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Parallel Session: Scales and care measures

Abstracts and presentations

Improving Quality of Life for Alzheimer’s Patients by using their preserved language abilities

Laurent Lefebvre, University of Mons-Hainaut, Belgium,

Communicating with patients with dementia is essential for establishing friendly relations, understanding their needs and more generally, improving a good quality of life for the patient and his/her family. However, it is well-known today that the language ability is impaired at different stages of the disease. If it is now commonly accepted that neuropsycholinguistic impairments are correlated with the disease progress, specifying more precisely the functions impaired at the different stages of the dementia remains necessary.

We met Alzheimer patients at the early phase of the disease (S1), at an intermediate level (S2) and at the terminal phase (S3), and evaluated them with a language evaluation battery. All verbal and written aspects of the language were tested. Results clearly show a loss of language proficiency correlated with the degree of the disease.

Notably, it seems that S1 patients are characterised by an anomia, but they keep an efficient semantic memory. S2 patients produce more often semantic paraphasia, and present semantic memory degradation. Finally, S3 patients are only able to name very familiar objects, their semantic memory becoming strongly impaired. We equally observe strong deficits in language production and writing ability for S2 and S3 patients, but these patients have a relatively preserved reading ability.

These results tend to prove that evaluating the language could significantly ameliorate the diagnosis for Alzheimer patients. We show that impairments in language vary with the degree of the disease, but equally that some abilities remain preserved until the term of it. For example, the reading proficiency stays efficient for S3 patients, and could represent an interesting channel for keeping some relations with the patient. We think that it is important for therapists to have a clear representation of the preserved language abilities in order to adequately adapt their relations and activities at the most efficient level. The aim of our next researches should now be to develop a language battery specifically adapted for neurodegenerative pathologies.

Measuring psycho-social aspects of people suffering from dementia in nursing homes with Quality of Life (QoL) Instruments

Martin Dichter, University of Witten/Herdecke, Germany,
Co-authors: M. Halek and S Bartholomeyczik

Background: A large number of people with late-stage-dementia are living in nursing homes. One important aim of nursing is the maintenance and promotion of their QoL, especially with regard to the psycho-social aspects. One possibility to achieve and to evaluate this aim is the use of QoL-instruments. However, one problem is the minor focus on psycho-social aspects in QoL questionnaires; consequently, they are only insufficiently considered in the caring process. Thus, the demand for standardised instruments of QoL that are suitable for obtaining valuable information on psycho-social dimensions arises.

Aim: The aim of the literature review was to identify and to analyse standardised QoL instruments that are suitable for measuring psycho-social aspects of people suffering from dementia.

Method: The literature review is based on a broad literature research in scientific databases with a focus on German and English publications. The main precondition of the literature research was the applicability of the identified instrument in both all stages of dementia and in nursing homes. Furthermore, the criteria to analyse the identified assessment instruments were their content relevance for nursing, their suitability for practice and their potential to lead to nursing actions.

Results: For this review six QoL instruments could be identified which fulfil the preconditions However, among these instruments the number of dimensions and, thus, the additional benefit derived for nursing practice, varies greatly. Depending on the instrument it is possible to measure emotions, the person-environment-relation, the individual’s self-esteem and his/her social interaction as well as the pleasure of taking part in activities and the care relationship. Furthermore, the instruments differ in their suitability for practice and their potential to obtain information leading to nursing actions. Finally, two instruments were identified that can be recommended for use in pilot nursing practice projects.

Consequences: Standardised QoL instruments offer the possibility to gain regularly and systematically information on psycho-social aspects for dementia care in nursing homes. This information constitutes a new basis for leading nursing actions and puts a greater focus on psycho-social aspects in nursing care.

Psychometric properties of the WHOQOL-BREF in patients with dementia

Ramona Lucas-Carrasco, Institut Catalá de l’Envelliment, Spain,
Co-authors: J. March, J. Gómez-Benito

Dementia is a neurodegenerative disease characterised by impairment of attention, memory, insight and communication. As currently there is no cure for patients, the focus of care is to promote wellbeing and quality of life (QoL). Our objective was to test the psychometric properties of the WHOQOL-BREF in patients with Mild Cognitive Impairment and Dementia. Methods: participants were selected from different centres providing care for patients with dementia (Day Hospitals, Day Centres, outpatient clinics) in Spain. Participants were included if they had a MMSE equal or greater than 12; all lived at home with a known caregiver. The study was approved by the Ethical Committee of the Autonomous University of Barcelona. Methods: We collected socio-demographic information, diagnosis of dementia (DSM-III-R), health perception (healthy vS unhealthy), a list of chronic health conditions, depressive symptoms (GDS-15), functional status (Barthel Index), and Quality of Life (WHOQOL-BREF). The WHOQOL-BREF is a generic quality of life scale which includes four domains (physical, psychological, social relationships and environment) and two global items related to general health and overall quality of life. Results: A total of 104 subjects participated, 64.4% were female, mean age was 78.8. Acceptability of the WHOQOL-BREF was good; percentage of missing information was less than 5%. Reliability, measured by internal consistency (Cronbach alpha) was 0.78 for Physical domain; 0.79 for the Psychological; 0.54 for Social relationships and 0.70 for Environment. A priori expected associations were found between WHOQOL-BREF physical domain with the Barthel Index and the psychological domain with the GDS-15, indicating good construct validity. No significant correlations were found between demographic characteristics (age, gender) and the WHOQOL-BREF. Confirmatory factor analysis of data showed a four-factor solution, basically corresponding to the four WHOQOL-BREF domains which accounted for 53.9% of the variance.Conclusions: Psychometric properties of the Spanish version of the WHOQOL-BREF were good in patients with mild and moderate dementia living at home. To our knowledge this is the first study using the WHOQOL-BREF in this population. Generic and specific QoL measures should be considered by professionals in their daily practice when assessing outcomes in patients with dementia.

Validity of the Severe Impairment Battery Short Version

Roland B. Wetzels, UMC St Radboud, Netherlands,
Co-authors: Jos F.M. de Jonghe, Ans Mulders, Sytse U. Zuidema, Raymond T.C.M. Koopmans

Aim: To examine cognitive function as measured with the Severe Impairment Battery short version (SIB-S) in nursing home patients with moderate to severe dementia, to evaluate construct validity of the SIB-S, and to examine potential floor effects for the SIB-S

Methods: Cross-sectional comparison of cognitive measures, dementia severity and functional dependency.

Results: A total of 290 patients were included of whom 264 had complete SIB-S protocols.

Internal consistency of the SIB-S was very high (Cronbach’s alpha=.97). Principle components analysis produced 3 factors, the first factor explaining more than 50% of common score variance. Semantic memory items loaded highly on the first factor. Total SIB-S scores were associated with cognitive impairment (SIB-S - MMSE rho = .91, p<.001), and with functional dependency (SIB-S - ADL scale rho = -.61, P<.001). SIB-S total scores differentiated between dementia severity as measured with the Global Deterioration Scale (F=164.6 df:3,260, P<.001).Comparisons of SIB-S total score variance across patients with moderate to severe dementia and patients with below or above average Mini Mental State Exam scores, support the lack of strong floor effects in the SIB-S test.

Conclusion: In this first study examining an independently administered SIB-S the scale proved to be a homogeneous and valid measure of cognitive impairment, particularly semantic memory loss. This short scale can be used to assess moderate to severely demented patients who may find it difficult to complete the traditional, lengthier neuropsychological tests.

Pilot study of the Functional Behaviour Profile (FBP): An assessment tool for identifying productive behaviour in daily life

Julien Ochs, Université Pierre-Mendès-France, France,
Co-authors: J. Bourgeois, J. Tyrrell, P Couturier

Background: Dementia can cause multiple psychological difficulties for patients and their caregivers, with a negative impact on quality of life. Furthermore, the effects of cognitive deficits on the daily performance of routine daily activities are sometimes difficult to understand Family caregivers may overestimate or underestimate the residual abilities or emerging deficits. The Functional Behaviour Profile (FBP) is an evaluation tool which aims to help caregivers to identify and describe patient’s abilities (problem solving, performance on tasks and social interaction). This research presents our pilot study of our French translation of this dementia specific evaluation tool

Aims: The purpose of this pilot study was: (1) to establish the clinical feasibility of the FBP functional assessment tool; (2) to evaluate the impact of the FBP on caregivers’ abilities to describe patient performance.

Methods: We recruited patients from people attending a memory consultation clinic in Grenoble University Hospital. We interviewed primary caregivers accompanying a patient with dementia; 30 relatives took part in a semi-structured interview in which they completed a French translation of the FBP In parallel, patients were assessed with other standard psychometric measures (MMSE, ADL, IADL).

Results: The FBP was used in a clinical interview to measure the patient difficulties and productive behaviours, in three domains of activities of daily living. Analysis of clinical data show a valid internal consistency of the scale (? = .90), and a significant moderate correlation between FBP scores and MMSE scores (r = .38; p<.01). The scale’s content is well accepted by French caregivers, and enable them to describe in a structured manner the patient functional abilities in everyday life.

Conclusion: The FBP helped caregivers to identify productive behaviour of their relatives. This information can be used to help the communication between the caregiver and the practitioner so they can jointly plan strategies to maximize and maintain patient’s function. The goal is to provide appropriate advice to the caregiver, and thus to improve the quality of life of community dwelling patients.

Development of an electronic observational pain scale

Greet Leysens, KH Kempen, Belgium,
Co-authors: De Maesschalck L., Bonroy B., Vanrumste B., Triau E., Wils M., Schiepers P, Miljkovic D., Exadaktylos V., Berckmans D.

Pen-paper observational scales have proven to be useful to monitor pain, but have also a lot of disadvantages. The aim of this study is to present and examine the advantages of an electronic observational pain scale. The pilot study (approved by a medical ethical committee) took place in a specific geriatric centre. Patients are included when they’re bedridden and have limited ability to communicate directly. The caregiver has to objectify pain by means of a behavioural observation scale. Their usability is often limited, they are time-consuming because of their duration, they cause difficulties in calculating scores and in post processing required to evaluate the pain evolution. Also the timing and timing patterns of the indicators could be very valuable to assess pain, but cannot be grasped using pen-paper assessment instruments. After an informed consent was signed by a relative, each patient was tracked for 6 random days, in which 6 assessment sessions were performed at clinically interesting moments. As input for the electronic scale, 3 valid and reliable scales were chosen: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Discomfort Scale - Dementia of Alzheimer Type, and the Faces Pain Scale Revised. The electronic device (a tablet PC with a touch screen) allows the caregiver to record indicator events, such as frequency and duration, as they occur in real time.

The scores are calculated automatically. The digital information is stored in a database, improving administration and allowing database applications. With the advantages of the electronic device, nurses will be stimulated to perform more frequent pain measurements. A more adequate treatment can be provided with the knowledge of a more accurate pain level.

Advantages of this electronic observational pain scale are an increased usability, less time-consuming and inclusion of complex timing patterns. This will lead to a more accurate measurement based scoring of pain, a more adequate treatment and thus improving quality of life.



Last Updated: Wednesday 21 October 2009