domains: "needed technologies", "characteristics of needed technologies", and "information about technologies". Conclusions: The results might guide future usage, development and research addressing end users' needs with regard to assistive technologies.

[Formal and informal support of patients with dementia at home: A mixed methods study within the Actifcare project]

BACKGROUND

Formal care services are less often used in dementia care than in care for people without dementia. The Actifcare project, in which eight European countries participated, emphasized the point in time in the trajectory of dementia when formal care becomes more and more important for supporting caregivers at home. A mixed-method study conducted over 12 months aimed to improve the understanding of care needs and the influencing factors for using informal and formal support for care at home. This report focuses on the German sample of the cohort study.

METHODS

People with dementia with their informal caregivers from the German federal states of North Rhine-Westphalia, Saxony-Anhalt and Saxony were interviewed between January 2015 and July 2016. A set of validated questionnaires was used for the baseline interviews and two follow-ups. Additional guideline-based semi-structured interviews were conducted with a subgroup of informal caregivers at the last follow-up interview. The standardized questionnaires were analyzed using a descriptive approach, and the semi-structured interviews were subjected to qualitative content analysis. Similar to the data collection processes, the results of both analyses were synthesized using a data triangulation approach.

RESULTS

A total of 52 people with dementia and their informal caregivers participated in the standardized interviews. A subsample of 12 informal caregivers was included in the qualitative interviews. At baseline, 28 out of 51 informal caregivers cared for their relatives with dementia without additional informal support (T2: 22 of 41). The social network of approximately half of the informal caregivers included three to four relatives, who were ready to help if necessary. On average, 3.4 support services were used (T2: 3.6). During the study period, the interest in educational, informational and counselling services decreased (T0: 11 of 52 informal caregivers; T2: 5 of 41). Formal care was more often rejected by people with dementia than by informal caregivers. Sometimes, the available services were considered insufficient in terms of personal needs of formal support, which should be flexible, unbureaucratic and tailored to the needs of the individual patient's situation. It is important for people with dementia and their informal caregivers to be involved in the decision-making processes of caregiving. Since dementia is a progressive disease, early participation is a prerequisite for making shared decisions about healthcare services.

CONCLUSION

People with dementia and their informal caregivers should be informed about formal care services and involved in decision-making processes as early as possible. To this purpose, account must be taken of the various informal social networks. This could improve the use of formal care services and the further development of these offers and thus prolong care at home.

[It's either all or nothing: Utilization of care and relief services amongst people with dementia. A cohort study based on administrative data]

OBJECTIVE

Caregiving often is a demanding task for family caregivers of people with dementia. In order to provide relief for caregivers and stabilize informal care, care and relief services for people with dementia and their caregivers were established by the German long-term care insurance ("Pflegeversicherung"). It is unknown how many people with dementia have used the additional care and relief services over the time and which characteristics predict permanent utilization.

METHODS

The analysis is based on administrative data. 2,887 people with prevalent dementia were followed from 2012 to 2015. The data was analyzed descriptively and by logistic regression.

RESULTS

About a quarter of the observed people with dementia continuously used the additional care and relief services from 2012 to 2015. 22.8% used them since 2013, while nearly a quarter made no use whatsoever of the services during the observation period. The probability of using care and relief services is higher when using an outpatient nursing service in comparison to family care and when the care level has gone up in the year before use.

CONCLUSION

Permanent utilization of care and relief services seems to be based on need in most cases. It could also be a learning effect or supplier-induced when simultaneously using an outpatient nursing service. People who discontinued service use or never used it could provide further information in order to adjust the additional care and relief services program.

[Good Outpatient Services Delay Nursing Home Admission of People With Dementia in the City of Zurich]

Zusammenfassung. Die Stadt Zürich hat ein gut ausgebautes ambulantes Angebot für Menschen mit Demenz. Dieses soll den Zeitpunkt der Institutionalisierung von Demenzkranken in der Stadt hinauszögern können. Anhand des Mini Mental Status (MMS) und der Cognitive Performance Scale (CPS) untersucht diese Studie den Schweregrad der Demenz beim Heimeintritt in zwei grossen Pflegezentren der Stadt Zürich in den Jahren 2009, 2010 und 2013. MMS- und CPS-Scores dieser Jahre wurden retrospektiv analysiert (n = 375). Die Resultate zeigen im Jahr 2013 einen höheren mittleren CPS- (M = 2,88 vs. 3,06) und einen tieferen MMS-Wert (M = 15,43 vs. 12,67) als im Jahr 2009, was einem späteren Heimeintritt, also erst in fortgeschrittenen Demenzstadien, entspricht.

[Nursing home placement of people with dementia: a secondary analysis of qualitative data and literature review on perspectives of informal caregivers and healthcare professionals]

Background: Nursing home placement of people with dementia can become necessary when informal care is no longer sufficient. Informal carers experience the transition period as an additional burden. Aim: Experiences and views of informal carers and healthcare professionals regarding the transition from people with dementia to a nursing home are investigated to improve the support for informal carers. Method: This secondary analysis included data from all five focus groups with n = 30 informal carers and healthcare professionals conducted as part of the “RightTimePlaceCare” project. To supplement the material which resulted from a single interview question, a literature analysis with the same focus was conducted. Results: The merged results indicated that informal carers needed professional support early on at home until after the nursing home placement. Concerns regarding nursing homes, financial aspects and family related issues were important aspects in the decision making. Healthcare professionals recommended provision of early guidance regarding those matters and making own experiences with nursing homes. Healthcare professionals should serve as mediators during the transition process and improve the collaboration between service providers. Conclusions: Empowering families to make informed choices could be facilitated by offering advice at home about their options for formal support services, financial support, and housing solutions. Healthcare professionals should support caregivers to make a decision, coordinate the placement and to cope with the new situation.

[Standardised pain assessment in cognitively impaired nursing home residents: Comparing the use of assessment tools in dementia care units and in integrated care units]

BACKGROUND

A large number of nursing home residents with cognitive impairments (CI) suffer from chronic pain, which is also discussed as a reason for challenging behavior. To assess pain in people with severe CI, the use of an observational pain instrument is recommended; for people without or with mild CI the gold standard is a self-rating instrument. It is unknown whether in German nursing homes pain assessment in residents with severe CI is actually conducted using observational instruments and which instruments are used. Because of different resident structure we assume that in dementia care units observational pain instruments are more often used than in integrated care units. The aim of this study was to investigate the conduction of pain assessments and the instruments used in both types of care units.

METHODS

We conducted an observational study based on standardized data collection. A questionnaire was used to elicit whether pain assessment had been performed and what kind of instrument had been used last time. The cognitive status was also assessed. Based on these data, we determined for each resident whether a self- or proxy-rating instrument had been applied, considering his or her cognitive status. Afterwards, the resident data were aggregated on a care unit level. The use of single instruments was calculated in percentages. Differences between dementia care units and integrated care units were investigated with descriptive statistics and an independent t-test. A mixed-effects binary regression model was used to adjust for cluster effects.

RESULTS

The analysis sample consisted of n = 1,397 participating residents living in n = 75 care units (n = 30 dementia care units; n = 45 integrated care units). In the dementia care units, a mean of 82 % of residents with severe cognitive impairments was assessed using an observational proxy-rating assessment instrument; in the traditional integrated care units a percentage of 42 % was calculated. In the dementia care units, the median percentage of residents with severe cognitive impairments who were assessed with a self-rating instrument was below 10 %; in integrated care units it was 51 %. The differences were statistically significant. A mixed regression model confirmed the results. In the majority of dementia care units a single pain assessment tool was used for all residents; in 18 of 30 dementia care units this was a proxy-rated observational instrument.

DISCUSSION

The results indicate that pain assessment in cognitively impaired patients is suboptimal in many integrated care units because the nurses use inappropriate instruments. Also, they confirm the results of previous studies by demonstrating that instruments are used in clinical practice that are not recommended because their German-language versions are not validated. Since valid pain assessment is a prerequisite to appropriate pain treatment, we may assume that in many residents this is also not carried out as recommended.

PRACTICAL IMPLICATIONS

Especially in integrated units, a defined and consented method of pain assessment is important because of the differences in their residents' cognitive and verbal abilities. Appropriate education may help to improve this process.

[Not Available]

Zusammenfassung. In der klinischen Praxis werden im Zusammenhang mit Demenz werden einige ethische Fragen schwieriger und werden öfters gestellt. Ohne auf die Vollständigkeit zu zielen – und um dem Praktiker zu helfen – befassen wir uns hier mit einigen von ihnen hier kurz.

[Not Available]

Zusammenfassung. Depressionen, leichte kognitive Störungen und Demenzen sind besonders bei älteren Menschen häufig assoziiert. Ähnliche neuropathologische Mechanismen scheinen diesen Zusammenhang und die gegenseitigen Einflüsse mindestens teilweise zu erklären. Wir schlagen hier eine Kurzreview der Rolle der Depression als Risikofaktor, Prodrom oder Folge der kognitiven Störungen vor und skizzieren kurz mögliche Behandlungsansätze.

[Not Available]

Zusammenfassung. Erwachsene in der Schweiz trinken durchschnittlich zwei Gläser Wein pro Tag. Alkoholmissbrauch und kognitive Störungen sind eng verknüpft, vor allem bei älteren Personen. Die klinische Untersuchung muss nach Anzeichen von Unterernährung suchen und eine neuropsychologische Untersuchung einschliessen, wenn der Mini-Mental-Status pathologisch ist. Bei Anzeichen einer Gayet-Wernicke-Krankheit muss eine intravenöse B1-Vitamin-Therapie zur prophylaktischen oder therapeutischen Behandlung eingeleitet werden. Kognitive Beeinträchtigung ist eine schlechte Prognose für die Behandlung von Alkoholabhängigkeit, sollte aber nicht dazu führen, die Behandlungsbemühungen aufzugeben.

[Not Available]

Zusammenfassung. Das Krankheitsbild des Normaldruckhydrocephalus ist seit 50 Jahren bekannt. Etwa genau so lange existiert mit der Möglichkeit einer internen Liquordrainage durch einen Liquorshunt die Möglichkeit einer effektiven Therapie. Moderne Shuntsysteme lassen sich sehr genau den Bedürfnissen der Patienten anpassen, und die operativen Eingriffe selbst haben nur noch eine sehr geringe Morbidität und Mortalität. Trotzdem wird nur ungefähr jeder zehnte Patient erkannt und einer Behandlung zugeführt. Bei Erfolgsaussichten von über 80% einer signifikanten Reduktion der Beschwerden entsteht für die unbehandelten Patienten, aber auch für die Gesellschaft, ein erheblicher Schaden durch den Verlust der Selbständigkeit und durch vermeidbare Pflegebedürftigkeit. Der Information über dieses Krankheitsbild und Aufklärung über die Abgrenzung gegenüber häufigen Differenzialdiagnosen kommt daher eine zentrale Bedeutung zu.

[Not Available]

Zusammenfassung. Wir stellen den Fall einer 65-jährigen Frau vor mit seit wenigen Jahren bestehenden Sehstörungen bei unauffälligem ophthalmologischem Befund. Die neuropsychologische Untersuchung ergab eine komplexe Agnosie mit deutlichen Einschränkungen in visuell-konstruktiven und visuell-perzeptiven Leistungen bei nur leichten Defiziten in der Mnestik. Die Befunde passen zu einer posterioren kortikalen Atrophie. Der Störung liegt eine Neurodegeneration zugrunde, meist als Folge einer Alzheimerkrankheit. Da die Patienten über ein ausgeprägtes Störungsbewusstsein verfügen, sind eine gute Aufklärung sowie das Entwickeln geeigneter Kompensationsstrategien sehr wichtig.

Internal consistency and construct validity of the Quality of Life in Alzheimer's Disease (QoL-AD) proxy – a secondary data analysis

Background: The maintenance and promotion of Quality of Life (QoL) of people with dementia is a major outcome in intervention studies and health care. The Quality of Life Alzheimer's Disease (QoL-AD) is an internationally recommended QoL measurement also available in German language. Until now, only a few results on the psychometric properties of the German QoL-AD were available. Objective: Evaluation of internal consistency and construct validity of the QoL-AD proxy. Method: A principal component analysis (secondary data analysis) of the 13 QoL-AD items was carried out based on the total sample of 234 people with dementia from nine nursing homes in Germany. Subsequently, the internal consistency of the identified factors was examined using Cronbach's alpha. Results: Two factors physical and mental health and social network were determined. Both factors explain 53 % of the total variance. The stability of both factors was validated in two sensitivity analyses. The internal consistency is good for both factors with a Cronbach's alpha of 0.88 (physical and mental health) and 0.75 (social network). Conclusion: The QoL-AD proxy allows the assessment of two relevant health-related QoL domains of people with dementia. However, in future studies especially the inter-rater reliability of the QoL-AD proxy has to be examined.

Handover between home and respite care concerning people with dementia: An online survey

INTRODUCTION

Respite care for people with dementia is increasingly promoted. However, little is known about the safety-relevant aspects of handover between home and respite care facilities for people with dementia. We thus focus on the safety-relevant information exchange taking place at the admission to and the discharge from respite care and discuss the need for improvement.

METHODS

A pilot online survey with staff in management positions in different types of respite care facilities in Germany was conducted between April and June 2014. The questionnaire contained 65 (open and closed) questions. The answers were submitted to explorative data analysis using descriptive statistics and qualitative content analysis.

RESULTS

50 respite care facility management staff participated. Nearly half of them reported involving external healthcare professionals (e.g., physicians). The results showed that early identification of informal caregivers or people with dementia in need of support (e.g., so-called red flags) is poorly addressed. Often, there are no medical, medication- and handover-related documents. Information delivery deadlines are not clearly defined. Only 38 % of the participating respite care facilities reported regular measurement of the information exchange quality, and only 15 % of the management staff reported that they conducted follow-up calls. Most participants reported having standardized procedures.

CONCLUSION

Handover between home and respite care facilities for people with dementia needs to be improved. Information delivery deadlines must be clearly defined. Communication training for respite care staff, including narrative intake methods, could enhance data collection at admission. Overall improved coordination between the parties involved would have a positive impact on safety-relevant aspects of information exchange.

[Family members' experiences of caring for persons with dementia and outreach counseling--an interpretative phenomenological study]

BACKGROUND

Almost two-thirds of the 110,000 people living with dementia in Switzerland receive home care from family members. Outreach counselling can reduce the burden for family caregivers and delay nursing home placement. However, little is known of how this works and how caregivers experience the counselling. The Canton of Aargau Alzheimer's Association has been conducting a pilot project to demonstrate the necessity, effectiveness and practicability of outreach counselling in (their canton).

AIM

As a part of the evaluation of the project this study explored how family members experience the process of caring for a relative with dementia and outreach counselling.

METHOD

Interpretive phenomenology–a qualitative approach–was used to analyse data from interviews with twelve family caregivers.

RESULTS

Most family members felt supported in caregiving by outreach counselling. Three aspects of the counselling were especially important to the participants: being understood and taken seriously by the counsellor; receiving answers to their most pressing questions concerning the illness and being supported when difficult decision had to be taken; regaining personal time and learning how to better interact with the person with dementia. Two participants would have wished for more help by the counsellor.

CONCLUSIONS

To meet the needs of the family members, consultants should have sufficient experience in dementia patient care and should be strongly networked across the local health and welfare system. This study shows that family members can experience outreach counselling as a great support in their caregiving roles.

[The scientific discourse about dementia in Germany-first results of the exemplary exercise of an integrative methodological approach]

BACKGROUND

The analysis of the discourse in dealing with people with dementia within the nursing and healthcare research in Germany is previously missing.Aim: How are people with dementia described in the discourse of the German nursing and health care research community and what does that mean for the nursing and health research in Germany?

METHOD

Using an integrative methodological approach, the first steps of an analysis of dementia discourse are developed and exemplarily tested in a selected limited context datjramework.

RESULT

The scientific discourse is focused on the burden or the family aregivers of the person with dementia.They are identified as those who have to handle the burden with their spouse or siblings with dementia.

CONCLUSIONS

A methodologiCal approach of integrative analysis was tested. According perspectives should be developed to incorporate the perspective of people with dementia in a stronger way.

[Admission and discharge of people with dementia- Communication from the perspective of respite care experts]

BACKGROUND

There is a lack of information regarding the structures and processes of communication between home and respite care at admission and discharge of people with dementia (PwD}. Considering the background,it was aimed to reconstruct information exchange between home and respite care of PwD and to identify factors which affect the quality of communication structure and processes.

METHODS

Semi-structured guided telephone interviews with 16 experts out of 15 respite care facilities were conducted. A structured content analysis and a process-mapping were performed.

RESULTS

Core procedures of admission and discharge of PwD were identified. There were differences and overlaps between the institutions. The differences were related to the point of time and the frequency of intake inter-"views, the checks of information completeness and the provision of information.The institutions had in common that no further coordinative steps were planned after discharge. Aneed for action was identified regarding the coordination of care and the performance of handover evaluations.

CONCLUSION

A timely provision of information for respite care is crucial fo rPwD. The coordination of all stakeholders,the assignment of responsibilities in communication, and easing the burden of informal caregivers is a requirement for care continuation. Across sectorial case-management, a standard of care transition, and the evaluation of hand overs is recommended.

[Fitness to drive in dementia - theoretical framing and design of a recommendation for German general practice]

BACKGROUND

General practitioners (GPs) are among the first to be contacted by persons with dementia and their relatives. Fitness to drive in dementia is a subject of uncertainty and conflict for GPs.

OBJECTIVE

Development of recommendations for German general practice on managing fitness to drive in dementia.

METHODS

Specification of problem areas by using relevant parts of a metasynthesis of international qualitative dementia research with GPs; literature review on evidence regarding the pre-defined problem areas; deduction of a preliminary design for a recommendation in a multi-professional team.

RESULTS

The difficulties include the assessment of fitness to drive in the office setting, concerns about damaging the patient-physician relationship by raising the issue of driving fitness, and uncertainties about the GP's own legal role. A diagnosis of dementia does not per se preclude driving. The majority of elderly people would accept discussing fitness to drive with their GP. In Germany, GPs are not obliged to assess fitness to drive, or to report unsafe drivers to the Licensing Agency, but under certain conditions they do have the right to report. Addressing the issue of driving and dementia early with the patient seems to be a prerequisite for a resource-oriented and patient-centred management.

DISCUSSION

The distinction between medical, ethical-communicative, and legal aspects enabled us to break down this complex problem and thus provide the informative basis to draft tailored recommendations. In an ongoing project, this framework will be further developed and informed by the expertise of patients, family caregivers, and professionals from various fields.

[How do family members of haemodialysis patients with dementia experience nursing care on a haemodialysis unit: a qualitative study]

BACKGROUND

Up to 70 % of dialysis patients over 55 years suffer from some degree of dementia. For a patient with dementia eventually agitated, staying at rest during the whole haemodialysis session could be difficult, which represents a real challenge for the haemodialysis team. Although relatives of patients with dementia or haemodialysis patients were described as care experts because of their support in everyday life, the perspective of relatives of haemodialysis patients with dementia has not yet been researched.

AIM

The purpose of this qualitative study was to explore the experience of nursing care of relatives of haemodialysis patients with dementia in a haemodialysis unit.

METHODS

Data were collected through eight interviews with relatives. Content analysis was used to analyse data.

RESULTS

Relatives knew that the patients were in good hands with their nurses. Their own attendance of the dialysis sessions was of variable duration, frequency and regularity, and they were hardly involved in the care. Relatives and nurses rarely communicated regarding the patients' situation. Although relatives described symptoms of dementia, it was important for them to attest that the patients were still "mentally all right".

CONCLUSIONS

Relatives of patients with dementia have diverse needs concerning their attendance during the therapy and the exchange of information with clinicians. Nurses should approach relatives and assess their individual needs to achieve a better collaboration.

[Men as caregivers for their wives - two phenomenological studies of the experiences of male primary caregivers in home care arrangements. Part II: men as caregivers for their wives suffering from dementia]

BACKGROUND

In Germany, men participate more and more in the extensive process of caring for their relatives.

AIM

Focus of the second study are husbands caring in home care for their wives suffering from dementia. Objective of the present study is to analyse the following questions, with focus on caring husbands: Firstly, how do caring husbands experience caring for their wives suffering from dementia? And secondly, how do they organise daily life?

METHOD

Narrative interviews with ten caring husbands were conducted. Analysis was performed using a modified phenomenological-interpretative approach as described by Diekelmann (1992).

RESULTS

Seven central issues evolved: "Dementia is a mischievous disease …" (disease as lingering crisis); "But there is a commitment …" (relationship); "Quarrel, that's not resolved without efforts …" (conflict); "Nothing's left from that …" (loss); "The amount of care, it didn't decrease, it's getting more …" (care); "The world's getting smaller …" (limitations); "I don't dislike it when someone's around supporting me …" (support). "Being bonded" emerged as a constitutive pattern, according to which caring husbands perceive their own life situation.

CONCLUSIONS

Caring husbands perceive and organise their wives' care situation individually. This includes their evaluation of professional assistance offers. Our findings point out the clear need for different offers of professional care givers when collaborating with caring husbands. Further research should focus on individual (long-time) care courses as well as reasons for declining professional assistance offers.

[Recommendations for diagnosis and therapy of behavioral and psychological symptoms in dementia (BPSD)]

In patients with dementia, Behavioral and Psychological Symptoms of Dementia (BPSD) are frequent findings that accompany deficits caused by cognitive impairment and thus complicate diagnostics, therapy and care. BPSD are a burden both for affected individuals as well as care-givers, and represent a significant challenge for therapy of a patient population with high degree of multi-morbidity. The goal of this therapy-guideline issued by swiss professional associations is to present guidance regarding therapy of BPSD as attendant symptoms in dementia, based on evidence as well as clinical experience. Here it appears to be of particular importance to take into account professional experience, as at this point for most therapeutic options no sufficiently controlled clinical trials are available. A critical discussion of pharmaco-therapeutic intervention is necessary, as this patient-population is particularly vulnerable for medication side-effects. Finally, a particular emphasis is placed on incorporating and systematically reporting psycho-social and nursing options therapeutic intervention.

[The Balance of Care approach for the development of custom-fit health care services for people with dementia on the margins of care between home and nursing home: experiences with its application in Germany]

INTRODUCTION

In Germany as in other countries of the European Union (EU), the majority of people with dementia are cared for by their informal caregivers at home. Across countries, however, there are considerable differences in the time to nursing home admission. The European research project RightTimePlaceCare intends to establish good practice recommendations for how to sustain the preferred living situation as long as possible. The Balance of Care approach was used to develop these recommendations, which combines empirical data, cost estimates and expert consensus, and thus implemented in a multinational context for the first time.

METHOD

In eight EU countries a survey was conducted among 2,014 people with dementia and their informal caregivers in nursing homes (n=1,223) or at home (n=791). Selected descriptive characteristics of the study participants were used for case type development. The case types were translated into 14 case vignettes, which were discussed by five to six expert panels (each consisting of three to four participants) per country. The experts (n=161) recommended the most suitable living place (at home or in a nursing home) and customised care packages for home care situations.

RESULTS AND STATE OF AFFAIRS

Across all countries, the experts predominantly recommended care at home for four of the case types whose reference group of study participants actually lived in a nursing home. These case types represent a relevant part of the study population. In Germany, the experts judged the case vignettes as realistic but criticised that information relevant for proper decision making was missing. Expert group discussions always ended in consensus, and care at home was predominately recommended. The proposed care packages most often comprised standard care services, and hence appeared to be realistic and feasible. The development of country-specific recommendations is still ongoing. In order to assess economic feasibility, estimated costs of home care packages will be compared with costs of nursing home care. Further outcomes like the quality of life will be considered for good practice recommendation finding.

CONCLUSION

Balance of Care supports the development of empirically based expert recommendations. The approach is widely applicable but seems to be particularly useful for the development of local custom-fit healthcare services. The clinical effectiveness, safety, and cost implications of the Balance of Care approach remain to be investigated in future studies.

[Development, application and evaluation of nursing interventions for people with dementia in nursing homes in Germany--a literature review]

In 2007 guidelines for the care of people with dementia living in nursing homes, especially for handling challenging behaviour, have been published that recommend certain interventions. The aim of this study is a systematic review of publications about projects and the development and utilisation of interventions recommended in the German guideline in German nursing homes. For this purpose, 22 publications from 8 projects were analysed. The analysis was carried out on the basis of the CReDECI-criteria for the reporting of complex interventions. The publications described the application of reminiscence-therapy, Snoezelen, Dementia Care Mapping (DCM) and the use of understanding diagnostics as well as assessment instruments. Although the interventions were based on similar theoretical frames and had the same aim they contained different components. For the implementation a considerably amount of teaching and support by the project members was needed. A process evaluation as well as information about necessary adaptations to general conditions was given seldom. Partly, information that is important for the use in practice as well as in continuative studies is missing in the publications.