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QOP2. Quick oral presentations – Care services

Detailed programme and abstracts

QOP2.1. Before the end of life in patients with Alzheimer's disease

IOANCIO IOANA, SPIRU LUIZA

Elias EmergencyHospital, Bucharest, Romania

Alzheimer’s disease is considered a neurocognitive disease with a slow evolution, experiencing a plateau in development when patients have been diagnosed early, have followed a closely monitored treatment and have been constantly clinically reevaluated. Support, both medical and from the family of the patient, are the key for a prolonged evolution of this irreversible illness.

Aims: Our study`s primary objective was the gerontopsychiatric evaluation of the final period of life of patients with Alzheimer’s disease, within the acute and hospital care cadre.

Methods: Our study was fulfilled in the Memory Clinic, Elias University Emergency Hospital, Bucharest, Romania, in the years 2017-2020. 117 patients diagnosed with Alzheimer’s disease, 77% women and 23% men, aged 72 years and over were enrolled in the study using international diagnostic criteria. We evaluated the patients as well as yearly and the next three years follow-up.

Subject evaluation was performed by a complex neuropsychological battery: Standardized Geriatric Evaluation.

Results: In the final months of life, patients admitted to our clinic have described three kinds of evolution. In one group, patients have resignedly looked towards the end, expressing requests to return “home”, in the company of their closest relative and with their favourite food. Another group has presented episodes of delirium, with psychomotor agitation and reversal of their sleep-alert schedule. The majority of patients met their end through comorbidities: sepsis, strokes, cancer or cardiovascular pathologies.

Conclusions: Patients with Alzheimer’s disease that are correctly treated and monitored meet their end through different pathologies, the most frequent being intercurrent infections, respectively sepsis. In the brief moments of lucidity, they evoke the image of their home.

QOP2.2. Dementia-sensitive design of the physical environment in 10 care facilities in Bavaria

DIETZ Birgit

TU München, Munich, Germany

Dementia-sensitive design of the physical environment in care facilities

After an application process, ten facilities were selected for the project "Dementia-sensitive design of the physical environment in care facilities". These facilities vary considerably in terms of facility size, year of construction, type of care offered, and number of residents.

The residents’ home is also the staff’s workplace. Therefore, the working groups were set up to include as many users (representatives for the residents, nursing staff, housekeeping and cleaning staff, caretaker, administrative staff and nursing managers) as possible in the process. Not only are all facilities home to residents from very different walks of life, they also employ staff with a wide range of experience in a variety of positions. Consequently, in each facility views of which action was required were initially quite different. We anticipated big differences in opinion in terms of prioritizing the implementation of our recommendations. On-site training combined theoretical knowledge about acoustics, colour and light with suggestions for implementation in practice. These suggestions were discussed from different perspectives, which proved successful. We were able to achieve a better shared understanding of the specific physical, mental and emotional situation of the residents and their special needs in terms of the design of their physical environment. Obstacles in implementing such design changes were also discussed.

An analysis of the measures most frequently recommended in the ten participating facilities shows that they are similar. This suggests that acquired knowledge of dementia-sensitive design in care facilities is generally transferable.

At the end of the process, it was also possible to determine which facilities could be redesigned to render them viable for the future.One of the facility decided to build anew.

QOP2.3. Succes factors of dementia friendly initiatives using realist review and - evaluation

THIJSSEN Marjolein1, KUIJER-SIEBELINK Wietske2, LEXIS Monique3, PETERS Jose2, RIANNE Janssens4, NIJHUIS-VANDERSANDEN Ria5, CHADBORN Neil6, RADFORD Kate6, JUSTINE Schneider6, RAMON Daniels3, LOGAN Pip7, MAUD Graff5

1Radboudumc, Nijmegen, Netherlands, 2dr., Nijmegen, Netherlands, 3dr., Heerlen, Netherlands, 4Msc., Heerlennetherlands, Netherlands, 5Prof. dr., Nijmegen, Netherlands, 6dr., Nottingham, United Kingdom, 7Prof. dr., Nottingham, United Kingdom

Dementia friendliness is a concept that underpins communities and initiatives that promote inclusion of persons with dementia and their carers. Mentality is a project that studies succcesfactors of dementiafriendly initiatives and -communities in three phases, using the realist approach. The main goal in a realist approach is to illuminate ‘what works, for whom, under what circumstances, and how,  as understanding these processes is important for informing policy and practice in terms of what helps or hinders successful and sustainable development of dementia friendly initiatives across different contexts.

In phase A, we conducted a realist review literature of community dementia friendly initiatives to develop understanding about the outcomes for persons with dementia and their caregiver and the key factors in achieving them. In phase B, we focused on key factors in developing and sustaining dementia friendly initiatives, using Dutch best practices. The ongoing work of Phase C is to implement these findings across multiple sites in Netherlands.

In Phase A, of the initial 6736 search results, 29 studies were included based on in/exclusion criteria. Data synthesis resulted in three midrange program theories, explaining how contexts and mechanisms produced outcomes for persons with dementia and caregivers. In phase B, a multiple case study was undertaken using interviews, observations and documentation from with 30 stakeholders from 4 Dutch best practices of dementia friendly communities. A realist logic of analysis within and across the cases resulted in six realist program theories, explaining how context and mechanisms produces outcomes for professionals, volunteers, persons with dementia and their caregivers in creating dementia friendly communities.

In this presentation, the realist program theories of phase A and B will be presented and discussed together with the protocol for phase C

QOP2.4. Sensory gardens in dementia care: will they survive the Covid-19 pandemics?

PROLO Paolo1, SASSI Enrico2

1Swiss federal disability insurance, Bellinzona, Switzerland, 2Architect, Lugano, Switzerland

Since September 2014, 75 elderly people have enjoyed a sensory garden in a daytime health care center in Balerna in southern Switzerland almost all year long.  Sensory gardens are supposed to be beneficial to improve mental well-being in vulnerable people. All subjects were diagnosed with Senile Dementia of the Alzheimer’s Type (SDAT) according to established criteria (Age: 69-89 yrs.; 20 males; 55 females). We already showed that the garden counterbalanced aggressiveness and anxiety. 55/75 people attending the garden from September 2014 until the first week of March 2020 enjoyed the scents and fresh air. Since then and several weeks thereafter, the daycare center and garden were closed due to the Covid-19 pandemic. This has suddenly changed one’s target to social distancing. Although video calls and tablet application has showed positive behavioral effect in nursing homes, one cannot confine individuals indoor forever.  The garden is composed of two areas with different functions and appearances: the system of ramps and a ring circuit. 60/75 users enjoyed the most waling the ramps like it were their way home. The only gathering point was represented by a water fountain where all 75 subjects drank fresh water. Non more than 2 or 3 people together were observed at any time close to the fountain by caregiving personnel. Moreover, no more than 8 people were admitted to the garden at any time. This was due to the center’s standard timing and regulations. We could not demonstrate any improvement in social interactions. In conclusion, at the present time the garden will still provide a kind of sensitive stimulation and represent a psychosocial intervention that can be delivered by non-fully specialist healthcare without enhancing an unrequested health risk.

QOP2.5. The Optimus Domi model: an home based assistance proposal in facing dementia during covid-19 pandemic

MORGANTI Francesca1, MORGANTI Francesca2, CAROBBIO Egle Miriam3, BRIGNOLI Paola4

1Universitàdegli studi di Bergamo, Bergamo, Italy, 2UNIBG, Bergamo, Italy, 3Innovative Elder Research, Bergamo, Italy, 4THE CARE GROUP, Bergamo, Italy

In the last 25 years, changes in the family organization have led to include an house-nurse for continuous assistance to the elderly at home. Moreover, the progressive isolation of the family stressed them in facing the care problems of relatives out of a network. Thus the experts share the need to rediscover the preventive-promotional function of the social interventions that support home care.

The Optimus Domi - an Italian home care model developed for about 20 years by Paola Brignoli - aims to widely respond to this social need. It provides environment tips, good practices, personnel selection, staff and caregiver training, supervision and continuous support. The goal is to cover daily services with particular attention to the psycho-social support of the entire care system.

The family takes affective care back with less stress, less usury for emotional ties and the state of health; also preserving from negative impacts on work, on social and economic well-being, and ultimately strengthening and creating community networks of support in order to reduce the risk of isolation.

During COVID-19 pandemic Optimus Domi showed an average rate of mortality (calculated from December 2019 to April 2020) in families living in the Northern Italy (4%) lower than the ones observed in the sanitary structure (21%). 

These results underlined the necessity to adopt new strategies for caring dementia people at home especially during a sanitary emergency such as COVID-19 pandemic.

QOP2.6. Mapping models of residential respite services in England for people living with dementia and their carers

COLE Laura, COLE Laura, ORELLANA Katharine, MANTHORPE Jill, SAMSI Kritika

King's College London, London, United Kingdom

Residential respite care, or a short stay in a care home, can be beneficial for people living with dementia and their carers. It provides them both with a break and is seen as a way of supporting people living with dementia to stay at home for longer, potentially delaying a move to a care home. However, little is known about respite services on offer, especially in terms of availability, access, service provision and cost. The first part of this two-year study aims to ‘map’ or identify the different models or types of residential respite available to people living with dementia and their carers across England. This was achieved by 1) asking residential respite providers to complete a short mapping template detailing the service they provide (including questions about number of places available, minimum or maximum lengths of stay, how the service can be accessed and who pays); and 2) conducting a stakeholder workshop with social care practitioners, providers and commissioners of residential respite services to discuss the key issues. The information gathered from these two methods are currently being collated, themes or consistencies will be drawn out and presented. We will also discuss the second part of the study in which we aim to interview 80 people living with dementia and their carers about their views, expectations, and experiences of residential respite.  

QOP2.7. Ιmportance of ergonomic interventions at the living space

ANAGNOSTOPOULOU Konstantina

Occupational therapist, Athens, Greece

Occupational Therapy is a health science that is increasingly concerned with improving a person's quality of life with dementia. One of the main points of interest in geriatric occupational therapy is the proper configuration of the individual's living space. Below are basic suggestions for ergonomic arrangement of the space, so that the daily life of the person becomes more functional and easy.

The basic condition for the amendments is that the person be autonomous and not in need of supervision. The place must be organized in such a way that it is functional, simple, efficient and safe for the person with dementia. General recommendations for the whole house are the correct placement of the furniture so that it is not difficult to move around the house. All doors should have a sticker indicating or depicting which room it is. Gathering basic items such as keys, phone, wallet and more at a specific location would be helpful. Equally important would be the existence of a notebook in a fixed location where the person's daily schedule would be recorded as well as emergency telephones.

It is important not to omit these and other interventions, which may be related to the kitchen, bathroom and any room in the house. By changing the place, reduces the stress of everyday life, the lack of orientation, and simplifies the daily activities inside the house, making them easier and safer. In addition, interfering in the place prolongs the autonomy and independence of the individual.

In summary, there are many more ergonomic arrangements that are tailored to each person's needs. The main concern of every occupational therapist is to assess the needs and to improve in every way the quality of life of the person with dementia, his autonomy and the disposition for life.

QOP2.8. Improving night care for community dwelling people with dementia

COUPRY Olivier, MOUACI Catherine

Fondation Médéric Alzheimer, Paris, France

Introduction: Night care for community dwelling people with dementia are still little or not covered by an adapted aid or care device. However, the end of the day and the night are sensitive times when several difficulties may arise which can increase the burden of caregivers and precipitate institutionalization. It can also lead to dramatic accidents or deprivation of liberty. Caregivers are also affected by these situations, which are often a breaking point in home life.

Methods: In March 2018, the Fondation Médéric Alzheimer launched a call for projects "Alzheimer: improving night-time support for people living at home". Four projects have been selected and are currently being supported until the end of 2020. Two projects are home-based support and two projects offer overnight accommodation in a gerontological establishment. These projects provide respite and advice to caregivers and are an opportunity to offer quality personalized support to people with dementia. Projects are being monitored in parallel by a firm specialising in social and medico-social evaluation. Data collection is based on questionnaires, observation grids and interview for people with dementia, caregivers and professionals. Effectiveness, impact measure, conditions for sustainability and cost/benefit ratio will be analysed.   

Results: Intermediate results are encouraging. Final results are expected by December 2020. They should lead to a publication and the elaboration of a guide for future project leaders, decision-makers, funders and direct beneficiaries based on the lessons learned from these projects.

Conclusion: Safety and quality of life of people with dementia depend to a great extent on the care given to usual living environment. The professionalization of night care can be one of the keys and is a priority for people still living alone at home. It can also be a way to delay institutionalization, reduce night-time incidents, reduce costs and ease the burden on caregivers.

QOP2.9. France Alzheimer's vacation retreats

GILLY Lorène

France Alzheimer and related diseases, Paris, France

Organizing vacation can be so taxing for people living with dementia and their families that it sometimes seems easier just to not go. And yet, those people are very much in need of vacation! Time off is an essential respite in their fight with the disease and gives them the energy to face the daily challenges it poses. Those fighting Alzheimer’s want the same vacation as anybody else. Hiking and tanning on the beach are examples of the little things which are highly appreciated by families.

To make it possible, they need the appropriate assistance. This is why vacation retreats have been one of France Alzheimer’s main focuses for the past 30 years.

Every year, from April to October, about 15 trips are organized by the Association in centers which are adapted for people with dementia and their caregivers. The retreats last for 10 or 11 days. Accommodation, full board, activities and excursions are all covered. Last year, 17 trips were organized for a total of 433 participants.

Thanks to France Alzheimer’s volunteers, who take charge of the entire organization, guests can relax while receiving the care they need. Stigmatizing the families is out of the question; quite the contrary, since the objective of these retreats is to focus on other things than the disease. 

More than 6,000 people have benefited from vacation retreats over the past 30 years.

An affordable price

In order to reduce vacation access inequalities and to grant this opportunity to as many people as possible, France Alzheimer offers 5 pricing plans. They are proportional to the participants’ yearly income tax. In other words, the cost is adapted to the income of those who wish to benefit from the retreat. The difference between the actual cost and the paid amount is covered by the Association.

QOP2.10. Uncovering variation in care; the first English national memory service case note audit

COOK Laura, ISAACS Jeremy, SOURIS Helen

NHS England and Improvement London Region, London, United Kingdom

In England, dementia is predominantly diagnosed in memory services operated by mental health providers. There is limited data comparing practices between services.  In 2019, memory services across England were invited to participate in a national audit comprising a case note audit of 50 consecutively seen patients.

85 out of approximately 215 memory services in England participated, contributing data on 3,978 patients. Results demonstrated significant variation in assessment, diagnostic and post-diagnostic practices. 57% of patients were asked about their hearing and 61% about their vision. The proportion of patients deemed not to require neuroimaging varied between services from 0% to 92%. 2% of patients were referred for a specialist investigation (PET scan, DAT scan, CSF examination). The proportion of people aged ≥ 65 diagnosed with mild cognitive impairment (MCI) varied from 0% to 47% and with any dementia from 22% to 100%. Among patients with dementia, the proportion given a vascular dementia sub-type varied from 0% to 43%. Overall, 7% of patients with dementia aged < 65 and 0.3% of those aged ≥ 65 were diagnosed with frontotemporal dementia. Average time from referral to diagnosis varied from 3 weeks to 34 weeks. Around a quarter of services were unable to provide cognitive stimulation therapy or carer psychoeducation. 36% of people with dementia were offered the opportunity to provide consent to be contact for research.

Key areas identified for quality improvement at a national post-audit meeting included: creating local memory service forums, improving liaison with neurology and neuroradiology, improving physical health assessments, creating a ‘consent to contact’ research script, reducing waiting times and training on recognition of MCI and frontotemporal dementia.

To our knowledge this is the first national memory service case note audit in England. It has enabled services to benchmark their performance and identified key areas for quality improvement.

QOP2.11. The effects of computerized cognitive training with whole body cryotherapy on cognitive functions in seniors

SENCZYSZYN Adrianna, SENCZYSZYN Adrianna, WALLNER Renata, SZCZEŚNIAK Dorota, ŁUC Mateusz, RYMASZEWSKA Joanna

Wroclaw Medical University, Wroclaw, Poland

Background: Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) are common in the elderly population and represent a high-risk group for progression to dementia. Innovative, complex and engaging non-pharmacological methods of cognitive stimulation implementable at this stage are needed. The aim of the study was to determine the effect of Computerized Cognitive Training (CCT) combined with Whole Body Stimulation (WBC) on cognitive functions of cognitively normal older adults and older adults with mild cognitive impairment (MCI).

Methods:  A 9-week single-blind pre/post case-control trial was conducted. The study enrolled 84 adults aged 60 or older and allocated them into one of two intervention group: EG1; CCT with psychoeducation, EG2; CCT with psychoeducation and 10 WBC sessions, or control group (CG), who were the usual care users. The primary outcome measures were cognitive functions evaluated with Montreal Assessment Scale (MoCA) and several other neuropsychological tools (e.g. SCWT, selected tasks from RBANS). The depressive symptoms assessed with Geriatric Depression Scale (GDS) were secondary outcome measures.

Results: The results show evidence for increased performance in the assessment of general cognitive functioning in both EGs (p≤0.05). Significant improvement was also visible in several cognitive domains such as: verbal fluency (EG1 and EG2), learning ability and immediate memory (EG1 and EG2), delayed memory (EG2), attentional control (EG1) and information processing (EG2) (p≤0.05). However, only in the group with combined interventions (CCT+WBC) participants presented significantly less depressive symptoms (p≤0.05).

Conclusions: Results from the study suggest that CCT, especially in combination with WBC, might be a practical and effective method of improvement in cognitive performance. Moreover, this combination seems to lead to a reduction of depressive symptoms. 

QOP2.12. Blood biomarkers and cost and wait time for diagnosing treatment-eligible patients for Alzheimer’s disease

MATTKE Soeren1, CHO Sang Kyu1, BITTNER Tobias2, HLAVKA Jakub1, HANSON Mark1

1USC, Los Angeles, United States, 2Roche, Basel, Switzerland

Background: A disease-modifying treatment (DMT) for Alzheimer’s (AD) might become available soon. Concerns have been raised that the large number of patients might overwhelm the healthcare system, because of scarce dementia specialists. Blood based biomarker (BBBM) tests for the pathologic hallmarks are a promising tool to improve triaging at the primary care level. We simulated their impact on cost and wait times.

Methods: We simulate the U.S. population age 50+ over 30 years combining a disease progression model and a system dynamics model for capacity constraints (specialist cognitive testing and confirmatory biomarker testing with PET or CSF). We compare four scenarios for primary care evaluation (1) cognitive screening only (MMSE), (2) BBBM only, (3) MMSE followed by BBBM if positive and (4) BBBM followed by MMSE if positive. Parameter were derived from published data and assumptions.

Results: Using MMSE or BBBM alone would result in specialist referrals that are projected to continuously exceed capacity from 2020 to 2050. Combining MMSE and BBBM in either order would eliminate wait lists after three years.

Projected number of correctly identified cases (i.e., true positive for MCI due to AD) will increase from ~480,000 for MMSE or BBBM alone to ~600.000 for MMSE and BBBM combined on average each year. Average cost per year would be an estimated $7.2 billion for MMSE alone, $7.5 billion for BBBM alone, and $6.8 billion for MMSE and BBBM combined, and cost per correctly identified case will decline from ~$15,000 for MMSE or BBBM alone to~$11,000 for MMSE plus BBBM.

Conclusions: Combining BBBM with MMSE is projected to increase efficiency and value of the triage process for DMT eligibility at the primary care level, as the addition of a BBBM would reduce wait times for specialist visits and diagnostic yield dramatically without increasing net cost.  

 

 
 

Last Updated: Tuesday 30 June 2020

 

 
  • Acknowledgements

    The 30th AE Conference received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe gratefully acknowledges the support of all conference sponsors.
  • European Union
  • Roche
 
 

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