Detailed Programme, abstracts and presentations
Poster presentations – Friday, 5 October
PO1: Better outcomes for patients with dementia and acute medical conditions in general hospitals: The development of the Dementia Care Bundle at New Cross Hospital
Dawn Brooker, Daryl Leung, Cheryl Etches, Karen Bowley, Pauline Smith, Grace Hampson, Dominic Upton, Julie Willoughby, Jennifer Bray
Objectives:Within acute hospitals in the UK 40% of patients are likely to have dementia (NAO, 2007) and be particularly at risk of poor quality care. This paper reports on a two year innovative project to develop a suite of evidence-based interventions utilising a care bundle approach to improve patient out-comes within the hospital.
Methods:A Dementia Care Bundle was developed focusing on information from patients’ families to support good communication, nutrition and an orientating environment. In order for the bundle to be undertaken reliably a suite of interventions were implemented to underpin this including a programme of staff and volunteer education, a specialist ward for patients with dementia and a hospital wide Dementia Action Network. This was evaluated using a variety of quantitative and qualitative techniques including questionnaires, interviews and a point prevalence survey.
Results:Patients, their families and staff are extremely positive about the changes. Complaints have reduced to zero. Within the hospital working with patients with dementia is high profile and is seen as exciting work. On the ward where the care bundle has been implemented there has been a reduced number of falls. The number of patients returning to their own homes has increased.
Conclusion:The complexities involved in the development of the service and the evaluation should not be underestimated. The accurate identification and coding of people with dementia is essential in the planning of services, particularly those with mild dementia. Improving outcomes for patients with dementia is challenging but with good leadership and the right interventions. It is possible to make a significant difference to outcomes of people with dementia in acute hospitals.
Disclosure of Interest: None Declared
PO2. Communicating well with people living with dementia and their families: Stand by me and Come into my world: DVD assisted training in skilling up practitioners across the dementia care pathway in UK and Australia
Dawn Brooker, Alison Wotherspoon, Sean Macreavy, Kay De Vries, Cheryl Poole, Kathy Dale
The development of theStand by Meresource was a collaborative project between NHS Worcestershire, NHS Herefordshire, the Association for Dementia Studies and North East Worcestershire (NEW) College. The idea grew out of Professor Brooker’s collaboration with a programme calledCome into My Worldproduced by Flinders University and South Australia & Northern Territory Dementia Training Study Centre. Both DVD assisted training packs are designed to be easily available to support training and education programmes on person centred care for people living with dementia.
Education on person-centred dementia care can sound idealistic and difficult to describe. Using the same methodology both DVD’s have content that is appropriate for staff and students to reflect on the delivery of quality dementia care at all professional levels and in a variety of situations. The DVD’s provide a practical demonstration of the principles of good communication. These can be used alongside a teaching resource pack to help show staff how to manage in realistic situations, applying the principles of person centred care to good effect.
Each DVD consists of a number of short films depicting the care pathway.Stand by Mecovers the GP consultation about diagnosis, care at home, a move into a care home, paramedic emergency care, acute hospital care and palliative care at home. The scripts for the films were constructed from focus group discussions with staff and professionals working across a variety of health and social care settings. Focus groups were also held with people with dementia and family carers to test out the validity of the emerging scenarios. The majority of actors in the films are health and social care staff. People with the experience of living with dementia acted alongside them. The films and the resource packs have been very well received. This model of building a country based resource using culturally appropriate scenarios is one that is transferable to different countries and results in a usable product to promote good practice.
PO3. Life story work as an aid to dementia patient and carer support – the “portrait of a life” multimedia tool kit.
Peter J.S. Ashley, Suzanne Wightman
Designed by South West Yorkshire Partnership NHS Foundation Trust Collaborative, the “Portrait of a Life” toolkit was developed some 2½ years ago with the aid of award funding from the Mental Health Foundation, it was then launched in 2010. This was achieved by obtaining one of the awards from over 300 applicants. Well over 150 of these toolkits have been sold to Care Homes and other Health and Social Care establishments for providing intellectual stimulation for people with dementia (also learning disabilities and other forms of mental illness) along with their carers, both family and professional. These toolkits are in use in the following countries and regions, the UK, Europe, North America, Australasia and the Far East. A new and revolutionary follow-up and complimentary system is in the final stages of development which will be launched in the very near future.
'Portrait of a Life' is innovative, supporting individuals, family carers and care staff to undertake life story work; it contains a variety of training materials and resources in a range of multimedia formats. It helps understand the importance of life story work including; the evidence base, the risks and the benefits, consent and ethics and how to sustain life story work in practice. Individuals with experience of life story work have provided expert contributions to the toolkit, the presenters and a small dedicated and experienced team of practitioners along with contributions from academic leads such as Professor Dawn Brooker, Dr Graham Stokes, Professor Mike Nolan and Toby Williamson. The models promoted within the toolkit support the user to understand person-centred care and relationship-centred care in addition to the CARER model which promotes working in partnership with the individual and their families to explore life histories and develop a life story for the future; it provides intellectual stimulation for the person with dementia. Additionally, the toolkit can be used by organisations or academic institutions to provide practical and theoretical training and education in an accessible format
PO4. Daily care in Monaco: A new approach with the Speranza-Albert II Center.
Philippe Migliasso, Patrick Bonarrigo, Marion Gerace, Natascia Sciolla, Solange Hesse, Alain Pesce
The aim of this study is to report the activity of a day care center characterized by : a link with home care services, a complete geriatric assessment processed at home before admission, and an interdisciplinary medical and psychosocial approach.
Our pluridisciplinay team includes: nurses, care assistants, psychologist, orthophonist, animators, and is supervised by the head of the geriatric department of the Princess Grace Hospital, also head of the home care services in Monaco. In addition to his usual work, each member of the Center has additional skills such as: music, sportive activities, painting, photography. The Center is located in Monaco, in a little house with 3 floors, each of them oriented in a type of activity: social link, physical, and cognitive.
For each patient, a specific project is built, based on: deep knowledge of the person, his behavior and disabilities, links with the family and professional carriers, help to carriers. Homogeneous groups of patients, and ethical approach strengthen the specific project. The Center is also a place for information and training for professionals and families, and a research site linked to the geriatric research unit.
Between 2007 and 2012, 250 patients where welcomed at least once a week: 162 women/88 men; middle age 84 (58-102); without disability 12%, middle disability 70%, severe disability 18%. Middle duration of staying was 13 months (maximum: 57). 33% of patients deceased and 61% where addressed to nursing homes or long time hospitalization.
The initial MMS-E was from 0 to 9 in 24 patients (9,6%); 10 to 19 in 92 (36,8%); 20-26 in 107 (42,8%) and 27-30 in 27 (10,8%).
The evolution of MMS-E after 12 months of follow-up in 83 patients was : a decrease of more than 3 points in 17 patients (20%), stable in 52 (63%), and an increase in 14 (17%). A gain of more than 5% of body weight was observed in 10,2% at 6 months, and in 22% at 12 months.
In conclusion, these results show that: a high level of hospitalisation and mortality can be observed; a high proportion of patients can have a stable MMS-E score; some patients may have a significant gain in weight, especially after one year of follow up. These observations lead us to propose for patients welcomed in day care centers, this approach based on a deep initial assessment and a regular pluridisciplinary follow-up.
PO5. Training for General Practitioners in The Early Assessment of Dementia
Luisa Bartorelli, Pino Fucito, Lucilla Iorio, Paolo Marin
Introduction:There is the increasing need for early diagnosis of dementia both by the medical community as well as by family caregivers. This new project targets training for General Practitioners to help them recognize the early signs of dementia diseases, in order to improve the management of patients and their caregivers.
Purpose:The project involves the training of 50 General Practitioners (GPs) who are employed in the National Health Service in Rome. The goal is to train the GPs with a course that explains Alzheimer’s Disease in detail and more importantly, describes how the characteristics of the disease appear in the patient. This then helps the GPs to identify the cases where there is a suspected diagnosis and then to send these patients to specialized diagnostic services. The results from these training sessions are then compared with the experience of 50 GPs who are not attending the course.
Material and method:The training program (over a 2 day period) covers four main topics. It starts with a discussion entitled The First Suspicions of Alzheimer’s Disease, dealing with the questions of physiological aging, MCI or dementia. This topic covers criteria for early diagnosis, epidemiology, clinical expression, cognitive and behavioural symptoms, depression and dementia. Then follows a discussion about the Relationship between GP, Patient and Caregiver. This deals with the questions about how to announce the disease, family support and caregiver experience. Next is a discussion entitled What To Do? Why, When and How? This is about pharmacological therapy for cognitive and behavioural symptoms versus non-pharmacological therapy. And finally, the topic discussed is The Daily Management of the Patient, which reviews individual assistance plans, environmental influence, working in networks and legal and ethical problems.
A questionnaire is given out at two time points - one month after the course and then three months later. The questionnaire is given also to the group of GPs not attending the course.
Results and conclusions:The training has begun and the preliminary results are expected to be ready by September 2012, in time to present at the Alzheimer Europe Conference in Vienna in October 2012.
PO6. Music in the Body and the Mind: A Violin in the Hands of Persons with Alzheimer’s
Luisa Bartorelli, Silvia Ragni, Machiko Nagasawa, Stephanie Levi
Introduction:Music therapy is widely used in psychosocial interventions for persons with dementia, even though there is still insufficient EBM data to properly validate it.
Purpose:A study was conducted at the Alzheimer Centre of the Rome Foundation to determine whether music therapy using the violin, which is an instrument not commonly selected, can help people suffering from mild to moderate dementia to acquire a new set of skills. Specific objectives are: to verify, from a musical point of view, the transition from an unconscious abiity to a specific capacity and to observe, from a clinical point of view, any improvement in motor coordination.
Material and method:The study was conducted with 8 persons from the Alzheimer Day Centre, who had been diagnosed with probable Alzheimer's Disease, according to the criteria of the DSM IV. The discriminating factor for inclusion was the level of positive participation in all activities of the Centre. The people were divided into two groups and participated in 16 meetings, 1 hour twice a week, led by a music therapist and a professional musician. A physiotherapist and a psychologist were also present as observers at each session and they recorded the patients' responses to the exercises on a grid built ad hoc. Before the start of the study an information sheet was created for each patient which included previous experiences in music along with the usual clinical assessment tests (MMSE, GDS, Tinetti, PPT, etc.). All these tests were then repeated at the end of the study. The caregivers of people with dementia also monitored some variables in order to detect any effect on the family environment. The sessions were divided into two phases: a more general phase holding and stroking the violin, and a more practical phase of playing the violin using the bow, leading to musical exercises of increasing difficulty.
Results and conclusions:Although we generally observed an improvement in verbal expressiveness, musical response and in the integration of gestures and postures, statistical significance can be seen only in the PPT and in certain musical tests. There were also some very positive comments from family members. The music therapy sessions were filmed and a video was created showing the most important and significant moments, validating the experience for the people involved. The musical experience, including both passive listening and active violin playing, proved to be of great significance in terms of the participants’ motivation, improvement of mood, reinforcement of the sense of identitiy and in self-esteem. The use of a manageable instrument like a violin, which is held close to the body, has fostered a strong emotional attachment, soliciting autobiographical memories, even in depressed patients. The experience was also very stimulating for the whole team, providing them an approach with a different dimension.
PO7. An evaluation of dementia care in Maltese hopsital wards
Anthea Innes, Scerri, C, Kelly, F, Abela S.
Objectives:To evaluate the quality of care services provision for people with dementia living in general older people wards in a Maltese hospital.
Methods:Four data collection methods were used:
- Two structured questionnaires were used to gather staff views on the person-centredness of the ward environments (Edvardsson et al 2010a,2010b).
- The Environmental Audit Tool (Fleming et al 2003) was used to evaluate the physical environment of the wards.
- Dementia Care Mapping (Bradford Dementia Group 2005) was used to evaluate the patient experience on the wards.
- Audit of patient medication
Findings:Findings indicate a discrepency between staff views of person centred care and the principles of person centred care embedded in Dementia Care Mapping. The physical environment does not meet the standards and principles underpinning the Environmental Audit Tool due to the difficulties of providing dementia care in an environment that has not been built on dementia friendly design principles.
Discussion and conclusion: Initial conclusions are that there are building blocks in place in the hospital wards evaluated, however much is to be done to improve the quality of care provision in these settings in the future, including improving the physical environment, enhancing the quality of staff interactions with patients, adjusting medications as required as a result of the medication audit, training staff to help raise awareness of how to increase the quality of the care service they provide.
PO8. A prospective observational study of AD patients and their caregivers in three European countries – Study design, patient characteristics and baseline clinical findings of the GERAS study
Catherine Reed, Josep Maria Argimon, Mark Belger, Giuseppe Bruno, Richard Dodel, Michael Happich, Josep Maria Haro, Roy W Jones, Diego Novick, Bruno Vellas, Anders Wimo
Background:The impact of Alzheimer’s disease (AD) for both patients and caregivers is substantial in terms of quality of life, disease burden and healthcare costs. Although hospital stays and institutionalisation are the main drivers of healthcare cost, the cost of caring for AD patients in the community and informal caregiver time is important from a societal perspective. The GERAS study aims to assess the country costs associated with AD for patients and caregivers over 18 months, stratified by severity of patients’ AD at baseline.
Objective:To describe the study design, patient characteristics and baseline clinical findings of the GERAS study.
Study design:A prospective, multi-centre, naturalistic, non-interventional, cohort study in the UK, France and Germany, enrolment October 2010-October 2011. Patients presenting within the normal course of care who were >55 years, diagnosed with probable AD (NINCDS-ADRDA), not institutionalised, with an informal caregiver and without coexisting potential causes of dementia were categorised according to MMSE score as mild (26-21), moderate (20-15) or severe (14 or less) AD. The study aimed to enrol a similar number of patients in each MMSE category in each respective country. Data collected included demographic characteristics, medical conditions, current medications and resource use on both patient and caregiver, clinical measures of cognition (ADAS-cog), function (ADCS-ADL) and behaviour (NPI) of the patient, as well as the burden (Zarit Burden Interview) and health-related quality of life (EQ-5D – caregiver and proxy version) from the caregiver. Following baseline, 6-monthly visits up to 18 months in the UK and up to 3 years in France and Germany will be completed. Patient characteristics and clinical outcomes are reported by MMSE category. P-values for the ADAS-cog, ADCS-ADL and NPI scores between MMSE severity groups are taken from an ANOVA model with independent factors for MMSE severity and country.
Results:The study cohort included 1497 AD patients (38% mild, 32% moderate and 31% severe AD) and their caregivers (n=419 France, n=552 Germany and n=526 UK) with a mean (SD) patient age of 77.6 (7.7) years, 55% female and an average of 2.2 (2.2) years since AD diagnosis. Mean (SD) MMSE score in the mild group was 23.3 (1.6), moderate 17.9 (1.7) and severe 9.5 (4.3). Mean (SD) total ADCS-ADL scores were mild 58.5 (14.2), moderate 48.3 (15.4) and severe 30.0 (17.3) which were significantly different between groups (p<0.001). Mean (SD) ADAS-cog 11 scores were mild 19.0 (6.2), and moderate 27.1 (7.6) (severe patients did not complete this assessment) and there was a significant difference between groups (p<0.001). Mean (SD) total NPI scores were mild 10.2 (10.8), moderate 14.3 (12.6) and severe 22.0 (19.4) which were significantly different between groups (p<0.001).
Conclusions:Patients in the GERAS study provide up to date information on a large AD cohort from three European countries including a large sample of severe AD patients living in the community. As expected, the clinical findings demonstrate that cognitive, functional and behavioural outcomes deteriorate with increasing AD severity. Longitudinal follow up is ongoing and will provide important data on disease progression and the impact on healthcare costs.
This study is sponsored and funded by Eli Lilly and Company Limited.
PO9. A prospective observational study of AD patients and their caregivers in three European countries –characteristics, health-related quality of life and burden of caregivers at baseline in the GERAS study
Catherine Reed, Josep Maria Argimon, Mark Belger, Giuseppe Bruno, Richard Dodel, Michael Happich, Josep Maria Haro, Roy W Jones, Diego Novick, Bruno Vellas, Anders Wimo
Background:The impact of Alzheimer’s disease (AD) for both patients and caregivers has been described in terms of quality of life, disease burden and healthcare costs. Caregiver burden is an independent risk factor for early mortality (both patients and caregivers) and time to institutionalisation. The GERAS study aims to assess the country costs associated with AD for patients and caregivers over 18 months, stratified by severity of patients’ AD at baseline.
Objective:To present the caregiver characteristics, health-related quality of life and burden at baseline of the caregivers of AD patients enrolled into the GERAS study.
Study design:A prospective, multi-centre, naturalistic, non-interventional, cohort study in the UK, France and Germany, enrolment October 2010–October 2011. Patients presenting within the normal course of care who were >55 years, diagnosed with probable AD (NINCDS-ADRDA), not institutionalised, with an informal caregiver and without coexisting potential causes of dementia were categorised according to MMSE score as mild (26-21), moderate (20-15) or severe (14 or less) AD. The study aimed to enrol a similar number of patients in each MMSE category in each respective country. Data collected included demographic characteristics, medical conditions, current medications and resource use on both patient and caregiver, clinical measures of cognition (ADAS-cog), function (ADCS-ADL) and behaviour (NPI) of the patient as well as the burden (Zarit Burden Interview) and health-related quality of life (EQ-5D – caregiver and proxy version) from the caregiver. Following baseline, 6-monthly visits up to 18 months in the UK and up to 3 years in France and Germany will be completed. Caregiver characteristics, health-related quality of life and caregiver burden are reported by MMSE category.P-values for the EQ-5D and caregiver burden scores between MMSE severity groups are taken from an ANOVA model with independent factors for MMSE severity and country.
Results:The study cohort included 1497 AD patients (38% mild, 32% moderate and 31% severe AD) and their caregivers (n=419 France, n=552 Germany and n=526 UK). Caregivers had a mean (SD) age of 67.3 (12.0) years, 64% female and 66% were the spouse and 27% child of the AD patient. 10% of caregivers reported depression but there was no difference between caregivers based on patient MMSE severity groups. Caregiver burden as assessed by the Zarit Burden Interview was significantly higher when caring for severe AD patients [mean (SD) score for mild 24.7 (14.2), moderate 29.4 (14.8) and severe 34.1 (14.8);p<0.001]. EQ-5D VAS score was significantly different [mild 75.8 (16.5), moderate 76.4 (16.5) and severe 73.0 (19.2);p=0.014] with poorer health scores reported by caregivers of severe AD patients. The EQ-5D health index score did not statistically differ between caregivers based on the MMSE categorisation (p=0.07) [mean SD) scores for mild 0.82 (0.2), moderate 0.81 (0.2) and severe 0.79 (0.3)].
Conclusions:The GERAS study provides up to date information on a large cohort of AD patients and their caregivers from three European countries. The majority of caregivers were the wives of the AD patients. On average, caregiver burden was highest and caregiver health-related quality of life was lowest when caring for severe AD patients. Longitudinal follow-up is ongoing and will provide important information on the impact of disease progression on caregiver quality of life and burden.
This study is funded and sponsored by Eli Lilly and Company Limited.
PO10. Alzheimer´s disease and swallowing disorders
Swallowing is vitally important for us. Everybody is swallowing at least 1000 times a day – and we are not aware of it.
To swallow in the right way we need about 50 pairs of muscles and 5 brainnerves.
Sometimes a swallowing disorder comes along with Alzheimer´s disease. The reasons for it can be sensomotoric changes or configuration changes.
Swallowing problems cause health and social problems like:
4. Avoiding social life like lunch or dinner with family and friends
First indications for swallowing disorders can be:
- problems with chewing, taste and smell
- coughing during or after the meal or drinking (triggering the swallowing reflex too late)
- “forgotten” food in the mouth
- Wet sounding voice during/after meal or drinking
- Avoidance of eating and/or drinking
- Subfibrile temperature
For the optimal therapy setting it is important to know the medical diagnose and to know about the medication the client is receiving, as some medicine can force a swallowing disorder.
In order to guarantee a successful therapy it is essential to know in which places/swallowing phases the problems are located. We have 4 phases for swallowing: 1.oral prephase, 2. oral phase, 3. pharyngeal phase , 4. oesophageal phase. For this we use the logopaedic swallowing diagnose.
To make sure not to miss a silent aspiration we can introduce to a FEES or videocinematographie .
Based on this diagnose we arrange a logopaedic swallowing therapie perfectly made for the patients problems.
Therapy options to choose or combine:
- Causal Therapy, where we try to train sensibility and muscle tonus (FOTT, PNF, C. Morales,…)
- Compensatoric treatments to manage swallowing without laryngeal penetration or aspiration.
- Dietetic therapy to guarantee the right consistence of the food to prevent aspiration.
- Utilities like a straw or bigger glasses for drinking to avoid antiflection of the head.
For best results it is important to work together in an interdisciplinary team with neurological doctors, physiotherapy, ergotherapy and dietology.
The nature of dysphagia (Logemann 1997; Cherney 1994)
Aspiration occurs, whenever food enters the airway below the true vocal folds. Aspiration can occur before, during or after swallowing.
Aspiration before swallowing
Aspiration occurs before swallowing in case of a delayed or absent initiation of the swallowing reflex. It may also be the result of poor tongue control, which allows food to trickle into the pharynx while the patient is still chewing.
Aspiration after swallowing
Aspiration can occur after swallowing under several different circumstances:
The patient may pocked food in the oral cavity. Later, when he or she lies down to sleep, the food will fall down into the airway.
Food may get stuck in the pharyngeal recesses. This happens to everyone, but someone with a normal system would realize that the food was there and swallow again. A patient with sensory impairments allows the food to drop into the larynx.
PO11. Decision-making by direct care staff in residential aged care facilities when the person about whom decisions are to be made has a diagnosis of dementia
Laura Tarzia, Deirdre Fetherstonhaugh, Michael Bauer, Rhonda Nay, Elizabeth Beattie, Glenn Rees
In Western democracies, the concept of personal autonomy is central to social and political discourse. Autonomous individuals make choices and decisions about their own lives, and have the right to have those choices respected by others. This is particularly important when it comes to health care decision-making. When an individual has a diagnosis of dementia, however, decision-making becomes somewhat of a grey area, particularly when the individual moves into a residential aged care facility. Staff and families face a balancing act between respecting the autonomy of the individual with dementia to make decisions, while also ensuring that their health and wellbeing is not compromised. Research has shown that a diagnosis of dementia does not preclude one from making decisions, and that individuals with dementia want to participate in decisions regarding their own care. In practice, however, decision-making for individuals with dementia living in residential aged care facilities is often taken over by staff and families. This can be a result of the assumption that the individual with dementia does not know what is in their own best interests, or, alternatively, can be due to practical issues within the facility such as scheduling conflicts or staffing levels.
Considering the established connection between autonomy and individual well-being, it is important to gain a deeper understanding of how, when, and why the rights of people with dementia to make their own decisions are taken away in residential aged care. This paper will present the findings of a qualitative study examining the experiences and processes of direct care staff and decision making for residents with dementia. The presentation will include research data from care staff at all levels working in a range of residential aged care facilities in two Australian states. Findings underscore the need for further education for staff regarding decision making in order to promote a more consistent approach to practice.
PO12. Thinking about dementia systemically; Working with the family to achieve better outcomes and improve relationships
Admiral nurses are mental health nurses who work specifically with dementia, primarily with family carers to support them in the role of caring for a person with dementia. They may work with both members of a couple where one has dementia where insight or need dictates, or more extended families where several people are involved in offering support. They may work with spouse couples who need to discuss the impact of the diagnosis on their life and future planning, or families where adult children are supporting a parent who is a main carer, from pre diagnosis to during end of life care and beyond. In this role, complex family dynamics are often evident and for families who struggle with caring, sources of support which address the system rather than an individual within it are rare if they exist at all. Admiral nurses are well placed to work systemically with families to address misperceptions or conflicts about dementia and care within the family, and help family members learn ‘new ways of being’ in relationship with the person diagnosed.
Relationship problems often predate the diagnosis and can resurface as family members resources are stretched in the caring role, but these difficulties in adjusting to changed roles are not addressed within traditional mental health support. Even strong relationships can struggle under the duress of the type of changes that can occur in a person with dementia, and these losses are keenly felt, and often deeply grieved, but are rarely if ever the target of mental health intervention. Family carers are heavily depended on by health and social care services to provide informal care, but services which address the aspects of care that can be most emotionally challenging for carers and the person with dementia as relationships change are rare. Working therapeutically to involve the person with dementia and their family in talking together about problems is a model for good practice that both families and services can learn from, but which needs more exploration.
This paper will suggest that admiral nurses are uniquely well placed to develop working systemically with families and address a service shortfall. It will use case vignettes to demonstrate the potential value of supporting a whole family as a unit, and some different ways of doing so. The overall aim of working this way is to strengthen family resilience and relationships between family members during what is usually a very extended period of change and adjustment for a family, dealing with many transitions. It will explore the transferability of family therapy approaches to support working in this way, and ask where this may fit in to current service provision and what training needs this may highlight.
PO13. A preliminary study in Greek caregivers of people with dementia
Nika, A. Vlachogianni, L. Andrianaki, P. Sakka
Objective:It is well established in many studies that the role of caregivers of people with dementia (PWD) is linked with burden and distress. Caring experience also varies depending on the relationship with the care receiver. The aim of the current study is to investigate the profile of Greek caregivers of PWD. In addition the present study aims to assess awareness about the services provided by Day Care Centers and Alzheimer’s Associations.
Method: Structured questionnaires were given to 433 caregivers of PWD who attended educational seminars about caregiving within context of Carer’s Day celebration on 19th March. The results have been analyzed with ANOVA.
Results:The vast majority of caregivers of PWD are women (80%), mainly children (62,5%) and spouses (24,5%). Spouses provide care for an average of 19 hours per day, while children spent fewer hours in caregiving, 9 hours in average. Women complain more often about health problems and regarding the relationship with the care receiver, spouses report more health problems than children.
Only a small percentage of family caregivers (30,9%) share the caring responsibilities with a paid caregiver. Women rarely engage a paid caregiver and only 5,7% of spouses assign a paid caregiver to provide care. At the same time 25,2% of children caregivers provide caring jointly with a paid caregiver. Another finding of this study is that the half of the participants is not informed about the services provided by Alzheimer’s Organizations.
Conclusion:Our results verify the evidence of literature that mostly women undertake the responsibility of caring a PWD. The fact that only a small percentage of Greek caregivers share their care responsibilities with a paid carer underlines the Southern European model, where family is primarily responsible for supporting PWD. The majority of Greek families undertake entirely the caregiving tasks and responsibilities. In view of the fact that families tend to provide exclusive care, the necessity of effective community support services is imperative.
PO14. Disclosure of Diagnosis: Greek and European prospective
P. Sakka, E. Margioti, O. Lymperopoulou, F. Kalligerou
Despite growing evidence that many people with dementia want to know their diagnosis, there is wide variation in attitudes of Healthcare professionals towards disclosure. Revealing the diagnosis of dementia is a complex ethical and practical issue and is increasingly recognized as being imperative. Most European countries do not regulate the right of knowing the diagnosis as an absolute right for patients. Few intervention studies to improve diagnostic disclosure to patients with dementia and their caregivers have been reported to date.
In Greece, despite growing evidence that many people with dementia want to know their diagnosis there is a wide variety of attitudes of relatives and Healthcare professionals on the matter. With this study we tried to examine the attitude of Greek caregivers towards the disclosure of a dementia.
This survey involved 233 family caregivers of people with dementia attending programs at the Day Care Centers of Athens Alzheimer’s Association in the years 2010-2011. Caregivers were asked to complete a structured questionnaire. Their mean age was 60 (35-87) and their years of education were 13 (6-18). The vast majority were women (64%) and mainly spouses (48%) and children (45%). All of them (100%) wanted to know the diagnosis of their relatives. 52% of them reported that they did not want the doctor to disclose the diagnosis to patient. In contrast to the above finding, 96% of caregivers wanted to know the diagnosis if they themselves had dementia. Specifically, 66% wanted to know the diagnosis from the very beginning in order to develop management strategies (legal, ethical and financial issues etc.).
Revealing the diagnosis of Alzheimer's disease should be done with discretion and be accompanied by information and counseling, as well as useful contacts such as Alzheimer’s organizations. Patients and caregivers should be provided with education and support.
PO15. Is there a relationship between the Nutritional Status and Quality of Life for Care-dependent People with Dementia in Shared-Housing Arrangements?
Saskia Meyer, Johannes Gräske, Andreas Worch, Karin Wolf-Ostermann
Objectives:An adequate and healthy nutrition is especially important for people with dementia. Malnutrition contributes not only to the negative alteration of physical health status but also has negative consequences on quality of life (QoL) of a person. The concept of shared-housing arrangements (SHA) can minimize the risk of malnutrition of older people. The nursing concept is organized around doing household chores like preparing meals together. But there is a lack on findings concerning a possible positive impact of a better nutritional status on residents’ QoL and social activities.
Methods:In a longitudinal study with a one year follow-up the nutritional and health status of 104 residents of 34 SHA in Berlin/Germany were evaluated. Standardized face-to-face interviews where conducted concerning the nutritional status (BMI, MUST and MNA), activities of daily living (Extended Barthel Index), severity of dementia (GDS) and quality of life (ADRQL), social activities as well as other socio-demographic characteristics.
Results:The residents (73.1% female, 79.0 years, 87.0% with dementia) show a low to moderate cognitive functioning (mean MMSE 11.5). According to the MNA, 16.4% have an adequate nutritional status, 14.5% are malnourished and 69.1% show a risk of malnutrition. According to MUST, 2.4% of all residents have a high, 9.6% a medium and 88.0% a low risk of malnutrition. Malnourished residents have a low QoL and do not participate in social activities e.g. cooking and housework
Conclusion:The results show that a proper nutritional status of residents in SHA can not be taken for granted and therefore a constant supervision of residents’ nutritional status is essential to maintain a high QoL. On the other hand monitoring the nutritional status offers a great benefit in terms of quality of care at little cost.
PO16. Social participation
Maud Graff, Myrra Vernooij-Dassen, Ria Nijhuis-van der Sanden, Marcel Olde-Rikkert
Background:Social participation is one of the four central themes for good quality of person centered care in dementia in Europe.
Aim:to evaluate feasibility and effectiveness of a newly developed tailor-made social fitness program on participation in meaningful social activities of community-dwelling older people with dementia and caregivers.
Intervention:this tailor-made social fitness program starts by a volunteer of a welfare organization for the elderly, who cycles through the region with all kind of social information (digital and written information on social activities & social communities), and who attends all kind of places where older people come. This welfare person informs and motivates people with dementia and their family members to cooperate in meaningful social activities in the region. If these activities need to be adapted or people need to be trained to be able to participate, a multidisciplinary program will be offered containing of occupational therapy , physiotherapy, home care or volunteers and coaching on a distance.
Methods:the research project will follow the steps of the MRC framework for evaluation of complex interventions. Using mixed methods: qualitative research methods defining successful program components and testing of the feasibility of the program and of a research protocol for a main randomized controlled trial. Finally, this RCT will evaluate the effectiveness of the social fitness program on (n=114) older people with dementia and caregivers. Primary outcomes assessed at baseline, 3 and 6 months: patients’ and caregivers participation in meaningful social activities. Secondary outcomes: patients’ autonomy, cognitive functioning, self-esteem and sense of loneliness; caregivers’ sense of competence; patients’ and caregivers’ quality of life. Alongside this RCT we’ll perform a process analysis.
Implication of results:it is expected that this program will be effective because it is based on almost all components of successful psychosocial interventions and on two positively evaluated intervention programs. This study will be presented and discussed at the conference.
PO17. Pain evaluation in nursing home people not responder to self report scales, with cognitive declension: pain cross sectional (prevalence) study by DOLOPLUS2 scale.
Flavio Paoletti, Monica Bello, Carlo De Vuono, Erica Garavelli, Gloria Moretto, Ivan Nestorov, Ariella Raunikar , Valentina Sossi
Introduction:Advanced age is characterized by a major presence of chronics and degenerative pathologies and by important cognitive symptoms, which are often included in dementia and Alzheimer disease. This clinical picture together with psychological and social factors, which can modulate a subjective response, can often determine a pain symptomatology . When cognitive declension increases, people’s ability to refer their pain perception decreases and it determines a wrong pain interpretation from the part of professionals that undervalue the phenomena . The prevalence of pain in elderly nursing home people is 40% - 80% , a range too much wide showing that there isn’t an agreement on real prevalence of pain. This symptom, in people with cognitive impairment is undervalued and not registered in the case history because of the self report pain scale that cannot be used. A different approach can be done for assessment in non communicative patients, put to use observation scale, mostly formulated on behavioural indicators summarized into the American Geriatrics Society guidelines. The tool that better responds to these variables and that demonstrates good reliability is the DOLOPLUS2 scale. It is composed by ten items put down in three behavioural records that investigate the somatic, psychomotor and psychosocial reactions. The range score goes from 0 to 30.
This tool permits to professionals and carers to measure the chronic pain intensity in old people through behaviour observations in the different moments and situations of the day, including the social interactions and during the sleep .
Methods:It is a cross sectional (prevalence) study. The aim of the research is to determine the prevalence of pain in people with cognitive declension that don’t respond to self report scales (VAS, NRS and VRS), to guarantee the right not to suffer pain, through the specific and personalized clinical pathway. It is a convenience sample, made up of the residents in two municipality nursing homes (213 resident people) in Trieste, evaluated by multidimensional tools, who have a cognitive declension highlight by the cognitive performance scale (CPS). The criteria of the cognitive declension is confirmed by the Mini Mental State Examination score (MMSE Folstein e coll 1975). If the person has a MMSE score < 10, they enter in the study. If the score range is from 10 to 15, it will be evaluated from the district psychologist by Token Test (De Renzi e Vignolo, 1962; Spinnler e Tognoni, 1987). If the result will be positive the person will enter in the study. If the score is > 15 the person doesn’t enter in the sample.
If the people have a severe dementia registered in their case history, they enter in the study without the MMSE evaluation.
In January 2012, it was made a daily training to the nurses of the nursing homes and the health district about the correct use of the DOLOPLUS2 scale. Further, the study was presented to the General Medical Practitioners that work in the nursing homes.
From the first of February to 30th June 2012, all people that have the inclusion criteria will be evaluated by nurses in charge of the residents together with the district nurses using the DOLOPLUS2 scale. Evaluations will be repeated every month in the specific days (study protocol).
If the score is = > to 5, which in literature is considered the cut-off to define the presence of pain, some procedures will be put into operation to contrast pain and will be repeated the evaluation after the pain killer treatment. These data will not be registered in the study.
Results:Beyond representing the prevalence of pain symptom in the target people, we will make a multivariate analysis among DOLOPLUS2 score, sex, age, MMSE score, take drugs. The measures of statistical position will be analyzed by Excel software, while the measures of correlation by Graphad Instat software.
Discussion:In June, at the end of the study, we will publish the results and the conclusions.
Poster presentations – Saturday, 6 October
PO18. World Alzheimer report 2012 on Stigma
The stigma related to Alzheimer’s disease and other dementias is one of the main barriers for people with dementia to understanding the disease, seeking help, getting diagnosed and access to services. It keeps families from discussing the disease openly and makes physicians think they have nothing to offer.
Alzheimer’s Disease International (ADI) has commissioned a report that was launched on 21 September with the purpose to better understand this stigma, to find out how people with dementia and their caregivers respond to it and what possible action can be taken to overcome stigma.
Elements of the report are a literature review, survey results into the insights of people with dementia and caregivers, essays on various aspects of stigma and an overview of projects from Alzheimer associations around the world that aim to raise awareness, better understand dementia and bring people with dementia out of the shadows.
PO19. An exploration into how the general public understands and responds to dementia.
Patricia Mc Parland
Background:The experience of dementia for an individual takes place within a social context and interaction becomes increasingly difficult in the face of cognitive decline. The citizenship of people with dementia and their status as members of society is also dependant on the way they are viewed and the status afforded to them by others. How the general public understands and responds to dementia provides an indication of the value placed on people with dementia. It influences the type of interactions people are likely to have with someone who has dementia, the institutions we create and the type of care we provide.
Methods:This is a three year mixed methods study exploring knowledge, attitudes and self-reported responses to dementia. An attitudinal survey was completed with 1200 people. A random selection from this group took part in five focus groups held in each of the five health trusts in Northern Ireland. A further selection of nine volunteers from these groups participated in an interview. Survey data were analysed using SPSS (V19) and a thematic analysis was carried out on the qualitative data using NVivo 9.
Findings:There is a reasonable level of knowledge about dementia among the general public in Northern Ireland, although the link with age and dementia continues to be misunderstood. The general public is not convinced of the value of telling someone their diagnosis. Participants use stories to contextualise their knowledge and this experiential knowledge has more power than information received from other sources. Paternalism and infantilisation are evidenced in attitudes towards people with dementia, thus diminishing their status as fully active citizens of society. People view those with dementia as “other” and take steps to create social and psychological distance and a nihilistic, stereotypical view of dementia exists linked to the worst-case scenario. Age, gender, education and knowing someone with dementia have emerged as significant variables.
Conclusions:Partial and confused understandings of dementia exist among the general public. There is no sense of a life worth living with dementia, rather dementia is seen as hopeless. The relatively recent cultural shift to ideas of successful ageing potentially further disenfranchises those with dementia who personify ideas of unsuccessful, dependant ageing. Attitudes to dementia perpetuate stereotypes and are deeply stigmatizing
PO20. Perceptions of dementia
Going back to the origins of the word dementia it is easy to see how the condition was perceived early on. The term dementia is taken from the Latin originally meaning “madness” from de – “without” + ment from the root of mens “mind”. This led to the perception that all people with dementia were insane and led to many of them being treated in insane asylums. This has carried on to modern day with many dictionary definitions of dementia still using the terms madness or insanity in them. Up until the end of the 19th Century dementia was a much broader clinical concept which included mental illness and any type of psychosocial incapacity.
Whilst modern medicine and treatments have evolved and improved the treatment of the condition, many people still view dementia from this angle. I will look at how the origin of dementia has contributed to many of the perceptions of dementia today.
I will look at some of the more common misperceptions of dementia the general public still have today, that all people with dementia forget everything and are unable to make decisions, take risks or have a valuable input in their own lives or the lives of their family, friends and community. I will also take into account some of the perceptions of the family members and friends of the people I have cared for professionally and how this affects them during their everyday life.
I will explore how the some of the people I have cared for professionally perceive themselves and how that changes as their condition deteriorates. I intend to look at how this perception can differ depending on the age of the person with dementia, i.e. how it was always seen as a condition that would typically affect older people and how it was considered an almost normal result of getting older.
I will give some background into my personal experience of caring for my grandmother who had dementia and how my perceptions of her changed, i.e. she went from being my caregiver and emotional support in all aspects a grandmother would to me becoming the carer for her and having to accept the role reversal and the difficulties in accepting who she had become to me
PO21. Sunday excursion and support group
Both were created by people who have been « Close caregivers – family caregivers”.
Introduction:Sunday excursions initiated by a group of “relatives” bringing their patient to a “short rest” center. Those became friends and have set up the Sunday excursion once a month.
Support groups have quickly followed. Conversations occur between caregivers. They are helped by people who lived the same situation.
Objectives:Sunday excursion: Firstly of all, the purpose is to find conviviality, to break the loneliness, to allow exchanges between friends and to do joint group activities.
They are short – a few hours – so as not to tire the patient.
Support group: Helps to share the emotion and the inquietude with people who lived the same situation and allow exchanges of idea.
It helps to break the solitude and may bring some answers to some questions. It allows considering more serenely the future.
Both influence the quality of live and the well-being of all, remove the caregiver’s guilt feeling, improve the relationship and increase the social contact and the circle of friends
PO22. Novel policy framework for active, healthy and dignified ageing and provision of health and long term care services
Radka Vepřková, Iva Holmerová, Marcela Janečková, Ondřej Mátl, Tomáš Roubal
Project aims to develop modern policy framework improving quality, accessibility, and financial sustainability of health and long-term care services, while increasing the economic potential of the elderly through active and healthy ageing. expert and public debate and exchange of experience comprising of best practice identification at municipal and national levels, through on-site visits and workshops; public(surveys) and expert debate (seminars, workshops) will be carried out to gain sufficient experience for designing new policies. This will comprise of development of the National Policy Framework - “Strategic plan for active, healthy and dignified ageing and provision of long-term care services” and the “Toolkit for Municipalities”.
The Toolkit based on best practices identification will provide municipalities with guidance and practical tools of how to support active ageing and creation of a network of services that will respond to the needs of the community, while maintaining their accessibility, quality standards and financial sustainability.
In our presentation we will introduce some examples how municipalities in the Czech Republic support persons with dementia and their family caregivers.
This presentation is supported by the European Union programme for employment and social solidarity - PROGRESS (2007-2013). This programme is implemented by the European Commission. It was established to financially support the implementation of the objectives of the European Union in the employment, social affairs and equal opportunities area, and thereby contribute to the achievement of the Europe 2020 strategy goals in these fields. The seven-year programme targets all stakeholders who can help shape the development of appropriate and effective employment and social legislation and policies, across the eu-27, EFTA-EEA and EU candidate and pre-candidate countries. For more information see: http://ec.europa.eu/progress
PO23. Romanian Alzheimer’s society memory testing campaign
Catalina Tudose, Cristina Adina Popescu, Maria Moglan
Background:The recent Alzheimer Europe’s five country survey revealed public’s clear interest in pre-symptomatic diagnostic testing. The importance of promoting better access to diagnostic services in order to ensure that early diagnosis becomes a reality was stressed.
Last year Romanian Alzheimer’s Society launched a campaign to free memory testing in order to enhance public’s access to specialized services. The results of the first phase of this campaign are presented.
Methods:The persons who have expressed their interest to participate were included in a two-stage evaluation procedure: preliminary screening was followed by the diagnostic evaluation of screen-positive persons. Romanian adaptation of the Addenbrooke’s Cognitive Examination- Revised (R-ACE-R) and Rey’s Auditory Verbal Learning Test (RAVLT) were applied for cognitive screening. Subjects’ scores on Mini Mental State Examination (MMSE) were derived using the R-ACE-R assessments. The persons who were considered screen-positive were evaluated by a comprehensive diagnostic assessment procedure.
Results:Romanian public responded promptly and in large numbers to the campaign announcement. The results for a first group of 149 persons are reported here. Age range was large: 50 to 86 years, mean age 67.28 ± 8.98. Females prevailed (66%). Number of years of education ranged from 7 and 21 years, with an average of 14,26±2,55 years. Half of the persons graduated from university, 30.6% had worked in the economic field and 28.5% in the technical one. Almost a fifth ( 18.79%) had relatives with neurodegenerative pathology. About one third (31.5%) accused memory problems; 6% had been previously diagnosed with dementia and asked for confirmation of diagnosis.
The scores on MMSE varied between 20 and 30 (mean 28.41± 2.12)}; 23.8% of the subjects had scores below the normative median values. On the R-ACE-R the scores ranged between 53 and 100 (mean = 91.31± 7.35); slightly more than a fifth of the subjects (22%) had overall scores slightly lower than their age-and education-appropriate normative values ( ≥ mean-1 s.d.); a fifth of people had clearly abnormal scores (≤ m-2 s.d.) on this scale. On the RAVLT almost one third of the subjects were scored slightly below the normative values (≥ m-1s.d) and less than a fifth (17.2%) had abnormally low scores (≤m-2a.s.).
The 32 persons who had scores outside normal range on the screening scales were subsequently assessed using a comprehensive diagnostic procedure and the following diagnoses were established: dementia in 11 cases (34.4%), mild cognitive impairment in 11cases (34.4%), associated with depression in three of them, very mild cognitive impairment in 4 persons (12.5%), depression in 3 cases (9.4%).
Conclusions:A significant public interest for cognitive testing and diagnostic assessment was observed. The Romanian Alzheimer’s Society Campaign of free memory testing and the two-stage assessment procedure proved their values for promoting a better access to diagnostic.
PO24. Use of Tabl. Sertaline organic derangement of mood at Vascular Demention
Olivera Bundaleska, Agnesa Mitevska, Lence Neloska
Introduction:To evaluate efficacy and safety of the drug Tabl. Sertaline in the treatment of patients with organic derangement available Gerontology developments in which the Department for the period year 2009-2011
Objective:The Department Gerontology which come with internists ac patients -internist illness (hypertension, diabetes,circulatory changes) and neurological anyone. These illnesses reflected directly Sheet affective changes in patients for direct brain sufferings.
Method:symptoms of derangement developments available in the form of light or a little dipper depression, emotional bad mood learning and improving their birth while using Tabl. Sertraline were evaluated according to the Clinical Global Impression of the reasons disease and improving clinical wellness. Security of white drug was judged according to individual patients' statements appear not enough symptoms. The usual daily dose was 50mg.
Results:There were investigated 64 patients (40 women and 24 men, all with organic mood disorder developments. These patients had the opportunity to be a regular basis to receive therapy in 35 women and 17 men to him there was a withdrawal symptomatology developments, Code of patients who were incontinent with emotional withdrawal symptoms of learning is slower, and lo and at 5 therapy had an effect. In the course of treatment for some patients to done enough effects: dry mouth, diarrhea, insomnia who retreated treatment (internal medicine specialist).
Conclusion:The drug was given very good results for the group of patients and proved to be a good therapeutic choice in patients with organic mood disorder developments.
Key words (3-6): organic, availability of learning, disorder, choice
PO25. Developing a tailored intervention for elderly dementia caregivers: a single case description
M.Turci, A. Bonora, G. Menabue, E. Boni, P. Bevilacqua, A. Fabbo, R.Chattat
M.E. was a 84 years old woman with AD diagnosed 5 years ago, living at home with her old husband, her principal caregiver They have 2 sons (male),who give some help in caregiving. ME during the last months of 2010, due to disease progression present severe BPSD. A home care assessment done by geriatric services outline an NPI score of 54 with high score level on delusion (9), agrressiveness (6), wandering (12) and sleep disorders (6). M.E. present a severe mental deterioration with significant loss of functional ability (Barthel Index 87). In order to face husband difficulties in BPSD management, the local caregivers association (ASDAMonlus) is involved to provide a house support within the ongoing “Hours of Relief” project. The project consist of few week-hours of home support by trained assistant; that was accepted by M.E. However, the patient. shown an increasing irritability and BPSD worsening. The GP (General Practitionner) in order to develop a plan for BPSD management suggest a temporary admission of M.E. to a Special Care Unit for Alzheimer disease into a residential care setting of the district (Mirandola).
ME was admitted for 4months in the Special Unit, and the Hours of Relief was suspended. During this period the pharmacological therapy had been revised (administration timing and dosage of antipsychotic drugs). Furthermore, M.E. is involved in occupational and pleasant activities such as smarten up, washing vegetable and fruits and Snoezelen sessions (in a Snoezelen Room) are also administered to promote relaxation and well-being.
The family caregivers and other members receive a support sessions and the discharge project, toward home, is developed together. At the discharge a full time home assistance is arranged after a period of training inside the Unit Care (for behavioral strategies).
A psychological support, after discharge is available for the family in order to promote adaptation and to develop effective strategies in symptoms management; the Hours of Relief were reactivated for the first period.
At this no increase of BPSD symptoms of M.E. is shown: 32 NPI total score at the discharge and 33 NPI total score after 6 months follow-up.
We can conclude that the care of person with dementia and their caregivers involve different setting and agencies and the relief of symptom and home care depend upon a well coordinated care. This case was chosen as example of integration of social and health services for the care of people with dementia and their caregivers.
PO26. Why do discrepant ratings occur when measuring change in QoL in dementia?
Measurement of quality of life (QoL) in dementia often incorporates perspectives of people with dementia and carers, although variation in their perspectives is acknowledged. This qualitative study using Interpretative Phenomenological Analysis explored why discrepant evaluations may occur. In-depth interviews were conducted with 9 people with dementia and their 9 carers to explore experience of change, attributions of change, and management of change. Participants had previously taken part in a larger quantitative study measuring change in QoL using the DEMQOL, a dementia-specific quality of life measure (Smith et al, 2005). Findings revealed that people with dementia and carers talk about QoL in different ways. While the former spoke more positively of their capabilities, carers focused on deteriorating functions and abilities. Carers attributed most changes to their relative’s dementia. They approached caregiving in a practical manner and accommodated change in the same task-focused way. Carers, therefore, tended to describe QoL as deterioration in ‘external indicators’ like cognitive ability, functional ability and social life. People with dementia attributed changes to other conditions of old age, and managed change by using psychological coping styles such as normalizing the condition and focusing on positives. Their account of QoL was thus based on ‘internal indicators’ like mood, feelings, self-esteem and sense of self, which they described positively and relatively unchanged. As a result of these different ways of perceiving QoL, there was discrepancy between self-rated and proxy-rated QoL. Understanding discrepant evaluations has significant relevance for people with dementia, carers, clinicians and researchers.
PO27. Who should protect people with dementia from financial abuse?
Jill Manthorpe, Kritika Samsi
Financial abuse of people with dementia concerns many family carers, voluntary sector staff and professionals. Interest in prevention and response is growing. Although there is potential for community prevention and early alerts, little is known about preventative and early response practice among community services staff. We explored the barriers and facilitators to minimising risks of financial abuse for people with dementia with 15 Adult Safeguarding Coordinators (ASCs) inEnglandusing qualitative interviews. In an online survey of 86 local Alzheimer’s Society staff acrossEngland, we also sought information about the risks associated with managing money among people with dementia and factors that may protect someone from financial abuse. Framework analysis was used to delineate themes in the transcripts usinga prioriresearch questions; identified themes were included in an iteratively developed coding framework. Almost all respondents had encountered people with dementia experiencing problems with money management, and almost half reported cases of financial abuse over the past year. Interviews revealed that financial abuse of older people with dementia is seen as a major risk but prevention may be assisted by making plans to manage money in advance and through general awareness amongst public and practitioners of attempts to exploit vulnerable people. Most participants were alert to a range of warning signs and vulnerabilities, including changes with relationship with money, being trusting of strangers, unsolicited help from strangers, changes to bank account arrangements and financial statements. A number of participants felt that financial institutions, like banks, could be engaged more with vulnerable clients and be approachable to concerned carers. Not all systems of financial decision-making proxies were seen as optimally effective. Most felt that principles of risk empowerment enshrined in current legislation could be used by practitioners to support people with dementia, carers and care staff and provide greater protection against financial abuse. Participants offered suggestions relevant to policy and practice about prevention and risk minimization. As with other forms of elder abuse, healthcare professionals and supporters of people with dementia may need to be more alert to risks of financial abuse of patients with dementia and may find that engagement with safeguarding practitioners facilitates prevention and effective response. We explore these issues and present a range of strategies at the micro or individual level, the meso or relationship level and the macro or societal level.
PO28. Analysis of anger in family carers of people with dementia: Gender differences
Elena de Andrés Jiménez, Rosa María Limiñana Gras
The psychological variables considered most relevant to explain the emotional impact of caring have been the individual variables, stress, anxiety, hostility or anger and depression (Crespo & López, 2005; Ferraraet al., 2008; Flaskerud, Carter & Lee, 2000). Hostility has been considered one of the variables that negatively affect health, as well as becoming a source of stress (Ferraraet al., 2008; Ochoaet al., 2010). The differential analysis of anger management in men and women caregivers will facilitate the understanding of emotional management when caring people with dementia, and possible consequences for their health.
The study population consists of a total of 100 family carers of people with dementia: 77 women and 23 men, members of various associations and care centers in southeastern Spain. The average age of men was 54.70 years (SD=14.22). On the other hand, the average age of women is 55.48 years (SD=12.28).
The results show statistically significant differences with the normative data. The carers of the sample who are men have lower external expression of anger and more internal control than men in the general population. Moreover, women carers show lower external expression and greater external control of anger. We also found significant differences by gender: both men and women get a lower rate on expression of anger, however, men have more internal control of anger and women lower rates of expression of anger.
Analysing the relationship between suffering and psychopathological symptoms in anger management, the obtained results associate the expression of anger to suffering and the development of psychopathological symptoms, while with greater anger control less suffering is observed in general.
These results may provide valuable information about anger management, facilitating their inclusion in the planning of psychological intervention and implementation of programs for caregivers of people with dementia.
PO29. Neuropsychiatric symptoms and imaging changes in elderly patients with dementia of vascular etiology
Raluca Moraru, Stefan Alexandru Sterea, Mona Andreea Blacioti,Gratiela Baidac, Alice Petrescu, Luiza Spiru
Introduction:Neuropsychiatric symptoms are common features of vascular (VaD) and mixed (MixD) dementia and have a negative impact on patients and caregivers. Our study investigated the relationship between socio-demographic variables, neuropsychiatric symptoms and imaging changes in VaD and MixD elderly patients.
Methods:We studied 71 non-institutionalized subjects (mean age 75.5±8.9 years, n=22 with VaD and n=49 with MixD); we cross-referenced their assessment results between the two diagnostic groups. Patient assessment included natural history, clinical (including psychometric) and brain imaging findings. Neuropsychiatric symptoms were assessed using Neuropsychiatric Inventory (NPI).
Results:There was no correlation between socio-demographics and NPI scores. The means (m) scores for VaD and MixD groups vs. different NPI scales showed VaD subjects had significantly higher scores (0.01 level, t-test) for agitation/aggression (m=4.55) and euphoria (m=3.14), while MixD subjects had significantly higher scores for delusions (m=4.16), depression (m=4.59) and apathy/indifference (m=4.51).
There was a significant, negative Pearson correlation between MMSE and total NPI scores (r=-0.30, 0.05 level).
Conclusions:NPI score positively and significantly correlated with overall imaging scores (r=0.52, 0.01 level), while individual imaging changes correlated with certain NPI scales (t-test): leukoaraiosis with decreased agitation/aggression score; demyelination with increased aberrant motor behavior score; hypodense parietal lobe with increased hallucination and disinhibition scores and decreased depression score as well; widened subarachnoid spaces with increased apathy/indifference scores and decreased eating change scores; lacunae with increased disinhibition scores; and finally, hypodense occipital lobe with decreased apathy/indifference score and increased disinhibition score (p<0.05 in all pairs).
PO30. The importance of cardiovascular risk factors for Alzheimer’s dementia
Gratiela Baidac, Alexandru Sterea, Alice Petrescu, Luiza Spiru
Alzheimer’s dementia is a multifactorial disease. The most important risk factors involved in its etiology are age, feminine gender, family history and heredity. These are unmodifiable risk factors which can’t be influenced by medication. Other risk factors of Alzheimer’s dementia are psychosocial ones. It has been reported that the cardiovascular risk factors (which can be influenced by medication), are involved not only in the etiology of vascular dementia, but also in the etiology of Alzheimer’s disease. The purpose of our study was to verify how important are cardiovascular risk factors in the etiology of Alzheimer‘s dementia, by comparison with the genetic and psychosocial ones.
Methods:The study was realized at the Geriatric and Gerontology Clinic, Elias Hospital, Bucharest. It included 104 patients (71 females and 33 males) who were diagnosed with Alzheimer’s dementia, using patient and informant interview, physical and neurological examination, cognitive tests (MMSE, clock drawing test, verbal fluency), daily functionality scales (ADL, IADL), evaluation of psychiatric symptoms, laboratory tests and non-contrast MRI of the brain.
We investigated the incidence of various risk factors in the study group, which were identified using the interview, physical examination and laboratory testing.
Results:A percent of 64.42% (n=67) of our patients had high blood pressure, 36.53% (n=38) had dyslipidemia, 17.33% (n=18) had diabetes mellitus, 9.61% (n=10) had atrial fibrillation and 9.61% (n=10) of them were smokers. Also, 75.96% (n=79) patients were over 70 years old, 68.26% (n=71) were female, 14.42% (n=15) had family history of Alzheimer’s disease, 56 3.84% (n=56) of them had depression, 45.19% (n=47) had lower education and 7.68% (n=8) were drinkers.
Conclusion:Even if old age is considered the strongest risk factor in Alzheimer’s disease, the outcomes of our study highlight the important role of high blood pressure in the etiology of the disease, almost similar with that of old age. Other vascular risk factors like dyslipidemia, diabetes mellitus, atrial fibrillation and smoke seem to have a smaller role by comparison with high blood pressure, but because all of them can be influenced by medication, a good management of Alzheimer’s disease onset and evolution would especially target the management of vascular risk factors.
PO31. Pain and depression in MCI patients – cognitive rehabilitation
Mona Blacioti, Luiza Spiru
Introduction:Pain symptoms are a common reason for seeking treatment and are often associated with depression. However, little is known about the association of pain and depression in MCI patients. Therefore, our study aimed to explore pain symptoms and their associations with a current depressive episode in MCI patients.
Methods:A total of 290 male and female patients aged 55–75 years, referred to our Clinic of Memory Diseases from Bucharest, Romania, were enrolled in the study and assessed with a proper battery of psychometric tests that included the Visual Analogue Scale (VAS), the faces pain scale, the Hamilton Scale for depression and the Yessavage Scale. The inclusion criterion was the presence of depression and MCI. Data regarding patient’s education level and social status, not included in this report, were also recorded.
Results:From the 290 patients included in the study, a percent of 85.2% (n=247) indicated at least one pain symptom. About a fifth of the patients (N=63, 21.7%) suffered from a current depressive episode. The patients with depression suffered significantly more often from any pain symptom (94% vs. 83%; p<0.05) and reported significantly more often three or more symptoms of pain (73% vs. 40%; p<0.01) than those without depression.
Conclusion:Study findings highlight the significance of pain symptoms for co-morbid depression in MCI patients. Thus, patients with pain symptoms should be thoroughly investigated both physically and psychologically. A comprehensive, interdisciplinary elaborated therapeutic scheme for these patients may actually improve their well-being and quality of life.
PO32. Extrapyramidal syndrome in MCI - a rarity?
Alice Elena Petrescu, Gratiela Mariana Baidac, Stefan Alexandru Sterea, Luiza Spiru
Introduction:Extrapyramidal syndromes may occur in various pathologies of old people. (1). Classically, it is considered that the extrapyramidal syndrome occurs in advanced stages of Alzheimer’s dementia, while in vascular dementia this syndrome may be present in earlier stages (2)..Our aim was to evaluate the incidence of extrapyramidal syndrome in patients with various cognitive impairment stages, with a special focus on mild cognitive impairment (MCI).
Methods:From 160 patients, males and females aged over 65 years, with degenerative or mixed (degenerative and vascular ) cognitive impairment, referred to our Clinic of Memory Diseases from Bucharest, 54 of them were diagnosed with MCI, 38 with mild dementia, 58 with moderate dementia and 16 with severe dementia. During their clinical exam we kept the check on the presence or absence of the extrapyramidal syndrome.
Results:In our patients we detected the extrapyramidal syndrome in about half of the patients with MCI (51.85%). The syndrome was also present in 55.26% of the patients with mild dementia, in 67.30% of those with moderate dementia, and in 62,5% of those with severe dementia. The incidence of extrapyramidal symptoms seems to increase with the severity of dementia. Epidemiological studies show that gait dysfunctions is present in early stages of cognitive impairment and that the clinic and quantitative evaluation of gait can predict the development of cognitive dysfunction Etiologically, the altered dopaminergic neurotransmission is considered the main cause of the extrapyramidal syndrome, while the cholinergic one would be the main cause of cognitive dysfunctions. However, there are complex relationships between these and various other neurotransmitter pathways. Central dopaminergic dysfunctions in AD patients were reported by certain authors (3).
Conclusions:We observed the presence of extrapyramidal syndrome in more than half cases of MCI. Further studies related to the interplay of central dopaminergic, cholinergic and other neurotransmitter systems in MCI patients with extrapyramidal symptoms, together with the examination of vascular pathology in the striatal territories may enlighten the plurietiologic nature of pathological cognition paralleled by extrapyramidal symptoms.
PO33: Practical aspects in improving workforce for dementia care. The Romanian « BrainAging » SOP-HRD Project
Luiza Spiru, Ileana Turcu, Ioana Ioancio, Mona Blacioti, Raluca Moraru, Mariana Martin, Elena Banu
Introduction:In the context of population aging, the awesome challenge of neurodegenerative pathology requires a radical improvement of the 3rd Age component of health care. There are several conditions for succeeding, but the basic one is to develop a highly skilled workforce, able to acquire, adapt and perform any new scientific and practical knowledge for improving health care services and cost/benefit ratio. Despite the prolonged transition period Romania is prepared and committed to implement the above commandments. Our SOP-HRD 46975 BRAINAGING Project - Training in Brain-Aging Medicine and Related New Medical Technologies for Doctors and Nurses Working in Specialized Ambulatories and Hospital Departments promotes healthy Brain-Aging as the capital component of healthy and active aging.
Project description:The project runs between 2011-2013, at national level, under the coordination of Ana Aslan International Foundation and in partnership with the Romanian College of Physicians and The Romanian Order of Medical Assistants and Midwifes. It fills the formal education gap of overspecializing the medical staff in Brain-Aging and related pathology, thus responding to the healthcare system's stringent needs of acquiring specific competencies and skills. The principal objectives of the project include the specialized training of nationwide healthcare professionals (1220 physicians and 1600 nurses) for developing competencies in the field of Brain-Aging, the promotion of last-hour knowledge, best practices and new technologies in the field, the elaboration of an original, complex Curriculum/Syllabus and the building up of a national network of specialists in Brain-Aging.
Project actual outcomes:To date, the project has been implemented in 5 Romanian Euro-regions. The large number of attendees, that exceeded by 100% the estimated number of participants in those regions, confirms the acute need for such a complex and integrative educational project in the field of Brain-Aging. There have been elaborated 12 specific Curricula and Syllabus in Brain-Aging, for the two professional levels (physicians and medical assistants), corresponding to 6 medical specialties: Geriatrics, Neurology, Psychiatry, Anesthesiology and Intensive Care, Molecular medicine. One of the added values of the project resides in its main innovative dimension - the overspecialization of medical staff in Brain-Aging medicine, while the second one is the elaboration of the Brain-Aging Integrated Informatics System.
Conclusion:The project is unique in Europe as well as in Romania. Its actual outcomes argue that the project’s concept and practical issues represent a golden model for developing a highly skilled workforce in the field of brain-aging, able to be disseminated and developed.
PO34: Behavioral and psychological symptoms in dementia: the effectiveness of Donepezil vs. Donepezil-Memantine combined therapy on patients and their caregivers
Luiza Spiru, Stefan Alexandru Sterea, Alice Petrescu, Gratiela Baidac
Introduction:Dementia patients can develop behavioral and psychological symptoms with negative impact on their life and that of caregivers. Our study aimed to compare the influence exerted by Donepezil-Memantine combined treatment vs. Donepezil alone on the behavioral and psychological symptoms in patients with vascular (VaD) and mixed dementia (MixD).
Methods:Our 12 months long study enrolled 108 male and female dementia patients aged 50-80 years, treated for at least 3 months with 5-10 mg/day Donepezil and/or Memantine 20 mg/day and followed up in 3 visits (one at each 4 months).
The battery of evaluation scales included: the Neuropsychiatric Inventory (NPI), Global Deterioration Scale (GDS), Activities of Daily Living (ADL), Resource Utilisation in Dementia (RUD Lite), and the Zarit Burden Interview applied to patient’s caregivers.
Results:The main results will be presented in Vienna.
Conclusions:In the MixD patients, the Donepezil-Memantine combined therapy seems to have a higher positive influence than the Donepezil monotherapy on the behavioral and psychological functions described by the evaluation tests. The same is true for VaD patients group, in which the positive influence on NPI, ADL and especially Zarit scores is even greater. RUD Lite scores show greater improvement in MixD than in the VaD group. Further investigations are needed to extend the outcomes of this pilot study and to improve statistical data processing.
Last Updated: jeudi 13 septembre 2012