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Parallel Session: Assistance and support (Institutional care)

Abstracts and presentations

A pluralist evaluation of memory services: Perspectives from people with memory problems, their families and memory service staff

Paul Clive Baldwin, Bradford Dementia Group, United Kingdom,
Co-authors: M. Downs, J. Tasker, M. Jubb, M. Place

In England memory services are considered a key plank in the Department of Health’s strategic plans for transforming the quality of dementia care. While these services have been shown to lead to improved quality of life for people with dementia and their family carers, less attention has been paid to how service users and their families experience these services. The present study reports on a pluralist evaluation of memory services. It addresses the following questions: What do service users and carers feel are the benefits and drawbacks of the memory service they attend? Specifically, to what extent do service users and carers feel their needs for psychological and social support, information and empowerment have been met by the memory service? What do memory service professionals - psychologists, nurses, social workers and old age psychiatrists - perceive to be the strengths/benefits and weaknesses/drawbacks of their service? Implications for policy and practice will be addressed.

Making Meaningful Activities Happen in Care Settings

Maria McManus, Dementia Services Development Centre for Northern Ireland, United Kingdom,

Meaningful activities are recognised as vital to the health and well-being of people with dementia. Maintaining and improving quality of life depends a great deal on having access to activities that are valued and which matter to the person. Critically, activities are a vehicle by which a person’s sense of purpose and sense of themselves (personhood) is sustained and affirmed. In consideration of these truisms, if meaningful activities have so much to offer people with dementia in care settings, how come they don’t happen in the way they should?

Commonly, care settings experience difficulty establishing, sustaining, monitoring and improving the quality of the programmes of activity they deliver. There tend to be disparities between the views of staff and managers about how high-quality, value for money services can be delivered. Typically problems with resources, knowledge and skills will be cited as being central issueS Staff and managers have differing views as to where change needs to take place in order to bring about improvements; often each will consider the other responsible. Family carers and loved ones may not feel empowered or included and, ultimately, people with dementia often do not have access to the variety and types of activities they deserve and which they need to support their well-being. Everyone recognises there is a problem but no-one feels they know what to do.

This paper will provide a critical analysis of the challenges and barriers to providing good quality meaningful activities in care settings. Taking an organisational development approach, the themes of leadership, organisational culture, knowledge and skills, change management and making success happen will be presented.

Needs of persons with and without dementia in residential homes

Hein van Hout, VU University Medical Centre, Netherlands,
Co-authors: Eva van der Ploeg, Marijke Boorsma, Giel Nijpels

Background: Many persons in residential care suffer from dementia but little is known about met and unmet needs. Unmet needs are associated with a decreased quality of life, worse mental health, dissatisfaction with services, and increased costs of care.

Objective: The aim of this study was to compare the number and type of (unmet) needs between residents with and without dementia.

Methods: 224 residents or their family informant were interviewed about 24 topics linked to needs using the Camberwell Assessment of Needs for the Elderly (CANE) interview. 58 of the 224 included persons were diagnosed with dementia. Outcomes were adjusted for age, gender and family informant interview.

Results: Residents with dementia had more needs than persons without dementia (respectively 8.6 vS 7.0 needs, p<0.001). Persons with dementia also reported slightly but not significantly more unmet needs (0.5 vS 0.3 unmet needs, p=0.46). Topics with the most identified needs (met and unmet combined) were ‘looking after home’ (97.8%), ‘food’ (94.7%) and ‘mobility/falls’ (92.4%). Most unmet needs were reported for the topics ‘eyesight/hearing impairment’ (6.3 %), ’mobility/falls’ (4.5%), ’company’ (4.5%) and ‘psychological distress’ (3.6%). Persons with dementia reported more often needs than persons without dementia for ‘memory problems’ and more often unmet needs for ‘managing money’.

Conclusions: People with dementia in residential care reported more needs compared to their counterparts without dementia. Although most needs were met, personnel in residential care settings may be trained to increase awareness and responsiveness to specific needs of people with dementia.

People with dementia in hospitals

Sabine Jansen, Deutsche Alzheimer Gesellschaft, Germany,
Co-author: Hans-Jürgen Freter

Very often hospitals are a bad place for people with dementia. Carers report that some hospitals are not able to work with people with dementia with the result that patients return very confused and lose their abilities. The German Alzheimer Association started its Hospital Project in November 2008. Its goal was to improve communication between people with dementia, family carers and the staff of hospitals. An “Information sheet about people with dementia” was developed. Carers fill it out and give it to the hospital staff. It contains information about daily routines, speaking and understanding language, preferences eating and drinking, likes and dislikes of the patient etc. This sheet was sent out to regional Alzheimer Associations and self help groups which gave it to family carers. Later it was sent to about 1,800 hospitals in Germany. This paper presents results of the evaluation of the project.

Interdisciplinary Implementation of Quality Instruments for the Care for People with Dementia in Nursing Homes

Margareta Halek, University of Witten-Herdecke, Germany,
Co-authors: Daniela Hardenacke, Cornelia Krüger, Gertrud Bureick, Stefan Wilm, Sabine Bartholomeyczik

Dementia care especially for people with challenging behaviour puts high demands on caregivers and nurses. Challenging behaviour can be disruptive, aggressive or even physically harming. However, every behaviour has its reason, also that of people with dementia.

A German guideline for the care for people with challenging behaviour for nurses was developed containing seven recommendations. The first recommendation refers to “understanding diagnostics”. Nurses first have to understand why a person with dementia behaves as he/she does before they decide to initiate or even better to refrain from interventions. Case conference is an important method for implementing “understanding diagnostics“. Moreover, standardized assessement tools (IdA) can help nurses to structure und guide these case conferences. Nurses, key family members, the residents' general practitioners or other involved staff should participate in the meetings. General practitioners who treat residents in nursing homes often lack special evidence-based knowledge of dementia care. Therefore a dementia guideline for GPs was developed and will be implemented in the project.

Aim of the study: Improvement of QoL of residents with dementia and challenging behaviour through understanding diagnostics used by nurses, the utilisation of a dementia guideline by general pracititioners and an improved cooperation of nurses and general practitioners.

Methods - Intervention

  1. Training of nurses in understanding diagnostics
  2. Training of GPs in the German dementia guideline
  3. Introducing regular (interdisciplinary) case conferences, based on the standardized assessment instrument IdA

Design: The implementation-study uses a pre-post-test design (2008-2010)

Outcome measures

  1. Residents’ QoL measured by QUALIDEM
  2. Residents’ challenging behaviour measured by NPI -NH
  3. Residents’ physical maintenance measured by PSMS
  4. Residents’ psycho-pharmaceutical medication

Sample: The study sample includes 200 residents with dementia (MMSE ? 24) in 15 nursing homes in Witten and Dortmund (Northrhine-Westfalia, Germany).

Results: The preliminary results of the pre-test phase of the study will be presented. Furthermore, the advantages and disadvantages of the study interventions (trainings and case conferences) will be discussed.

Explaining American Standards of Care in Geriatric Settings

Jean Szilagyi, St. Joseph’s College of Maine, USA,

The government of the Unites States of America (USA), through the Omnibus Budget Reconciliation Act of 1987, formulated a Residents’ Bill of Rights, to assure kind and considerate care to the residents in long term care facilities. The basis for social justice to the elderly in institutions was derived from social gerontologists, who sought to afford dignity and respect to these citizens. This landmark legislation changed forever society’s legal expectations of nursing homes and their care. Long-term care facilities were mandated to provide services so that each resident can “attain and maintain her highest practicable physical, mental, and psycho-social well-being.”

The goal of this presentation is to review these rights, explain their implementation and practical application. This will realised by a power point presentation outlining the specific “rights”. Examples of confirmed deficiencies as documented by regulatory compliance enforcers will be included.



Last Updated: Wednesday 21 October 2009