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PO3. Care services

Detailed programme, abstracts and presentations

PO3.1. Disruptions, discontinuities & dispersions: an ethnography of disjunctures in orthopaedic wards

CROSS Jane, FOX Chris, POLAND Fiona, HAMMOND Simon, BACKHOUSE Tamara, PENHALE Bridget

UEA, Norwich, United Kingdom

Enhanced recovery Pathways (ERPs) as currently seen in the literature are based on the premise of evidence based medicine being brought to bear in a sequence of events to maximise throughput, productivity and quality. It is notable that usual care is full of multiple types of disjunctures (disruptions and discontinuities and dispersions) for both patients and staff and when patients who are living with dementia pose particular disruptions to usual practice.

As part of a large Programme of study (PERFECTED), we aimed toestablish what actually happens in usual practice on acute orthopaedic hospital wards, and how delirium and/or dementia impact on practice. We used ethnographic observations to inform the development of an ERP from a social science perspective. Observations of routine “public” care places and activities were conducted over 4 weeks in 3 locality sites in acute hospitals where hip-fracture patients experiencing cognitive impairment were admitted.

Our data richly identifies multiple types of disruptions and discontinuities for both patients and staff, with patients who are living with dementia posing particular and specific disruptions to usual practice, conditioning and suggesting a variety of staff responses. Such practice dilemmas are known but not well-captured in this setting to detail and assess their specific impact on clinical care. Knowledge gained can make a valuable contribution to ERP development.

After attending this session, participants will be aware of the value of ethnographic observations in health science research, how disjunctures arise in acute settings, and how ERPs can be situated in usual care practices.

PO3.2. Implementation of the PERFECT-ER intervention designed to enhance recovery for people with hip fracture and cognitive impairment in acute trauma wards

FOX Chris, CROSS Jane, HAMMOND Simon, POLAND Fiona, BACKHOUSE Tamara, PENHALE Bridget

UEA, Norwich, United Kingdom

Background: Patients who have fractured their hip and have a cognitive impairment have poorer outcomes compared to those with full cognition. We aimed to determine whether a novel multi-component intervention developed to enhance the recovery of hip fracture patients with cognitive impairment could be implemented in acute trauma wards.

Methods: A Plan, Do, Study, Act model for service improvement was used in 4 cycles to change practice in 3 acute orthopaedic trauma wards in England. The PERFECT-ER intervention was used to assess care, inform action planning and as a catalyst for service improvement. A Service Improvement Lead (SIL) facilitated implementation at each site. Intervention scores, implementation process reports and observational fieldwork data were collected. Thematic analysis was conducted by case.

Results: All sites implemented multiple aspects of the PERFECT-ER, with Service Improvement Leads (SIL) using different implementation styles. All SILs tackled easier changes first. More complex and organisational changes occurred when SILs had gained working knowledge and confidence. Results show some implementation reflected changes in documentation or wording to make existing practices visible rather than actual changes in practice although numerous changes in practice were made. The PERFECT-ER intervention was collaboratively refined and an implementation manual created. Barriers and facilitators to implementation were identified.

Conclusions: This study demonstrated the novel multi-component PERFECT-ER intervention can be implemented in acute orthopaedic trauma wards and practice can change to facilitate care of hip fracture patients with cognitive impairment. Further testing is needed to identify if practice changes influence patient outcomes.

PO3.3. “Bribe Them with Cake”; implementing change in acute hospital settings; an action research study

FOX Chris, CROSS Jane, HAMMOND Simon, BACKHOUSE Tamara, POLAND Fiona, PENHALE Bridget

UEA, Norwich, United Kingdom

Hip-fracture is a common orthopaedic injury amongst older adults worldwide, incidences are expected to surpass 6 million by the year 2050 as aging populations grow in developing countries. People living with cognitive impairment have an increased risk of a hip-fracture compared to cognitively intact cohorts and have poorer outcomes. Adapting acute hospital care to the needs of these patients is vital if we are to improve their prospects.

This study was part of a large programme of research (PERFECTED), which aims to improve the care of older hip-fracture patients who are experiencing cognitive impairment. We used an action research design (plan-do-study-act) to implement and refine a newly developed ward-level intervention (PERFECT-ER) to improve care for this cohort of patients. We worked with three hospitals in England to generate knowledge to understand how to best implement the intervention, change practices and optimise care.

Our findings showed PERFECT-ER could be implemented in a range of ways, which were influenced by both the management style of the Service Improvement Leads and the existing ward culture. We identified multiple barriers and facilitators to the implementation of a new intervention in acute medical settings. The lessons learnt will be key in the successful testing of the intervention (PERFECT-ER) during the next stage of the study – a feasibility Trial.

This session aims to inform participants how a complex intervention can be embedded into hospital wards through action research cycles and how patient care can be adapted and improved through staff working together to implement changes.

PO3.4. “Are you comfortable now?” Person-Centred Care practices on acute trauma wards caring for people with cognitive impairments: an ethnographic study.

FOX Chris, CROSS Jane, HAMMOND Simon, POLAND Fiona, BACKHOUSE Tamara, PENHALE Bridget

UEA, Norwich, United Kingdom

Background: Older people and their families consistently place high value on hospital care that promotes personalised relationships between staff and patients, often termed Person-Centred Care (PCC). PCC features in care guidelines from across Europe, North America and the Asia-Pacific region, demonstrating the value increasingly placed by policymakers on methods emphasising ‘personhood’-in care practices. However, as many secondary care settings such as acute trauma wards become highly rationalised and task driven, PCC orientations can be given less priority.

Methods: This paper reports on an ethnographic study undertaken within an international research programme exploring ways of delivering care to people living with dementia and admitted to secondary care with hip fracture. Observations were undertaken by five academics and three trained ‘lay’ researchers in Emergency Departments and Trauma wards in three hospitals from across the United Kingdom, generating a data set of 192 hours of observations (48 observations, approximately 4 hours each).

Results: Fieldnotes collected from the differing spaces were thematically analysed and further analysed applying Kitwood’s (1997) person centred care framework. Data illuminated staff creativity in identifying and responding to opportunities to maintain patient personhood while performing the routine care tasks prioritised within settings.

Conclusions: Staff in acute care environments can bring an integrated awareness both of policies prioritising PCC opportunities and policies prioritising task performance, to moderate their practice in creative ways.  We conclude that skilled practice responses can ensure task-orientated routines and providing PPC need not be mutually exclusive.

PO3.6. It’s good care, but who is it good for, me? A multi-perspective insight into stakeholder constructions of ‘good care’ for people living with dementia and hip fracture

FOX Chris, HAMMOND Simon, CROSS Jane, BACKHOUSE Tamara, POLAND Fiona, PENHALE Bridget

UEA, Norwich, United Kingdom

Aging populations in developed countries worldwide place hugely increasing pressures on health services. Older age is a significant risk factor for falls, with hip-fracture being one serious potential consequence. The US and Northern Europe have particularly high rates of hip fractures, while many developing countries are also likely to see future increases as their currently younger populations age. Many older patients experiencing hip fracture also have cognitive impairment(s). These patients tend to have poorer outcomes compared to the more cognitively able.

As part of the Peri-operative Enhanced Recovery Hip FracturE Care of paTiEnts with Dementia (PERFECTED) programme, a multi-perspective, multimethod qualitative approach was used to explore professionals’, patients’ and carers' (n=74) constructions of what ‘good’ care entails for patients with hip fracture in acute trauma wards. The presentation draws on data from 7 focus groups, 35 interviews, 6 of which were carried out in collaboration with trained lay-researchers. This was analysed using discourse analysis.

Our analysis mapped competing discursive orientations articulated by stakeholders in relation to claiming expertise to define what ‘good’ care is and who it is ‘good for’.  These discussions also highlighted the situated repair work participants needed so as to continue to engage in this discursive context. These findings are related to dominant interpretative repertoires of patient emancipation, carer transformations and care-flow, and examine how these mutually intersect here.

Our conclusions highlight the socio-economic and political dynamics in constructing ‘good’ care in the context of acute trauma settings and also what tropes are recruited by various stakeholders to advance their claims to expertise about what, and for whom, such care is ‘good for’. In positioning claims to expertise, we identify psychosocial dilemmas associated with competency that can help re-construct experiences of care to be drawn on by clinicians, patients and carers in more mutual negotiations of care.

PO3.7. Asked for Help, A person centred approach to symbols

SHIELDS Sandra, BURNS Pamela

NHSGGC, Glasgow, United Kingdom

People living with dementia who require to attend an acute hospital may have additional person centred support needs.  There are many schemes available that use a pictorial label to identify a person living with dementia.  However, can a label that depicts a disease or condition ever be person centred?    Recent research by Featherstone, K & Northcott A (2018) identified, that for many staff, a diagnosis of dementia suggests late-stage dementia and assumptions are made that can distress people living with dementia and can compromise their right to make decisions and maintain skills. 

NHSGGC have created a project that identifies people who may want additional support in a person centred way.  The project “Asked for help” is person centred with the emphasis on improving the patient, families, friends and carers experience, initially, within an outpatient service. The project aims were to ensure what matters to the patient is delivered seamlessly during the outpatient appointment.  “Asked for Help” is being used to alert staff that someone has self reported additional needs.  The project success has been the openness to include all patients, it puts the onus on to staff to find out what it is the person requires help with and creates a person centred conversation that prevents the use of assumptions or links to any particular disease.

The presentation will demonstrate the outcomes from the project evaluation

It will give an overview of audit data and a planned program of further spread within NHS Greater Glasgow and Clyde Acute Hospitals

Identified outcomes

Improved focus in delivering person centred care for everyone.

Offer a service that is responsive to what matters to patients, family, friends and carers during the time in the department.

Robust communication tools in place to ensure help is given when identified or asked for.

PO3.9. Cognitive impairment in heart failure patients:  preliminary findings from the Deus ex Machina study

FERNANDES Lia1,2,3, MOREIRA Emilia2, MOREIRA Emilia2, MARTINS Sónia1,2, AZEVEDO Luís Filipe2,4, SILVA-CARDOSO José2,5,6, FERNANDES Lia1,2,3

1Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal, 2Center for Health Technology and Services Research/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal, 3Clinic of Psychiatry and Mental Health, S. João Hospital Center, Porto, Portugal, 4Department of Community Medicine, Information and Health Decision Sciences/MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal,5Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal, 6Department of Cardiology S. João Hospital Center, Porto, Portugal

Introduction: Cognitive impairment(CI) is common in Heart Failure(HF), ranging from 25% to 80%, depending on HF severity and cognitive assessment procedures. CI involves different pathophysiological processes and is associated with worse HF prognosis.

Aims: To determine the presence of CI in HF outpatients and analyse associated factors.

Methods: Participants were randomly selected from the patient list of an HF outpatient clinic in a University Hospital. Sociodemographic data, Left Ventricular Ejection Fraction(LVEF) and New York Heart Association(NYHA) class were registered. CI was defined as MoCA score<22. Instrumental Activities of Daily Living(IADL) were assessed with the Lawton Scale. Associations with CI were explored using univariate analysis and a logistic regression model, with CI as the dependent variable, entered as covariates age, education, LVEF, NYHA, and IADL.

Results: We included 81 HF patients: age 57±13, 33% women, 55% with reduced LVEF(rLVEF), 26% intermediate LVEF(iLVEF) and 19% preserved LVEF(pLVEF). Regarding NYHA class, 31%, 52% and 17% were respectively at class I, II and III. MoCA mean score was 22.1±4.8. Patients performed worse in delayed recall(2.3±1.6), abstraction(1.0±0.9) and executive function(3.3±1.4) subtests. Overall 43% of patients showed CI. They were older (U=1.242.5,p<0.001), with lower education(U=285.5,p<0.001) and more dependent in IADL(X2=3.9,p=0.047). No differences were found in NYHA class. CI was present in 47% of rLVEF, 20% of iLVEF and 60% of pLVEF patients(X2=6.3,p=0.043). In the regression model, only age(p=0.024) and education(p=0.001) showed an independent association with CI.

Conclusions: CI was found in 43% of HF patients, being associated with older age and less education. CI in HF may differ according to LVEF. This may be further studied with the sample enlargement, to better understand cognitive prognosis in HF patients.

Acknowledgments: supported by ERDF through POCI-01-0145-FEDER-007746, funded by COMPETE2020, National Funds through FCT, within CINTESIS(UID/IC/4255/2013), and Project-"NORTE-01-0145-FEDER-000026-Symbiotic technology for societal efficiency gains:Deus ex Machina", financed by NORTE2020 under PORTUGAL2020

PO3.10. “Development of Memory Clinics in the Netherlands: an update from 1998” 2016

RAMAKERS Inez1, GRUTERS Angelique1, KESSELS Roy2, BOUWMAN Femke4, OLDE RIKKERT Marcel2, BLOM Marco3, DE VUGT Marjolein1, VERHEY Frans1

1Maastricht University, Maastricht, Netherlands, 2Radboud University Nijmegen, Nijmegen, Netherlands, 4VU University Medical Center, Amsterdam, Netherlands, 3Dutch Alzheimer’s Society, Amersfoort, Netherlands

Background: To improve early diagnosis and treatment of cognitive disorders, including dementia, specialized Memory Clinics (MCs) have been set up. To gain more insight into the development and efficacy of these clinics in the Netherlands, the first national survey was published in 1998. The aim of the present study is to determine the number, characteristics and working methods of MCs in the Netherlands in 2016, and to compare these findings with earlier results to investigate the development of MCs since 1998.

Methods: A survey was sent in 1998, 2004, 2009 and 2016 to all operational MCs in the Netherlands. The survey concerns question about organisation, collaboration, patient characteristics, referrals, diagnostics and additional assessments.

Results: The number of MCs increased substantially from 12 MCs in 1998 to 91 in 2016. Both capacity and geographical distribution increased in the last twenty years. In 1998, most of the patients received a dementia diagnosis (85%), but nowadays about half of the patients had milder cognitive problems. MCs are often part of regional care chains and better embedded with regional care organisations. Diagnostic tools, such as a blood tests (97%), neuropsychological assessment (95%) and imaging (92%) were used in nearly all MCs. There was an increase in use of neuropsychological assessments, while use of imaging, CSF, and EEG/ECG have decreased. Remarkably, many differences in the diagnostics, and used scales and questionnaires could be identified between MCs.

Conclusion: MCs in the Netherlands developed substantially since 1998 and are nowadays accepted as regular care facilities for people with cognitive problems.

PO3.11. “Music-based interventions in the acute setting for patients with dementia” targeting agitation

SOUSA Lídia1, FERNANDES Lia1,2, SCHNEIDER Justine3, MCDERMOTT Orii3

1CINTESIS, Porto, Portugal, 2Faculty of Medicine of Oporto University, Porto, Portugal, 3Institute of Mental Health - Nottingham, Nottignham, United Kingdom

In recent decades, the population ageing and the consequent increase in dementia prevalence became a major health problem worldwide, posing great challenges to society and to health care systems. Particularly problematic are the acute non-programmed admissions to hospital of demented patients. Old patients, and especially those with dementia, are more often hospitalized and for longer periods, than general population. They also have more medical intercurrences and have a greater risk of developing acute confusion and agitation, frequently managed with sedation and even physical restraint. The latter strategies are known to be associated with important secondary complications, not to mention the ethical implications. Non-pharmacological interventions are thus needed, to deal with agitation, in the acute setting.In this context, Music based interventions (MBI) have been used with people with dementia (PwD) with promising results. Evidence for short-term improvement in mood and reduction in behavioural disturbance seems consistent. However, the acute setting is especially challenging, and few interventions have been conducted in this context. To our knowledge, there isn’t any RCT or other robust study evaluating the administration of MBI to PwD acutely admitted to hospital. In a scoping review, we only found 6 individual studies reporting MBI, in the acute setting, with PwD, but they were rather small studies, with limited methodological quality. We aim at developing an MBI program, to be used in the acute setting, with PwD and to conduct a feasibility study. Moreover, we envision the possibility to proceed in the future to an RCT to test its efficacy/effectivity to reduce/manage agitation in a more effective and humanizing way, in this setting. The present project and preliminary results (obtained until September 2018) will be presented, along with a theoretical background.

PO3.12. Specialist Dementia Unit Improvement Programme

MCCARTHY Tom, RODRIGUEZ Cesar, LITHGOW Stephen, KELLETT Rebecca

Healthcare Improvement Scotland, Edinburgh, United Kingdom

Descriptor: Commitment 11 of the 2nd Scottish Dementia Strategy 2013-16 recognised the need to improve care provided for people with dementia in settings outside acute hospitals. Specialist Dementia Units (SDU) were identified as a priority area. To support this the Scottish Government commissioned a national improvement programme. This includes 4 SDU demonstrator sites and a national network. The programme aims to work with staff, carers and those with dementia working at the frontline to understand their experiences of the service and how this could be improved.

Methodology: All 4 demonstrator sites have used the Experience Based Co-Design (EBCD) as the basis for their approach. This enables the experiences of those providing and using services to be captured. By following the process, it has generated and prioritised the opportunities for improvement. The framework has enabled a wide range of experiential data to be captured through conversations, observations and workshops. This has then been analysed and themed. Augmenting EBCD is the use of model for improvement to implement agreed change ideas. A steering group involving all stakeholders including staff and carers has been established in each site to oversee this work.

Results/Outcomes: Supported the active participation of staff, carers and people with dementia through 120 hours of clinical observation, 95 interviews and local workshops in each site. Challenged existing assumptions that people with advanced dementia are unable to participate in improvement or share their views. Development of improvement skills including knowledge of legal and ethical issues by staff in the SDU’s. Now working on improvement themes including: Activity, Team Development, Stress and Distress, Handover/ Staff Communication, Mealtimes, Environment and Carer Information.

PO3.13. Perioperative care for people with dementia: is there room for improvement?

DIAZ-GIL Alicia1, BROOKE Joanne1, KOZLOWSKA Olga1, PENDLEBURY Sarah2, JACKSON Debra1

1Oxford Brookes University, Oxford, United Kingdom, 2NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom

Background: The increasing prevalence of dementia impacts on healthcare services, with higher numbers of people diagnosed with dementia undergoing surgical procedures. Perioperative care for patients with dementia represents a challenge for the person with dementia, their family members and healthcare professionals. Currently a comprehensive understanding of the prevalence of postoperative complications for people with dementia undergoing similar surgical procedures with those without a diagnosis of dementia is lacking.

Aim: To identify major challenges for people with dementia undergoing surgical procedures that affect postoperative outcomes.

Methods: Relevant literature published between 2000 and 2017 was searched on the electronic databases CINAHL, PubMed, BNI and PsychINFO. A systematic approach was used for this critical literature review. A thematic analysis was used to identify the common factors that influence postoperative outcomes for people with dementia.

Results: A total of ten articles were identified, five of which contained quantitative data and five were based on qualitative methodology. Results show that patients with dementia undergoing surgical procedures have higher risk of postoperative complications such as infections or respiratory problems. Healthcare professionals often lack of the necessary skills to identify signs of postoperative complications in patients with dementia. No specific risk points have been identified in this review that influence the postoperative outcomes of people with dementia.

Conclusion: There is a wealth of information on the impact of a hospital stay for people with dementia, but it is commonly related to general or acute settings and not linked directly to the perioperative care trajectory. Studies conclude that there is a need for more guidelines and protocols for healthcare professionals in postoperative care of people with dementia in order to improve care and reduce postoperative complications.

PO3.14. Addressing the emotional needs of individuals with dementia when in hospital.

DENING Tom, PETTY Stephanie

University of Nottingham, Nottingham, United Kingdom

Individuals with dementia are particularly vulnerable when in hospital, with serious risks to their physical and emotional wellbeing. Hospital staff are expected to understand and respond to the emotions of the person with dementia as an important component of integrated care and hospital care; however, the available guidance does not detail how this can be achieved. A freelisting interview study was conducted in a UK hospital ward providing dementia care. 47 hospital staff members of a range of professions, constituting the whole ward, gave spoken lists of: all the ways they notice emotional distress, the causes for emotional distress, all the ways they respond to the emotional distress of individuals with dementia and the responses that seem to work. The ethnographic method and use of spoken lists described routine practice within the hospital culture. Individual responses were coded and analysed using cultural consensus analysis to establish agreed domains and the most salient domain items for each of the four questions. Coherent domain descriptions offer an operational definition of the skills required for delivering emotion-focused care for individuals with dementia when in hospital. This study provides an illustration of how an entire clinical team views emotional distress among patients with dementia and provides useful insights into possible and effective ways to respond. The findings intend to inform interventions to address a significant, international healthcare challenge, including training for the workforce.

PO3.15. Socialisation of student nurses into dementia care in the acute hospital.

BROOKE Joanne2, CRONIN Camille1, OJO Omo3

1University of Essex, Southend, United Kingdom, 2Oxford Brookes University, Oxford, United Kingdom, 3University of Greenwich, Greenwich, United Kingdom

Background: The global prevalence of people living with dementia has been estimated to be around 50 million, with 10 million new cases every year (World Health Organisation, WHO, 2017). As a consequence, the proportion of people with dementia being admitted in acute hospitals continues to increase. Little attention has been paid to the impact of the physical environment, the future nursing workforce and in particular the socialisation of student nurses into dementia care.

Method: A hermeneutic phenomenology design was used explore student nurses’ experiences of acute hospitals settings in England and New Zealand. Data was collected through focus groups toobtain a range of experiences, beliefs and perceptions. The framework approach which facilitates constant comparative techniques was used to thematically analyse a range of data. 

Results: The 11 focus groups from England and New Zealand included student nurses from diverse cultural backgrounds. Three constant themes were apparent from the data: negative perceptions of dementia, exposure to dementia, and lack of resources. Students described many negative pictures of dementia, the stigma, the “eye roll” when a patient was admitted. Students were exposed to dementia and what staff perceived as the “aggressive” nature of dementia and to “double up” and “watch them”. Lack of resources is a constant theme in acute hospitals and impedes dementia care more.

Discussion: Student nurses and their registered nurse mentors are not always equipped with the skills and knowledge to care for patients with dementia.  Students commented on a range of experiences from being protected by staff to feeling completely exposed to dementia. Lack of resources including time, staff, skills impact the care of patients; and specialist dementia nurses are few and their remit wide.

Conclusion: The global perspective of dementia and the socialisation of a future nursing workforce in dementia care is of great concern. 

PO3.16. Care for people with dementia in hospitals. A protocol for a literature review

RØSVIK Janne, ROKSTAD Anne Marie Mork

Norwegian national advisory unit Ageing and health, Oslo, Norway

Background: In hospitals, people are expected to express themselves, understand what goes on and move through the system as required. However, for people with dementia, hospital settings can be confusing and overwhelming. Hospitalisation is associated with adverse effects such as delirium, functional decline and the use of more sedative and antipsychotic medication for people with dementia. After discharge from hospital, people with dementia experience greater mortality and increased risk of institutionalisation. Therefore, it is important to find measures to prevent and minimize the adverse effects of hospital stays for people with dementia, and to create a dementia friendly environment.

Aim: The aim of this study is to get an overview of the research concerning measures to improve care for people with dementia in acute somatic hospitals.

  • Syntheses will be made in the following areas;
  • physical environment
  • patient transfer
  • staff competence
  • imlementation of person-centred care

The research questions for each synthesis are:

  • What needs are identified?
  • What models/methods exist?
  • Which outcomes are used and what are the effects of interventions?

Methods:

  • Quantitative and qualitative studies will be included.
  • The databases PubMed, Ovid Medline, Cinahl, Embase, Swemed+ og Cochrane will be searched.
  • Inclusion Criteria

Qualitative studies

  • Descriptions and evaluations of specific models or interventions will be included.
  • We will include any recognised method of qualitative data collection, including interviews, focus groups and observational techniques. This may be stand-alone qualitative research, or reported as part of a mixed methods intervention evaluation.

Quantitative studies

  • We will include all quantitative study designs reporting comparative data prioritising evidence from more robust study designs in the synthesis where possible.
  • Searches will be conducted in PubMed, Ovid Medline, Cinahl, Embase, Swemed+ and Cochrane

PO3.17. Predictors of cognitive performance in participants with MCI who attend non pharmacological interventions over a three years’ period

TSATALI Marianna1, BEKIARIDIS Dimitris1, POPTSI Elena1, GIALAOUZIDIS Moisis1, TSOLAKI Magda2

1Greek Alzheimer Association, Thessaloniki, Greece, 21st Department of Neurology, Medical school, Aristotle University of Thessaloniki, Thessaloniki, Greece

The aim of the present study is to develop a regression model for progression of mild cognitive impairment (MCI) in elders with MCI who attended non pharmacological programs for more than 3 years. We conducted regression analysis to find which of the following variables (demographics, clinical characteristics of MCI [MCI onset, first symptom, personality changes], and mood disorders [anxiety and depression]) represent predictive factors for cognitive performance after three years. Method: Specifically, two hundred and four (254) participants with MCI attended non-pharmaceutical intervention programs in the Greek Alzheimer Association two-three times per week over a three-year period. The following tools, that is the final outcome variables of the study, were administered to the sample before and after the three years’ period: a) MMSE, b) Rivermead test c) RAVLT d) verbal fluency test, and e) ROCFT. Results: In the final model, age (β= -.215,t=-3.993,p< .025), and memory as the first symptom (β= -.347,t=-2.494,p= .017) were significant independent predictors of the MMSE score. Additionally, Beck Depression Inventory score was significant predictor of verbal fluency score (β= -.718,t=-3.095,p= .013). On the other hand, age was a significant predictor of selective attention, as measured by the TEA (β= -.367,t=-2.676,p= .010). Moreover, age (β= -.315,t=-2.391,p= .021) along with personality changes (β= .310,t=2.351,p= .023), specifically increased irritability, and memory as the first symptom (β= -.278,t=-2.139,p= .038) predicted the redirection of attention. However, no significant predictive relationships were found for Rivermead test, RAVLT and ROCFT. Conclusions: Age, as well as memory deficits as the first symptom of MCI were predictors of MMSE and selective attention. Additionally, BDI significantly predicted verbal fluency. However, no other predictors were observed for episodic memory and visuospatial ability.

PO3.18. Exploring the experiences of living with dementia in Ghana

ANTWI Stephen

University of Stirling, Edinburgh, United Kingdom

Background: With demographic transition occurring worldwide, the sub-Saharan African countries have the youngest population but fastest growing rates of older people in the world (UN World Population Prospects, The 2015 Revision). Dementia and cognitive impairments are therefore set to be one of the biggest public health challenges for the sub-region in the 21st century. There is a paucity of information on dementia in the region and the few studies that have been conducted have mainly focused on prevalence and incidence with no investigation being conducted on the lived experiences of dementia. Individuals and cultures attempt to understand the symptoms of an illness based on their knowledge about it. The unique ways with which illnesses are constructed usually influence people’s perception, experience and coping strategies. 

This hermeneutic phenomenological study will explore the experiences of people living with dementia and the cultural perceptions of dementia in Ghana.

Method: The study used semi-structured interviews with people with dementia and their family carers and focus group discussions with healthcare professionals and prayer camp staff with experience of working with people with dementia. 

Preliminary findings: Early analysis of the data suggests that dementia is a taboo subject that attracts widespread stigma in Ghana. The findings also point to a number of misconceptions about the causes of dementia including witchcraft, curses and menopause.

Conclusion: There is a general lack of awareness and knowledge of dementia in Ghana. There is widespread presence and use of prayer camps for the treatment practices of dementia. Most families with people with dementia prefer to send them to a prayer camp as opposed to a more ‘conventional psychiatric services for care and treatment.  There is a need for work to raise the awareness of dementia to reduce the misconceptions and associated stigma.

PO3.20. Experiences of attending day care services designed for people with dementia - a qualitative study with individual interviews

STRANDENÆS Margit Gausdal1, LUND Anne2, ROKSTAD Anne Marie Mork1,3

1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Oslo, Norway, 2Oslo and Akershus University College of applied science, Oslo, Norway, 3Molde Universit College, Oslo/Molde, Norway

Objectives: Day care services (day care) play an important role in the care of people with dementia worldwide. Day care is assumed to promote independence in home-dwelling people with dementia and to increase their wellbeing and social stimulation. However, few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees’ experiences with day care designed for people with dementia.

Method: This study had a qualitative descriptive design and included individual interviews with 17 users attending day care designed for people with dementia. The data analysis was undertaken using content analyses.

Results: The participants reported that day care had a positive influence on their physical functioning, cognition, wellbeing and situation at home because they were provided with social stimulation, meals, and activities. The social setting, the meals, and the opportunity to leave the house are highlighted as enjoyable and preferred activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care centre a safe place to be and enhanced a sense of belonging.

Conclusion: This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation and enhances practical and cognitive functioning as experienced by the users. The staff have a major impact on the experience of the participants in the day care service

PO3.21. Traditional Chinese medicine therapy reduces the nasogastric tube feeding risk in dementia patients

CHOU Hui-Jer, LIN Shun-Ku

1Taipei City Hospital Renai Branch, TAIPEI, Taiwan, Province of China

Background: Dementia is an international health issue in elder people. Nasogastric tube feeding to address eating problems in patients with dementia introduce risks of respiratory tract infection or esophagus trauma. Traditional Chinese medicine (TCM) is widely used to treat swallowing difficulty in Taiwan. We investigated the long-term clinical effects of TCM for reducing the risk of Nasogastric tube feeding in dementia patients.

Methods: We used National Health Insurance Research Database to conduct a retrospective study of dementia patients with difficult voiding symptoms between 1997 and 2009 in Taiwan. We collected medical data from the onset of dementia to Nasogastric tube insertion. Cox regression proportional hazards model and cumulative incidence of the Nasogastric tube curve were used to determine the association between the risk of swallowing difficulty and TCM use.

Results: Data from 11069 patients with dementia was assessed, and 9438 participants who received medication for relief swallowing difficulty were categorized into 2 groups: 4094 (43.4%) were TCM users and 5344(56.6%)were TCM non-users with a mean follow-up period of 5.4 years. Cox regression demonstrated that using TCM may decrease the need for Nasogastric tube in patients with dementia (adjusted hazards ratio (aHR) =0.84, 95% confidence interval (95% CI): 0.76-0.92) compared to TCM non-users. A relationship between longer TCM use and reduced urinary retention with Nasogastric tube use was observed, especially in patients who used both herbal and acupuncture treatment (aHR =0.67, 95% CI: 0.58-0.76). Ban-Xia-Hou-Pu-Tong (aHR =0.76, 95% CI: 0.64-0.88), Li-zhong Tang (aHR =0.57, 95% CI: 0.35-0.74) were the most two beneficial TCM formulae.

Conclusions: The results of this study suggest that TCM is associated with a reduced risk of Nasogastric tube in patients with dementia, with enhanced benefits from longer durations of TCM use.

PO3.22. Functional mobility and risk of falls in patients of alzheimer’s disease attending a day care center

REDOLAT Rosa1, FERNÁNDEZ-RÍOS Mercedes1,2, GARCÍA-GARCÍA Raúl2, MAZZA Giacomo1,2

1University of Valencia, Valencia, Spain, 2Asociación de Familiares de Alzheimer de Valencia (AFAV), Valencia, Spain

Background: In our ageing society an increasingly number of patients with Alzheimer’s Disease (AD) attend day care centers. However, functional mobility and risk of falls in this group have received little attention in comparison with those living in nursing homes.

Methods: 42 AD patients attending a day care center were evaluated (17 men and 25 women) (mean age: 77.40 ± 7.90). All subjects completed the 35-pointLobo’s Mini examen Cognoscitivo(MEC) and Global Deterioration Scale (GDS). Risk of falls, balance and march were evaluated with Tinetti Test (TT) and UP and Go Test (TUG).

Aim: Our aim was to evaluate if scores in TT correlated with a shorter measure of risk of falling (TUG Test) and to determine if age and cognitive status modulate this relationship.

Results: The mean score in MEC was 22.52 (± 6.00) . The mean TUG score was 12.15 ± 2.73 and TT score reached 26.50 ± 2.22. There was a positive correlation between TT and MEC (r= 0.33;p= 0.05) and a negative one between TT and TUG (r= -0.65;p= 0.001). A trend towards correlation between GDS and mean TUG score (r= 0.3;p= 0.054) and a negative relationship between GDS and TT scores (r= -0.4;p= 0.01) were observed. Neither the correlation between TT and age nor between TUG and age reached statistical significance.

Conclusions: Correlation between TUG and TT scores indicated the suitability of a shorter instrument (TUG) to assess risk of falling in this population. These results could be useful in order to design interventions aimed to improve functional mobility and reducing the risk of falls in AD patients attending day care centers.

Acknowledgments: Generalitat Valenciana (PROMETEOII/2015/020), Ministerio de  Industria, Economía y Competitividad (Spain) (Ref. PSI2016-78763-P), Asociación de Familiares de Alzheimer Valencia (AFAV).

PO3.23a. Cognitive enhancement in Alzheimer’s and related disorders

CHRYSIKAKOU Iliana, ZACHARIADIS Andreas, EFTHYMIOPOULOU Catherine

the “Apostoli” charitable organization, Holy Archdiocese of Athens, Athens, Greece

This poster presentation is intended to show the benefits deriving from cognitive enhancement programs, within the context of non pharmaceutical interventions, carried out by psychologists, to patients with Alzheimer’s and related disorders.

The combination between, cognitive enhancement programs – non pharmaceutical interventions and administration of appropriate medication, have shown spectacular results. In more detail, significant improvement of the patients’ cognitive functions   has been noted, as well as of their ability to cope with demands of their everyday lives Within the cognitive enhancement framework, a wide variety of stimuli and appropriate techniques is used, in order to address a specific problem, and thus to obtain the desirable outcome. It is very important to customize each patient’s individual program, using diverse activities and as such, time and space re-orientation, conversation on contemporary news, learning or re-training on skills and various exercises aiming to implement again memory, attention, judgment and speech. Art therapy should always be included.

As relevant experience suggests and after the meticulous study of the contemporary scientific literature, the conclusions to which, we have reached, are that cognitive enhancement programs indeed constitute a therapeutic approach totally adapted to every patient’s needs. They can be administered on an individual or a group basis, and can be also modified according to the patient’s emotional or cognitive status. It should be noted that in this context the patient is encouraged to make conscious efforts, in order to help oneself. This means one does not rely only on medication, but takes an active role in the effort of dealing with dementia, retaining control over one’s life

Finally, it is very important to understand that non pharmaceutical interventions are not meant to replace medication, which has undoubted results but to be considered as complementary, acting in combination, in order to produce optimal results.  

PO3.23b. How a relative/carer should manage the emotional load deriving from taking care of a person with dementia.

CHRYSIKAKOU Iliana, ZACHARIADIS Andreas, EFTHYMIOPOULOU Catherine

the “Apostoli” charitable organization, Holy Archdiocese of Athens, Athens, Greece

By working in a unit which is specialized in diagnosing, treating and caring people with dementia, one is in constant contact with these persons’ family and other social environment. So, it is only natural that we continuously receive requests for psychological support, so that relatives and carers may continue to be able to cope with the difficulties deriving from caring   of a person with dementia. In the meantime, we also experience the difficult emotions they experience. Disappointment, anger and frustration being among them, which manifest during taking care of their relatives with dementia, while they try to stay connected with somebody who turns about to act differently from the individual they used to know.

“Psychologic loss” of the person with dementia, is a status which constitutes a part of the process of preparatory grief in dementia and precedes physical loss. It is an emotional response on an impending end, as well as an effort to preserve memories one has with the person with dementia. During preparatory grief, an unconscious procedure takes place, as a reaction to the damaged stability of the relative’s life, which includes stress, solitude, sadness, disappointment, grief, guilt and despair.  

The way to deal with all these negative emotions, includes at first the ability to recognize and accept them, while afterwards, to be able to adapt oneself with the new facts of the patient’s as well as the caregiver’s, lives. The creation of a new reality in the relationship with the person with dementia, based on love, mutual understanding, and acknowledgment, is the target, which will evoke to the caregiver emotions of relief and hope, thus inducing a normal transition towards the eventual physical loss of the person with dementia, viewed as the completion of one’s circle of life.

PO3.25. Effect of acupressure (Chinese manipulative therapy) on the quality of sleep in chinese old adults with intellectual disabilities (ID): A pilot study and on-going project

LUK Wai Ming Albert

Caritas Rehabilitation service, Hong Kong SAR, Hong Kong

Background:  Past studies reported acupressure could improve sleep disturbances in persons with sleep disorders. Nocturnal sleep problem is common in persons with intellectual disabilities (ID). No studies about the effect of acupressure applied on back and head to improve sleep quality in chinese population with ID has been reported.

Objective:  Our study aimed to investigate the effectiveness of acupressure on sleep quality of chinese old adults with ID.

Method:  A one group pre-test/post-test design. 20 clients (including 3 with dementia) with sleep disturbance were recruited from 2 hostels of ID, from September 2016 to February 2017. They received two to three sessions of acupressure treatment per week for 20 consecutive weeks.  Each session composed of a 10-minute spinal column acupoints (EX-B2) pinching massage (Niē jǐ), and then followed by a 5-minute gentle acupoints massage (Tui na) on each of the head acupoints (DU-20,EX-HN1,ST-8, DU-24).  Pittsburgh Sleep Quality Index (CPSQI) scores of clients was measured at baseline and after 20 weeks of intervention. 

Findings: The mean age of clients was 58.4 years. The global PSQI scores of clients reduced from 8.5 (pre-test) to 6.2 (post-test) (p<0.01) after treatment.  PSQI subscores, including sleep latency, sleep disturbances and daytime dysfunction components also significantly improved (p<0.01) after intervention.

Conclusion: This is the first study to examine the effect of Acupressure/Chinese manipulative therapy (a combination of both Niē jǐ with Tui na) on the sleep quality of old adults with ID. Acupressure on back and head can improve the sleep quality of clients with ID in supported hostels. This low cost non-pharmacological intervention is believed to have a positive impact towards the quality of life of our clients. Further study with larger sample size is therefore recommended for other ethnic populations with ID.

PO3.26. Informal care for dementia according to type of service

BRETTSCHNEIDER Christian1, HAJEK Andre1, STEIN Janine2, LUCK Tobias3, MAMONE Silke4, WIESE Birgitt4, MÖSCH Edelgard5, WEEG Dagmar5, FUCHS Angela6, PENTZEK Michael6, WERLE Jochen7, WEYERER Siegfried7, MALLON Tina1, VAN DEN BUSSCHE Hendrik1, HESER Kathrin8, WAGNER Michael8, MARTIN Scherer1, MAIER Wolfgang8, RIEDEL-HELLER Steffi G2, KÖNIG Hans-Helmut1

1University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 2University of Leipzig, Leipzig, Germany, 3Nordhausen University of Applied Science, Nordhausen, Germany, 4Hannover Medical School, Hannover, Germany, 5Technical University of Munich, Munich, Germany, 6Heinrich-Heine University Düsseldorf, Düsseldorf, Germany, 7Central Institute of Mental Health, Mannheim, Germany, 8University of Bonn, Bonn, Germany

Background: Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not in its components. 

Objectives: We aim to assess the degree of association between specific informal care services and dementia. 

Materials and Methods: This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating. Eight individual informal care services were considered. Logistic regression models were used to assess associations.

Results: 18% of 864 participants had a diagnosis of dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on ‘supervision’, ‘regulation of financial matters’ and ‘assistance in the intake of medication’. Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia.     

Conclusions: The delivery of all types of informal care services is associated with dementia. The association is pronounced for services, which can be integrated more easily in the daily routines of the informal caregiver. Policy makers who plan to integrate informal care in the general care arrangements for dementia should consider this.

PO3.27. An evaluation of the dementia early identification and care service: Characterization of users and needs to support

MATSUMOTO Hitomi1, TAKECHI Hajime2, OGAWA Masahiro1, MATSUMOTO Keiko3, KAWAKITA Yuichiro4, HARA Mayumi5, KOYAMA Yumi5, FUJITA Yoshinari5, OSHITA Katsunori5, MORI Toshio6, TOICHI Motomi1

1Faculty of Medicine, Kyoto University, Kyoto, Japan, 2Department of Geriatrics and Cognitive Disorder, Fujita Health University School of Medicine, Aichi, Japan, 3The Central Uji Area Comprehensive Support Center, Kyoto, Japan, 4Uji City Welfare Service Public Corporation, Kyoto, Japan, 5Uji City Government Office Health and Welfare Division, Kyoto, Japan, 6Kyoto Prefectural Rakunan Hospital, Kyoto, Japan

Background/Objective: There have been limited reports on characteristics of people who utilize an early identification and care service for dementia. The present study attempted to categorize community-dwelling people with suspected dementia in early identification and care service based on their cognitive impairment, activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD). We also reported the un-met needs after intervention of the early identification and care service in each group.

Methods: 162 community-dwelling people drawn from the early identification and care service in Uji-city, Japan were evaluated in terms of frequency and severity of cognitive impairment and ADL (the 21-item the Dementia Assessment Sheet for Community-based integrated care system), and BPSD (the short version of the 28-item Dementia Behaviour Disturbance scale). A non-hierarchical cluster analysis was conducted to generate groups based on the patterns of cognitive impairment, ADL and BPSD. Unmet needs were assessed with the needs assessment scale of discharge planning for dementia.

Results: The four subgroups were generated for people with suspected dementia in the early identification and care service for dementia; mild group (n=42, 24%), moderate group (n=45, 26.2%), BPSD group (n=38, 22.9%) with moderate cognitive impairment/ADL and severe BPSD, and severe group (n=35, 20.4%) with severe cognitive impairment and BPSD. The most reported unmet need across groups was “family functioning and perspectives (Mean score; 1.7±2.5)”, indicating that support strategy of education and management about dementia for caregivers is still not enough.

Discussion/Conclusion: The classification of the profiles of cognitive impairment, ADL and BPSD may allow care providers to proactively plan personalized interventions and to care people with suspected dementia promptly. The existence of unmet caregiver needs suggests a possibility that gaining quality of multidisciplinary interventions and developing community support resources for caregivers can reduce their care burden.

PO3.28. Shared housing arrangements for people with dementia – a cross-sectional study on quality indicators

WOLF-OSTERMANN Karin1, SCHMIDT Annika2, PREUSS Benedikt3

1University of Bremen, Bremen, Germany, 2University of Bremen, Bremen, Germany, 3University of Bremen, Bremen, Germany

Background:  Providing person-centered care for people with dementia (PwD) in small-scale homelike settings is a worldwide trend. During the last two decades we observed a great increase in Germany in the number of shared-housing arrangements (SHA) especially for PwD. Although there are a few outcome-based studies focusing on quality of life and challenging behavior etc., studies developing and evaluating quality indicators (QI) tailored to care in SHA are still widely missing. This study was conducted to develop such QI and to describe quality of care and support for SHA in Germany.

Methods: Based on literature reviews and adopted by expert consensus we developed 29 QI which focus especially on care and support characteristics in SHA for PwD. In a cross-sectional study in 74 SHA in Germany caring for PwD we evaluated structures of care and support as well as these QI. Data were analyzed using descriptive and inferential statistics.

Results: In total 623 persons lived in the participating SHA, on average 9 PwD per SHA (2 male, 7 female) with an average age of 79 years – most of them being highly care dependent, staying until end of life. Nearly all of the participating SHA report a setting-specific quality management concept as well as a setting-tailored concept of care and support. Participation of the residents in organizing daily living like choosing meals and activities is given in nearly all SHA. Staff in SHA is mostly (> 80%) employed continuously, but only 72% of all SHA have a dementia-specific concept of training. On average one full-time equivalent (fte) relates to one resident, but only 0,17 fte fall on skilled nurses.

Discussion: The findings point out that SHA are a specialized living and care environment for the vulnerable group of elderly PwD. Developing and evaluating quality assurance concepts are therefore widely needed.

PO3.29. Prevalence and outcome of Delirium in older people accessing to outpatient memory clinic in Modena (Italy): retrospective study

FEDERZONI Lucia2, MANNI Barbara1, MUSSI Chiara3, ZUCCHI Patrizia4, FABBO Andrea5

1Memory Clinic,Primary Care, Modena, Italy, 2Department Geriatrics OCSAE Hospital Modena University, Modena, Italy, 3Geriatrics Department OCSAE Hospital Modena University, Modena, Italy, 4Memory Clinic,Primary Care, Modena, Italy, 5Cognitive Disorder and Dementia Unit,Primary Care, Modena, Italy

Background: Delirium is a multifactorial geriatric syndrome characterized by a transient, acute and global disorder of cognition and consciousness. It refers to a clinical condition and is associated to adverse outcomes. It’s well known in hospital but few studies analyzed prevalence of Delirium in community that has estimated 1-2%  (Devis,2013)

Objective: To assess the prevalence, outcomes and features of delirium in a cohort of elderly people accessing to an Outpatient Memory Clinic in 2017.

Methods: Retrospectively we analized olders who had diagnosis of Delirium in 2017 in a Memory Clinic in Modena respect to the  3843 clinical and cognitive examinations executed. Each sample evaluation includes demographics, clinical, cognitive assessment and/or diagnosis of dementia, severity of dementia, functional status. People with Delirium was identified by Confusional Assessment Method. We compared cognitive, functional and behavioral outcomes 6months before and after  Delirium event; moreover we evaluated death event, hospitalization, institutionalization after 6 months.

Results:  We found 46 cases of Delirium (27:19=F:M) aged 84.3 Years old living at home, Prevalence of 2.1%. Most of them were affected by dementia (76%):moderate stage of dementia with MMSE medium 15.8,  moderate level of comorbidities (CIRS 2.17) and disabilities (ADL 2.7/6). 74% revealed Hyperactive form. After 6 months people that experienced Delirium showed a worsening in cognitive functions (MMSE), behavioral problems (NPI), disability (ADL). Mortality measured 21.7%, institutionalization 41.2% and hospitalization 32.6% in 6 months.

Conclusion: this study represent feasibility in management of Delirium in community but this syndrome increase risk of negative outcomes in particular in people with dementia

PO3.30. Use of non-pharmacological interventions in dementia: the Bavarian Dementia Survey (BayDem)

KARRER Linda3, NICKEL Franziska1, HESS Manuela2, DIETZEL Nikolas4, GRÄßEL Elmar5, KOLOMINSKY-RABAS, Peter L.6

1Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany, 2Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany, 3Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany, 4Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany, 5Centre for Health Services Research in Medicine, Psychiatric and Psychotherapeutic Clinic, University Hospital Erlangen, Erlangen, Germany, 6Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany

Background: Even though selected non-pharmacological interventions are recommended by international guidelines, there is still a lack of information on their dissemination and utilization rates. Thus, this analysis examines the use of occupational therapy, physiotherapy, physical activities and memory support groups for persons with dementia (PwD). With regard to informal caregivers the uptake of counselling services and support groups was investigated.

Methods: BayDem is a multi-center, longitudinal study at three different sites in Bavaria, Germany. Participants are PwD (according to ICD-10) and their informal caregivers. Data was collected by standardized face-to-face interviews. This analysis includes PwD who showed mild to moderate cognitive impairment at the baseline assessment (t0) (n=147). Data gathered in the period between t0 and the first follow-up assessment after six months (t6) and between t6 and the second follow-up at 12 months (t12) was analyzed.

Results: 12.9% of the participating PwD attended a memory support group in the period between t0 and t6 (between t6 and t12: 13.6%). Mild physical activities such as gardening were performed by 80.7% (between t6 and t12: 79.8%), whereas more intense physical exercise was done by 14.5% of the PwD (between t6 and t12: 11.8%). Further, occupational therapy was used by 6.7% and physiotherapy by 18.5% (between t6 and t12: 6.7% and 16.0%, respectively). With regard to caregivers (n=122) 27.0% visited counselling services and 12.3% caregiver support groups between t0 and t6 (between t6 and t12: 21.3% and 9.6%, respectively).

Conclusion: The results show that merely a small share of the participating PwD uses non-pharmacological interventions. Thus, information provision and access to these interventions should be enhanced.

Funding notice: The research was initiated by the Bavarian State Parliament and is funded by the Bavarian Ministry for Health and Care.

PO3.31. Caregiver support with activities at home for people with dementia (the MOMANT study)

KUYPER Ingrid1, SCHERDER Erik2, DRÖES Rose-Marie3, MILDERS Maarten4, BOSMANS Judith5, HEIJMANS Martijn6, VAN BOMMEL Sjef7

1VU University, Amsterdam, Netherlands, 2VU University, Amsterdam, Netherlands, 3VU Medical Centre, Amsterdam, Netherlands, 4VU University, Amsterdam, Netherlands, 5VU University, Amsterdam, Netherlands, 6VU Medical Centre, Amsterdam, Netherlands, 7Expert by experience, Amsterdam, Netherlands

The World Alzheimer Report 2010 emphasized the urgent need to develop accessible and cost-effective care for people with dementia and their caregivers. The intervention of this study reported here combines two approaches to caregiver support that have shown to be effective in empowering caregivers, i.e. a multiple component approach and actively engaging caregivers to involve the person with dementia in activities. The aim of this study is to investigate whether the intervention is effective and cost-effective to improve quality-of-life in the caregiver and in the person with dementia for whom they care. Additional research questions are whether the intervention can have positive effects on caregivers’ feelings of competence, mood and their experience of caregiving.

The study design is a pragmatic, cluster randomised controlled trial with cost-effectiveness analysis. The study participants are informal caregivers of home-living people with dementia, and the person with dementia for whom they care, recruited in various regions in the Netherlands. The intervention is presented to caregivers by health or social care professionals at local dementia care centres. The manual-based program contained caregiver education about dementia, coping with caring and engaging the person with dementia in activities and consists of 6 group sessions over 2 months. Outcome measures are compared between two groups: caregiver-person with dementia dyads where the caregivers received the intervention and caregiver-person with dementia dyads who received usual care only. Participants in both conditions are assessed on the outcome measures at three occasions: at baseline and at 3 and 6 months after baseline.

Preliminary results will be presented at the Alzheimer Europe Conference 2018 as well as experiences from caregivers and professionals who have completed or presented the intervention. The intervention potentially adds to the effective support of caregivers of people with dementia without greatly increasing the workload for health or social care professionals.

PO3.32. The Rosemary diary in home care for people with dementia: a pilot study

FABBO Andrea1, BRUNO Patrizia2, BEVILACQUA Petra3, BERGAMINI Lucia4, GUIDI Laura5, MANNI Barbara6

1Local Authority for Health and Services (AUSL) of Modena, Modena, Italy, 2Amnesia Association, Naples, Italy, 3ASDAM Association, Mirandola, Italy, 4Local Authority for Health and Services (AUSL) of Modena, Mirandola, Italy, 5Giovani nel Tempo Association, Bologna, Italy, 6Local Authority for Health and Services (AUSL) of Modena, Modena, Italy

Introduction and aims: The Rosemary diary is a useful and simple tool, developed in primary care, for older person with cognitive impairment to be use without instructions, but simply using intuition with icons and pictures for simple questions. The first part of diary references to the traditional ROT (a part of CST actually), while the second part collects the activities of daily life. The aim of our study is to determine if this tool could be a support for people with dementia at home improving or maintaining cognitive performances and autonomy.

Methods: we studied n° 87 PWD living at home (30 M, 57 F; mean age: 80± 7,4 years) divided in 2 groups: n° 71 subjects who use Rosemary diary for 2 months (one hour/day for 6 days a week) and n° 16 (control group) who use ordinary tools (such as newspapers, calendars or reminders). At the start (T0) and the end (T1) of the study time, the 2 groups were evaluated in order to assess cognitive performances (MMSE) , activities of daily living ( Barthel)  and mood ( GDS-15, short version).  The statistical analysis was conducted by SPPS-21.

Result: Significant improvements was found for depression (SG-GDS: t=5.36, p<0.001; CG-GDS: t=2.25, p<0.05) and functional parameters (SG-ADL: t=7.85; p<0.001; CG-ADL: t=2.37, p<0.05) in both groups, whereas only the intervention group (SG) had a significant improvement in MMSE scores (t=7.31, p<0.001).

Conclusion: these preliminary results suggest that a simple tool such as Rosemary diary could have not only a positive effects on cognitive functions (as temporal and spatial orientation) but also a positive interaction with ADL to promote and maintain autonomy in home environment. These preliminary observations need to be validated by more accurate studies conducted on large sample of elderly people with dementia.

PO3.33. “To be, or not to be”: Experiencing deterioration among people with young-onset dementia living alone

JOHANNESSEN Aud1

1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust and University of Southeast Norway, Tønsberg, Norway

Background: Having dementia before the age of 65 (YOD) represents a radical break from an age-normative and expected life course.

Aim: To examine how people living alone with YOD perceive the course of dementia, their needs, and coping strategies, with a focus on narrating everyday life experiences.

Method: A longitudinal study using a qualitative approach. Five interviews, each with 10 informants, took place every six months from 2014 to 2017. Data was analysed with grounded theory.

Findings: The main theme was persons` experiences of changes of identity over time. The most significant aspects of their experiences were: initial signs, coping efforts, concealing the diagnosis, social retraction, existential anxiety, revival of the self, worse and worse, and health personnel as background.

Conclusion: Their voices should be listened to for planning of services during the progression of dementia. Personalized care should be used to support them.

PO3.36. Supporting local service delivery: An Irish dementia needs analysis framework

BEGLEY Emer2, O'BRIEN Marita1

1Independent Researcher, Dublin, Ireland, 2National Dementia Office, Dublin, Ireland

The principles of personhood and citizenship underpin the Irish National Dementia Strategy. Translating these into practice means refocusing current services to address, in a responsive and flexible way, the needs of people living with dementia and their family carers. To achieve this, the National Dementia Office developed a Dementia Needs Analysis Framework for local service planners. The Framework importantly prioritises the inclusion of people with dementia and their family carers.

The framework is a tool for the health service to re-imagine how they design and deliver dementia services. The framework supports the identification of:

  • Supports and services that fit the needs and preferences of people with dementia
  • Gaps in existing provision
  • Priority areas for action in accordance with resource availability

In a climate where funding for dementia services is limited, the framework is a way to support the reconfiguration of existing resources to more appropriately meet need. The framework includes six steps, including:

1. Know your target audience – record prevalence and incidence of dementia in the region.

2. Know your available resources – map dementia specific services; generic services which people with dementia might use and other community assets.

3: Know the needs of people with dementia – using techniques and approaches that facilitate the inclusion of the experts, people living with the condition.

4: Know the needs of family carers – involve family carers as they are instrumental stakeholders in designing services.

5: Know the views of other key stakeholders – health and social workers have insights and experiences about what services and supports are needed.

6: Know the priorities – use the information compiled to determine priorities.

The framework provides practical guidance for local planners and others with limited experience working directly with people with dementia.

 PO3.37. Providing social care via dementia-capable group homes for adults with intellectual disability

JANICKI Matthew

National Task Group on Intellectual Disability and Dementia Practices, Rockport, Maine, United States

Specialized housing for adults with intellectual disability (ID) and dementia (ID/AD) is becoming more prevalent.  Many jurisdictions are setting up such housing for when families exhaust their physical and financial capital for continued home-based care.  Having advance information on the mechanics of such alternative care settings can help agencies to be proactive in planning for such homes, providing post-diagnostic supports, training staff, and anticipating effects of progression and length of stay.  An opportunistic longitudinal study (2011-2018) of three such group homes (GHs) provided information on the mechanics.  Beginning in 2011 a cohort of 15 adults with ID/AD (w/ 7 replacements) were followed annually, along with 15 non-demented community-dwelling adults as matched controls.  The 15 residents lived in 3 purpose-built, 5-resident, dementia GHs.  Data on their behavior, function, and health were collected annually as were specific data related to dementia-related impairment and administrative factors.  Prevalence and trends in health/function factors as well as morbidity data obtained can be useful for administrative planning.  Deaths, occurred at age-norms in accord to trajectory and duration expectations.  Co-morbidities showed presence of cognitive and physical health issues typically associated with dementia and physical debilitation.  An ebb and flow of movement related to stage of dementia was observed when an agency has multiple dementia GHs, as well as variations in staffing patterns and periods of staff care intensity during the day.  Over time, the 3 dementia GHs, due to administrative decisions for inter-home transfers and selective new admissions, have trended toward stage/level specific care settings.  These data provide useful administrative guidance on the feasibility of home development and maintenance, as well as markers for tracking of health and function, planning for morbidity and home transitions, and enabling agencies to provide in-community group housing and quality care in accord with stage-defined functional changes and needs. 

PO3.38. Development and evaluation of a dementia education intervention for community based health care professionals

JENNINGS Aisling, MCLOUGHLIN Kathleen, FOLEY Tony

University College Cork, Cork, Ireland

Background: Primary care based health professionals who provide care to people with dementia living at home are challenged by dementia care. International policy documents emphasize the need to develop inter-professional education to support collaborative dementia care in the community. The aim of this study was to develop an interprofessional dementia workshop for primary care teams (PCTs) and evaluate the pilot phase of the implementation of the interprofessional workshop.

Methods: An educational needs analysis was conducted with an expert reference group comprising of an occupational therapist, physiotherapist, public health nurse, dementia clinical nurse specialist and two GPs. This data together with previously conducted interviews with people with dementia and their family caregivers informed the development of an interactive, three-hour interprofessional dementia workshop for PCTs. The workshop was then evaluated by a post-workshop questionnaire completed by workshop participants and by a focus group with the workship facilitators.

Results: The workshop was piloted with three separate primary care teams. A total of fifty-four primary care based healthcare staff who represented fourteen different health care roles in primary care participated in the pilot workshop. All participants completed the post-workshop questionnaires. A focus group (n=8) was conducted with the program design team and workshop facilitators. The results of the pilot phase indicated that the workshop was useful and feasible. The workshop improved participants’ self-reported knowledge, understanding and confidence to support people with dementia and their families. Areas for improvement were identified and will be used to inform improvements to the workshop content and delivery in advance of a national roll-out.  

Conclusion: Future evaluations of the implementation of this interprofessional educational workshop should focus on its impact on healthcare professional behavior and outcomes for the person with dementia and their families.

PO3.39. Effects of and experiences with SPANkracht, an empowerment intervention for people with young-onset dementia

BIELDERMAN Annemiek1, KOOPMANS Raymond1, BAKKER Christian1, DE VUGT Marjolein2, GERRITSEN Debby1

1Radboud University Medical Centre, Radboud Alzheimer Centre, Nijmegen, Netherlands, 2Maastricht University Medical Centre, Maastricht, Netherlands

Background: In many people with young-onset dementia (YOD) their sense of usefulness is compromised, due to the loss of roles that are linked to a younger life phase. Feeling useful has been suggested to be important for quality of life and social wellbeing. Therefore, in collaboration with people with YOD and their carers, the SPANkracht intervention was developed. This intervention focuses on current capacities, and increasing opportunities to engage in meaningful activities and to feel useful. It contains methods for structured conversation about current and desired activities, particularizing activities, and making and executing a week schedule.

Methods: The study investigated the effectiveness of and experiences with the SPANkracht intervention in community-dwelling people with YOD and their carers. It used a pragmatic cluster randomized controlled trial to examine effects of the 5-month SPANkracht intervention on (1) person with dementia’s quality of life and self-management abilities, and (2) informal carers’ perceived sense of competence and distress. Questionnaires and semi-structured interviews were used to evaluate the effects of and experiences with the intervention. A familiar professional carer supported the person with dementia-carer dyad (n=35 intervention; n=27 control; mean age 63 years; 69% male) in applying the intervention by face-to-face consultations and telephone calls.

Results: Data analysis of the effects is in progress. Preliminary findings about participants’ experiences indicate that people with YOD appreciated the intervention’s conversation about preferences and wishes. Also, people with YOD reported to have more insight in their current activities and week schedule. In addition, carers reported to have acquired more awareness of and insights into the abilities of their partner. It appeared difficult to structurally add meaningful activities to their weekly routine. Professional carers emphasize to value the positive approach of the intervention. The key findings of the study (effects and experiences) will be presented at the conference.

PO3.40. Health care support for dementia caregiver dyads - How does social inequality matter?

WIEGELMANN Henrik1, VERHAERT Lisa-Marie2, WOLF-OSTERMANN Karin1, SCHIRRA-WEIRICH Liane2

1University of Bremen, Bremen, Germany, 2Catholic University of Applied Sciences North Rhine - Westphalia, Aachen, Germany

Background: There is evidence that, when it comes to the chances of a healthy ageing process, family caregivers of persons living with dementia are disadvantaged. However, despite this finding there is still the need to understand dyadic dementia care arrangements better to improve health related support structures. In general, there is a large pool of public health research about the importance of social inequality regarding health and health behavior as well as the design and effectiveness of interventions for health promotion and health prevention. There are studies that refer to these findings and empirically show that the way in which caregivers and persons with dementia act and decide in home based care arrangements is affected by social determinants. But do we know enough about the significance of social context? There is no systematic overview about how programs and concepts for health promotion and health prevention in home based dementia care dyads take account of social context. This paper seeks to fill this gap.

Research question: How does health related programs and concepts for home based dementia care dyads take account of social context?

Methods: Two systematic reviews, focusing on recent developments in Germany (2008-2018)

  • The first review is centred around social law and social policy developments
  • The second one focuses the scientific discourse
  • Mayor databases (i.a. PubMed, CINAHL, PsychInfo) will be used
  • The analysis includes quantitative as well as qualitative elements

Results & Discussion: The paper will provide information, if and to which extent and which impact, dimensions of social inequality are represented in the field of home based care of people with dementia. Furthermore, we will discuss how health related supports structures should take account of social context.

PO3.41. “I did not exist as a person to them, I was just a worker to them”: experiences of objectification and dehumanisation among live-in carers

VANDREVALA Tushna, ODWYER Emma

Kingston University London, Kingston upon Thames, United Kingdom

Although research in the care industry has consistently highlighted the impacts of caring on workers, scarce research has been carried out specifically on live-in carers. The current study therefore addressed the gap in literature, contributing towards to a better understanding of the experiences of live-in carers with a focus on stress, burnout and psychological wellbeing. Semi-structured interviews were carried out with 18 live-in carers in the United Kingdom and thematic analysis was used to interpret the data. The findings suggest that carers perceive empathy and having an understanding of the client’s circumstances and needs as imperative to their role. Adaptability and flexibility around the clock, rewards and accomplishment and dealing with challenging behaviours had both positive and negative implications on their ability to put themselves in their client’s shoes. Many carers experienced feeling of dehumanisation and objectification in their interactions with client’s families and own agencies. Drawing on theoretical accounts of dehumanisation, the implications of these findings on psychological wellbeing of live-in carers and organisational support will be discussed.

PO3.42. Young relatives of parents with dementia – how is their everyday life and well-being?

BJØRNSKOV Stina, GREGERSEN Rikke

VIA University College, Aarhus, Denmark

Background: In Denmark, approximately 2000 people have young unset dementia and a significant part may have children who are teenagers or in their early 20’s. So far, efforts to support these young relatives have been sparse and up until recently, they have constituted an overlooked group in the Danish welfare system. Experiences from practice and preliminary results from VIA University College suggest that young relatives may face major disturbances in everyday life and well-being. The caregiver burden of the adult relatives is well documented. However, knowledge regarding the young relatives is still inadequate.

Aim: The aim is to explore how 18-25 year-olds experience their everyday life with a parent with dementia and how it affects the youngster’s engagement in leisure activities, social life, education and work. This profile of their everyday life will be correlated with outcomes on the youngster’s self-reported well-being. The long-term goal is to contribute to improve preventative efforts, assistance and support provided by professional caregivers to this marginalized group. Furthermore, we aim to qualify the foundation of knowledge for the organization of future interdisciplinary initiatives.

Methods: In May 2018, a survey and a qualitative interview study among relatives aged 18 to 25 years are performed. Participants are recruited through dementia associations, social media and professional caregivers. Survey data is obtained by a nationally distributed online questionnaire and we aim to reach at least 100 replies. The questionnaire contains items related to everyday life and well-being. Qualitative data is obtained by 7 – 8 semi-structured interviews using a themed interview guide. Data will be analyzed and interpreted in a phenomenological-hermeneutic perspective inspired by Kvale and Brinkmann (2015).

Outcome: All data is collected by June 2018 and analysed during Summer 2018. Results will be presented.

PO3.43. Dementia training for homecare providers in the UK

PICKETT James, KAPOOR Raj

Alzheimer's Society, London, United Kingdom

As the number of people living at home in the UK with long term, often complex conditions increases, homecare workers are being asked to take on challenging tasks on a daily basis, in a lone role often under severe time constraints. The working environment in which they operate is unlike any other, and it is vital that quality training exists to ensure homecare workers are well equipped to carry out their role. The research also suggests at least 250,000 homecare workers in the UK are providing care for someone with some form of dementia.

More than 1/3 people living with dementia receive personal care from homecare workers, with providers estimating 60% of people using their service have some form of dementia (many of whom have not received a formal diagnosis).

The training programme would help to deliver key aims of The Prime Minister’s Challenge on Dementia 2020, which stated:

‘There should be greater recognition by commissioners across health and care services of the value of homecare services, both for those that receive them and in reducing costlier crisis care.’

‘By 2020 we would wish to see increased numbers of people with dementia being able to live longer in their own homes when it is in their interests to do so, with a greater focus on independent living.’

To address the above need Alzheimer’s Society has developed a one-day Train the trainer programme for homecare workers.

The programme is made up of three core components:

  • One day “train the trainer” workshop
  • Resource pack
  • Onward training of frontline care teams

The programme content is organised in line with NHS England’s transformation framework “The well pathway for dementia”: 

  • Diagnosing well
  • Preventing well
  • Living well
  • Dying well
  • Supporting well

PO3.44. Care and service needs of people assessed for cognitive impairment in primary health care in Norway

MICHELET Mona1, BERGH Sverre2, SELBAEK Geir1, ENGEDAL Knut1, LUND Anne3

1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust.  Department of Geriatric Medicine, Oslo University Hospital.  Faculty of Medicine, Institute of Health and Society, University of Oslo, Tønsberg, Norway, 2Centre for Old Age Psychiatric Research, Innlandet Hospital Trust.  Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Ottestad, Norway, 3OsloMet - Oslo Metropolitan University, Oslo, Norway

Background: A key to starting the right post-diagnostic support for people with dementia is a thorough needs assessment and a diagnostic work-up. In Norway, the responsibility of assessing and diagnosing people over the age of 65 with cognitive impairment, and without complicating factors, is assigned to the primary health care. The assessment and work-up should be done by the general practitioners, usually in collaboration with a municipality dementia resource team.  The aim of this study was to describe people assessed for cognitive impairment in primary health care, and to compare them with those assessed in specialist health care, in terms of symptoms and needs.

Methods: We collected data on a cohort of 229 people assessed for cognitive impairment in primary health care and compared them with a cohort of 1619 people assessed in specialist health care.

Results: More people assessed in primary health care got a diagnosis of dementia and fewer got a Mild Cognitive Impairment or Subjective Cognitive Impairment diagnosis compared to those assessed in specialist health care.

People assessed in primary health care were older, had less education, poorer cognitive functioning, more impairments in daily activities, more depression, and a larger proportion lived alone than people assessed in specialist health care. Their family carers reported higher carer burden than compared to specialist health care.

Implications: These results should be considered when planning care services and post-diagnostic support for people assessed for cognitive impairment in primary health care in Norway. Attention should be paid to the relatively large proportion of people with symptoms of depression, to make sure they receive the follow-up, psychoeducation/ information and support they need. Furthermore, considering that they are often older, live alone and many have problems in daily activities, primary health care should ensure help and services tailored to these people’s needs. 

PO3.46. Caring for Carers: A 12-week home care program designed to support and educate family carers

BARLOU Klea1, LAVDAS Michael2, VOUTOS Dionysios3, SAKKA Paraskevi4

1Athens Alzheimer Association, Athens, Greece, 2Psychologist, Athens, Greece, 3Social Worker, Athens, Greece, 4Neurologist- Psychiatrist, Athens, Greece

In Greece, more than 200.000 people are living with dementia and 400.000 family carers are responsible for their daily needs. Recent research suggests that in Greece 89% of people with dementia live at home with their families, whereas 77% of carers are elderly women at risk of developing physical and mental health problems. It is therefore argued that family carers who are home-bound are unable to cover their needs for medical, social and emotional support throughout the challenging years of dementia care.

In 2017 the Athens Alzheimer’s Association (AAA) in collaboration with “TIMA” Charitable Foundation, developed a program called “Caring for Carers”, designed to respond to carers’ needs. It focused on families with people with severe dementia facing socioeconomic hardships, isolated and unable to benefit from social support services.

The aim of the project was to support, educate and empower family carers in order to promote their wellbeing and offer high quality care to their relatives at home. A multi-disciplinary team of psychologists, nurses, social workers, psychiatrists and physical therapists conducted home visits, 2 times a week, for a period of three months. They provided services (psychiatric assessment, psychotherapy, counseling, physical exercise) tailored to the carers’ needs. Approximately 100 family carers (spouse/children) participated in the intervention.

To evaluate the effectiveness of the program mixed methodology was used. Psychometric scales were administered pre and post intervention, assessing levels of anxiety, depressive mood, quality of life and burden of care. Data collected at a database were analyzed quantitatively through SPSS v. 24. Qualitative methods were employed for further exploring the effectiveness of the project (interviews, focus group).

Results and possible implications of the program for future intervention are discussed.

PO3.48. Stability of home-based care arrangements for people living with dementia – a conceptual model derived from a meta-study on mixed research

HOCHGRAEBER Iris, KOEHLER Kerstin, DREYER Jan, VON KUTZLEBEN Milena, HOLLE Bernhard

German Center for Neurodegenerative Diseases (DZNE), Witten, Germany

Background: Worldwide most people with dementia live at home and are cared for by family members. During the trajectory of dementia, creating and maintaining a stable care situation is a guiding principle of informal carers and a desirable outcome of contemporary health care policies. So far, a theoretical conceptualisation of the ‘stability of home-based care arrangements for people living with dementia’ is lacking.

Research questions: How is stability of home-based care arrangements for people living with dementia constituted?
 What are the essential factors that influence stability?

Method: We conducted a meta-study including the three analytical components meta-data analysis, meta-theory and meta-method followed by an integrative synthesis. Qualitative, quantitative and mixed methods studies and (systematic) reviews are considered. The main analytical approach is thematic synthesis. See also PROSPERO (CRD42016041727).

Results: N=136 publications are included. Meta-theory: The dominant theoretical frameworks are models of the stress process, care trajectories and decision-making. Meta-method: Most quantitative studies focus on risk factors for institutionalisation, but fail to comprehend the dynamics behind. Qualitative research aims at understanding informal care as a social construction, but pays little attention to its direct impact on whether or not a care arrangement can be maintained. Meta-data: ‘Stability’ is a complex phenomenon that is influenced by the progression of dementia, the decisions and actions of the persons involved and their relationships and has to be interpreted in the context of the respective cultural, social and health care system. Meta-synthesis: A conceptual model of ‘stability’ explains the interrelations of related concepts and influencing factors. 

Discussion:

Our meta-study provides a sound theoretical basis that should be followed by empirical research to test and refine the conceptual model. We identified research gaps with regard to the perspective of persons with dementia, to longitudinal reconstructions of care trajectories and to positive aspects of care.

PO3.50. Is there a ‘right time’ for a person with dementia to move to a care home? Social workers’ and care home managers’ perspectives

COLE Laura, SAMSI Kritika, MANTHORPE Jill

King's College London, London, United Kingdom

Deciding if and when a person with dementia should move from their own home to a care home can be difficult for the person with dementia, family members and professionals. Currently there is little information to aid this decision-making. This study explored social workers’ and care home managers’ experiences of the decision-making process, and sought their views on whether there is an ‘optimal’, or best time for the move. Using a phenomenological approach, semi-structured, face-to-face interviews were conducted in 2017-18 with 20 social workers and 20 care home managers across England. Interviews were audio-recorded, transcribed and analysed thematically, identifying commonalities and differences across the two groups. Findings revealed a consensus that people with dementia should live at home for as long as possible, but should start to consider a move to a care home when risks are escalating, before a crisis point is reached. However, home care managers thought those living alone should probably consider moving to a care home sooner to benefit from the social stimulus and sense of wellbeing that a care home provides. All agreed that an ‘optimal time’ was individual to the person with dementia. Care home managers recognised that, compared to state funded residents, self-funding residents were not well supported in the decision-making process and information for them was scarce. Care home managers reported providing much information to self-funding families. Findings from this study will be used to develop factsheets to inform all who are involved in making these decisions.

PO3.51. The impact of dementia nurse consultant role within care home environments

MCALISTER Janice

Erskine Care Home, Bishopton, Renfrewshire, United Kingdom

The role of Dementia Nurse Consultants as strategic leaders of change within health board settings across Scotland is now well recognised and established with each of the 14 health boards having a dementia nurse consultant in post.

On evaluation there is evidence that this role has had a positive impact in terms of clinical outcomes for people with dementia, leadership, imbedding policy into practice and improving the skills and knowledge of workforce. Which raises the question should this model of care be limited to National Health Service?

 As Scotland’s foremost provider of care for veterans and their spouses, Erskine offers unrivalled nursing, residential, respite and dementia care in four care homes throughout Scotland for UK veterans. In 2017, Erskine's Board of Directors inline with national dementia frameworks recognised the potential long term benefits to residents by having a Dementia Nurse Consultant in post. Investing time, resources and finance the Dementia Nurse Consultant Model was adopted by Erskine. The unprecedented situation and uniqueness of having a Dementia Nurse Consultant post with a Care Home setting allows for a tailored approach to meet Erskine’s needs in bridging policy into practice.

I came to Erskine as Dementia Nurse Consultant in April 2017 from a background of equivalent post within the NHS, this has been advantageous in being able to adopt and implement previously tested methodology in relation to clinical leadership, research and educational aspects of the role. The post is site based which allows for both strategic and clinically co-ordinated approach to dementia care which focuses on improved clinical outcomes, delivery of person centred care whilst simutaniously ensuring a positive response to stress & distress and improving the care environment to meet the needs of residents with dementia. 

PO3.52. Improving staffs’ skills and knowledge within a care home setting

MCALISTER Janice

Erskine Care Home, Bishopton, Renfrewshire, United Kingdom

Erskine Care Homes are well recognized for providing care to veterans and their spouses across 4 sites for over 100 years. In recent years however as could be expected and inline with national statistics, there has been a rise in the numbers of residents with cognitive impairment. Although a great deal of improvement work has been carried out in relation to dementia care, Erskine board of directors recognized the potential benefit of having a Dementia Nurse Consultant in post. Coming into post from a background of equivalent post within NHS, I have had the benefit of being able to adopt and implement previously tested methodology in relation to clinical, leadership, research and education aspects of the role. A priority has been identified as improving the level of staffs’ skills and knowledge in relation to Promoting Excellence (Scottish Government 2011). A blended learning and partnership approach has been adopted in providing an educational framework across all 4 levels, for all staff within the care homes. The unprecedented situation and uniqueness of this post allows for a tailored approach to meet Erskine’s needs in bridging policy into practice. As part of teaching methodology the value of Simulation training has been recognized with Erskine funding the first onsite dementia simulation unit within care home settings in the UK.  This allows staff an experiential aging experience whilst carrying out everyday tasks.  The simulation experience is video recorded with staff observing their behaviours and difficulties encountered via playback. This methodology has enriched staff learning experience. This initiative has at it’s core the vision of Rights, Relationship & Recovery in breaking down traditional organisational/professional boundaries with the aim of driving forward service improvement for residents with dementia that is person centred and strengths based. Evaluation of training indicates improvment in level of skills, knowledge and behaviours.

PO3.53. Creative Conversations: an arts based dementia care staff development programme

ALGAR-SKAIFE Katherine1, WINDLE Gill1, KILLICK John2, PICKERING-JONES Luke3, CAULFIELD Maria1, ROBERTS Jennifer1, JELLEY Hannah1

1Bangor University, Bangor, United Kingdom, 2Dementia Positive, Settle, United Kingdom, 3Flintshire County Council Social Services, Mold, United Kingdom

Background: In the UK, care home staff training tends to focus on manual handling, fire safety, and safeguarding, rather than understanding ways to communicate with older people, including those living with dementia (Older People’s Commissioner for Wales, 2014). Previous research indicates projects with artist practitioners engaging people living with dementia in care homes also benefitted staff through learning new skills and increasing their understanding of the residents as individuals.

Objectives: This project aimed to develop and test a ‘Creative Conversations’ staff development programme using an arts-in-health approach to improve the quality of interaction between carers and people living with dementia and the knowledge and skills of the dementia care workforce. 'Creative Conversations’ is based on and takes its inspiration from two earlier programmes: The Descartes project (Zeilig et al.,2015) and The Arts and Older People Project (Killick, 2015). The project was a partnership between Bangor University, Dementia Positive, and Flintshire County Council Social Services.

Methods: A collaborative approach ensured that those thought to benefit from the staff development programme (care staff, people living with dementia, older people, family carers and Social Services) were involved in the design and implementation. A pragmatic stepped-wedge cluster randomised trial explored the feasibility and impact of ‘Creative Conversations’ on the quality of interaction between care staff and residents, knowledge and skills, job satisfaction, and burnout of care staff, and social care-related quality of life of residents with dementia.  

Results: This paper presents the study results including a discussion of the challenges and successes of the research design to enable the sharing of best-practice for evaluating complex interventions in care home settings.

Conclusion: An arts-in-health approach to care staff development offers an alternative to traditional training. Important implications have been learned regarding the feasibility of a stepped-wedge cluster randomised trial in care homes.

PO3.54. Rationalising antipsychotic prescribing to nursing home residents with dementia: A feasibility study

WALSH Kieran A.1, BYRNE Stephen1, MC SHARRY Jenny2, BROWNE John1, IRVING Kate3, HURLEY Eimir4, O'RIORDAN Alex1, ROCHFORD-BRENNAN Helen5, GEOGHEGAN Carmel6, TIMMONS Suzanne1

1University College Cork, Cork, Ireland, 2National University of Ireland, Galway, Galway, Ireland, 3Dublin City University, Dublin, Ireland, 4Trinity College Dublin, Dublin, Ireland, 5European Working group of People with Dementia, Sligo, Ireland, 6Dementia Ireland, Galway, Ireland

Background: Antipsychotic prescribing in nursing home residents with dementia is prevalent despite the known harms and minimal benefits. We developed an intervention (the Rationalising Antipsychotic Prescribing in Dementia [RAPID]) intervention, and involved people with dementia and family carers in the design process.

Aim: The aim of this study was to assess the feasibility and acceptability of the RAPID intervention in a nursing home setting.

Methods: Ethics approval was granted by the local ethics committee. We undertook an uncontrolled, pre-post, mixed methods feasibility study in one large (75 bed) publicly funded nursing home in Cork City, Ireland. Quantitative measurements included psychotropic medication data and behavioural symptom severity (Neuropsychiatric Inventory-Nursing Home [NPI-NH]). Quantitative data were collected at baseline and monthly thereafter for 3 months, and were analysed descriptively. Qualitative focus groups were conducted with nursing home staff and GPs to explore their experiences of the intervention, and analysed using a framework approach.

Results: Of 75 residents at baseline, 43 (57%) had dementia (median age = 84 [IQR = 79-92], females = 29 [67%]). The number of dementia residents prescribed at least one antipsychotic decreased from baseline to 3-months (from 44% to 36%), and the absolute number of ‘as required’ psychotropics administered monthly to dementia residents also decreased (from 90 to 69), while the NPI-NH score deteriorated slightly (median and IQR scores increased from 6 [1-24] to 10 [4-18]). Participants enjoyed the educational sessions, and expressed a desire to continue educating new staff even after the research team completes the study. However, confusion existed with regards one particular component of the intervention, and this compromised full implementation of the intervention.

Conclusion: This study confirms the feasibility and acceptability of the RAPID intervention. However, limitations exist with regards the uncontrolled nature of this study. Furthermore, important modifications are required prior to larger scale evaluation.

PO3.55. Personal attention is essential: interrelationships in the triad of residents, families and nurses

ENGELS Josine1, ACHTERBERG Wilco1,2

1Topaz, Leiden, Netherlands, 2Leiden University Medical Centre, Leiden, Netherlands

In order to strengthen the relational essence of quality of life and care, care organisation Topaz participates in 'Radical renewal nursing home care: from regulations to relations', a national endeavour organised by the Dutch Ministry of Health, Welfare and Sport and national client organisation LOC. At the start, a qualitative research was performed, focussing on interrelationships, encompassing two of the three relationships in the triad of residents, nurses and families; between residents and nurses and between nurses and families. It explored the essential aspects of these interrelationships from the perspectives of residents, families and nurses in a local nursing home. It used a mixed-method approach of interviews with residents, families and nurses, focus groups and observations. 

In general, the results indicated a remarkable consensus on several aspects between the different categories of participants. Dignity and respect for personal wishes, needs and preferences were essential aspects in the relationship between residents and nurses from all perspectives. Everyone expressed the importance of genuine attention. Both residents and families applied several coping styles in this situation, which was not always recognised by the nurses. Reciprocity was essential according to residents and nurses, while barely mentioned by families. The attitude, knowledge and skills of the nurses were pointed out by all participants as crucial aspects. According to the families and nurses, regulations, bureaucracy and administration are time-consuming barriers, which constrain residents and families in their personal freedom and nurses in professional freedom, wisdom and compassion. Additionally, nurses are restricted, often reinforced by themselves or colleagues, by confusing adages about professional distance and the preoccupation with being active. This study concludes that both passive presence and attachment are valuable for nurses and residents. A conducive environment is needed to create opportunities for change in daily care and thereby stimulate the development and increase of interrelationships. 

PO3.56. Quality indicators for the early detection of nursing risks

SAßEN Sascha

Korian Germany, Munich, Germany

National expert standards and accepted guidelines represent the current state of generally accepted care knowledge. The DNQP in Germany provides regular updates to all expert standards. These updates are based on new scientific research and findings and evidence that some prior interpretations in the "old" professional standards were found to be incorrect in practice. To ensure a successful implementation, the care facilitators should not only focus on the professional requirements of the standards themselves, but also the modified implementation strategies regarding the subject matter. Within the context of this lecture, the participants will be given examples of the changes/updates to the professional/expert standards for pressure sore prophylaxis, and taught ways to implement the changes into practice. In addition, the quality indicators for the “new” method(s), which support the proactive early detection and prevention of pressure sores, will be explained. Special focus is placed on risk identification and prophylactic care of pressure sores in people with dementia. 

PO3.57. Fall prevention and fracture prophylaxis

SAßEN Sascha

Korian Germany, Munich, Germany

Expert standards and guidelines describe the current level of nursing care and thereby create important indicators for assessing the care quality for people with dementia. Special focus will be placed on the topic of fall prevention, as a person’s right to freedom/not be restrained and the care expectation of not being injured are diametrically opposed. If nursing homes are able to demonstrate adherence to the accepted care standards, they successfully mitigate their liability exposure and the associated consequences, while also ensuring a reduction of falls. To ensure the successful implementation, the care facilitators should not only address the professional requirements of the standards themselves, but also the implementation strategies and further guidelines on the topic. The lecture will explain the assessment of an individual fall risk profile for people with dementia, as well as preventative measures for this target group, according to the most up-to-date care knowledge. Special focus is placed on risk identification and prophylactic care of fall prevention in people suffering from dementia. 

PO3.58. Relationship planning in the care of people with dementia - expert standard in Germany

SAßEN Sascha

Korian Germany, Munich, Germany

Shaping relationships in care for people with dementia – a new Expert standard of the DNQP in Germany. The new expert standard titled "Shaping relationships in care for people with dementia" was agreed upon as a part of the DNQP's best practices in October 2017. The content of the new expert standard is the result of research performed by a group of 14 experts under the scientific leadership of Prof. Dr. Ing. Martina Roes (German Centre for Neurodegenerative Diseases, DZNE, Witten). The basis of the new expert standard is an analysis of national and international research literature, developed by a team of scientists. The lecture will make observations and specifications regarding the topic of “caring for people with dementia”, and point out the needs and demands of people with dementia, and how to preserve and promote their sense of identity and strengthen their sense of being human. The intention and key component of the new expert standard is to ensure that every person in need of care is offered the opportunity to shape their relationship(s) in a way that acknowledges and promotes their need to be heard, understood and accepted, as well as their need to be connected to other people.

With this in mind, the expert standard places the focus on shaping and promoting relationships with people with dementia. The goal for care/nursing specialists is to recognize and acknowledge people with dementia as equal counterparts.

Thereby caregivers are contributing to the person’s sense of identity, and their need to be heard by, accepted by, and connected to other people. In order to achieve this, caregivers must also face the challenge of imparting this competence of awareness and recognition, to individuals within the immediate social surrounding of the person with dementia, such as relatives or assistants.

PO3.59. Dementia special care units in nursing homes – a rapid realist review

VOELZ Silke, PALM Rebecca, HOLLE Bernhard

DZNE Witten, Witten, Germany

Background/Aims: Studies report non-consistent results about the effectiveness of dementia special care in nursing homes. None of the studies give answer to the question if the effectiveness possibly varies as a result of underlying mechanisms and influencing contextual factors. Consequently, it is difficult for nursing home providers to understand existing research results and transfer them to their care settings. With our rapid realist review, we aim to create an initial program theory of how, why and for whom Dementia Special Care Units (DSCU) in nursing homes work or do not work.

Methods: Our initial program theory will be based on configurations of context, mechanism and outcomes (CMO). The CMO-configurations are to be developed within arapid realist review. The review is based on primary national grey literature and literature published in international scientific journals. Literature is identified by national experts in the field and a systematic search in 4 databases (PubMed, CINAHL, PsycINFO, Scopus). Only available literature that refers directly to a setting defined as a DSCU in a nursing home (no matter what the topic, research question or study design of the source is) is included. We extract data by categorizing them into deductively developed categories (intervention, context, mechanism, outcome) that are subdivided into inductively developed subcategories. While potential contextual factors and outcomes mostly are explicitly described in the literature, the underlying plausible mechanisms have to be assumed. The CMO-configurations are to be discussed with content experts and tested in a subsequent study.

Impact of the study/Outcomes: Within the initial systematic search we identified 449 publications (without duplicates). A number of 14 relevant sources identified by experts were added.

We will present preliminary CMO-configurations that will be the basis for the development of an initial program theory concerning DSCUs in nursing homes.

PO3.60. Fundamental nursing care for residents living with dementia: a qualitative study exploring views of home staff

WOOD Chloë

University of Exeter, Exeter, United Kingdom

Background: There is an increasing recognition of the importance of fundamental nursing care; an area particularly important in caring for people living with dementia. Amalgamation of Marginal Gains (AMG), the process of making a number of small changes that combine together for an overall improvement, has been suggested to be a potential intervention for improving quality in healthcare. The objective of this study was to explore the views and experiences of nursing staff on the planning and delivery of fundamental nursing care (focussing on nutrition, mobility, hygiene and elimination needs) for residents living with dementia in nursing and care homes. Initial views on the concept of AMG, and its potential use in this setting, were also explored.

Methods: Semi-structured face-to-face interviews were carried out with a purposive sample of individuals from three staff groups; managers, registered nurses and care assistants. The interview audio recordings were transcribed verbatim and analysed using a thematic framework method; a systematic and transparent approach of five stages; i) familiarisation ii) identifying a thematic framework, iii) indexing, iv) charting and v) mapping and interpretation.

Results: Nineteen members of staff were interviewed (7 managers, 7 registered nurses and 5 care assistants) from care and nursing homes in England.  Identified themes include; familiarity of the ideas of AMG, the importance of knowledge sharing between staff when planning and delivering care, maintaining consistency of care and the need of a personalised and flexible approach to caring for residents with dementia.

Conclusions: AMG has a potential use as an intervention in a nursing and care homes and further development work is justified. A future AMG intervention targeting fundamental nursing care for residents living with dementia would need to consider the emerging themes from the staff interviews for it to be workable and acceptable in practice.

PO3.61. “4 paws for a smile”

HALSDORF Michèle

Association Luxembourg Alzheimer, Luxembourg, Luxembourg

Assistance dogs in the care of people with dementia: introducing animal-assisted interventions at the nursing home “Beim Goldknapp” operated by the Luxembourg Alzheimer’s Association (ala)

Since 2010, the Luxembourg Alzheimer’s Association supports and promotes the use of assistance dogs at the nursing home “Beim Goldknapp”.

The association’s assistance dogs are provided to the institution by HANDI’CHIENS, a French association, which has successfully trained more than 1.500 assistance dogs since 1989. They pursue the task of supporting nursing staff and therapists in the accompaniment of people with dementia. The dog becomes a mediator, a link between humans.

At the nursing home “Beim Goldknapp”, two assistance dogs called Happy and Holly accompany the caregivers in their work with people with dementia. Their referents are responsible for the dogs’ daily life: diet, rewards, sleep and recovery, hygiene and health.

Welcoming an assistance dog is a collective project that requires the long-term involvement of a united team.

Animal-assisted interventions with the assistance dogs:

  • Support during care and therapy
  • Support in stressful situations
  • End-of-life accompaniment
  • Walks
  • Grooming
  • Basal stimulation
  • Biographical workshops
  • Gymnastics
  • Creativity workshops & art therapy
  • Music workshops

Benefits for people with dementia:

  • Stress reduction
  • Reassurance
  • Motor skills
  • Concentration
  • Communication skills
  • Social life

 

 
 

Last Updated: Thursday 15 November 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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