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P23. Care services

Detailed Programme, abstracts and presentations

P23. Care services (Saturday, 6 October, 10.30-12.00, Europa 5)

P23.1. Occupational therapists, speech therapists, psychomotor therapists and psychologists: which place in dementia care in france ?

Laëtitia Ngatcha-Ribert, Danièle Fontaine, Jean-Pierre Aquino

Between 2010 and 2012, the Fondation Médéric Alzheimer has surveyed in France four professions particularly involved in dementia care: occupational therapists, speech therapists, psychomotor therapists and psychologists, in order to gather a better knowledge of their practices (interventions, therapeutic approaches, relations with other professionals and families), issues and challenges faced.

Methods: Data were collected through 4 specific postal 15-item surveys, one for each profession. Quantitative data using closed questions were obtained from 1,495 occupational therapists, 4,262 speech therapists, 1,184 psychomotor therapists and 3,250 psychologists. Qualitative analysis used free written accounts of 369 occupational therapists, 380 speech therapists, 163 psychomotor therapists and 403 psychologists.

Results: Only 70% of responding occupational therapists, 64% of speech therapists, 26% of psychomotor therapists and 29% of psychologists declared that they had already cared for people with dementia. Dementia care was improved through the contribution of different professional practices:

42% of occupational therapists provided home interventions to adapt the environment, prevent falls and propose technical aids; 68% intervened in care homes, mainly to provide cognitive or physical readaptation and fall prevention;

70% of speech therapists provided evaluation of speech and cognitive functions and 58% evaluations of communication

92% of psychomotor therapists provided interventions to enhance body awareness and balance, emotional readaptation in walking (76%), regulation of tonus and emotion (78%), regulation of psychomotor disorders (76%)

40 % of psychologists intervened in the diagnosis approach. 90% of psychologists provided individual psychological support and 41% cognitive stimulation.

Common challenges in professional practice included issues with people with dementia (autonomy, comorbidity, communication…), with the circle of family and friends or with other care professionals. On a qualitative basis, emerging themes shared by the four professions included the time dimension, changes in views about dementia and people with the disease, changes in professional practice, perceptions of specific dementia care skills required in each profession. However, the four professions had specific way of expressing their differences, both in rhetoric and themes approached (doubts, self-limitation, end-of-life, questions about when to stop interventions…).    

Conclusion: These surveys, unique in France in terms of extent and scope, show the wealth of professional roles of occupational therapists, speech therapists, psychomotor therapists and psychologistsin dementia care.

P23.2. Dementia Care in Acute Hospitals in Germany

Christiane Pinkert, Bernhard Holle

The care of people with dementia (PwD) is one of the outstanding challenges for acute hospitals in the near future. In Germany about 12% of all patients in acute hospitals are PwD. (Arolt et al. 1997). For these patients a hospital stay can lead to adverse outcomes, such as functional and cognitive decline, delirium or nosocomial infections. The special clinical setting, the increased use of sedative drugs and the lack of normal daily routines seem to favor these critical situations (Kleina & Wingenfeld 2007). The health care professionals in Germany are not well prepared for caring for older patients with cognitive impairment and psycho-geriatric disorders.

In recent years a few hospitals in Germany have started to develop care concepts to face the specific care needs of PwD in acute hospitals. Until today there is a lack of systematic research concerning the different concepts and practical projects which are realized in German hospitals.

At the German Center of Neurodegenerative Diseases a study is being carried out to identify and analyze various care concepts. The aim of this research is to get an in-depth view of general conditions, core aspects, implementation barriers and expected outcomes of different approaches. The results could lead to recommendations and references for all hospitals wanting to improve the care of patients with dementia.

Therefore a qualitative approach was used and 17 interviews with experts and 6 group discussions with nurses and physicians were conducted. The data analysis was realized using the content analysis and documentary method.

The results show that hospitals focus mainly on the qualification of staff members and on environmental changes. Also the integration of family members and volunteers in care plans characterize most of the new concepts. But there is still a lack of commitment on the part of all professionals and hospital managers to adjust acute hospital care to the needs of people with dementia.

P23.3. Dementia Network Krefeld Patient centred Care with Constancy and Stability

Ralf Ihl, Katrin Krah, Dirk Bahnen

Many structures of care and services in dementia suffer from an insufficient cooperation of the medical and psychosocial system. One of the main challenges is to connect both systems. The dementia network Krefeld tried to overcome these difficulties and, moreover, it included the demand to deliver constancy and stability to the patient and to make participation and self-determination and respecting ethical requirements possible.

The network includes four work areas: services, organisation, development and research. When a practitioner has the suspicion of dementia in a patient he invites him to a further visit with the attendance of a case manager. A second way into the system starts when a patient comes to a ward of a somatic hospital. A contact person is educated on every ward and connects the patient via the dementia coordinator to the case manager. From this point on the case manager will accompany the patient over the whole duration of the disease.  For legal, financial, social and service structure questions he will be the contact person. The structure of the dementia network is supported by the other structures of the network (i.e. organisation, development and research). Consultants of the network are Alzheimer Associations of the region, the country and the nation as well as specialist organizations on a regional, country, national and a European level. The network is evaluated by several universities.

P23.4. Care Services - How Self Directed Support (SDS) can help people with dementia to remain living in their own homes

Yvonne Stewart 

Many people with dementia would like to remain living in their own homes for as long as possible.  However the system of social care in Scotland is not always sufficiently flexible to work in harmony with informal sources of support that people with dementia may have

Self-Directed Support (SDS) is a way of providing social care, which provides individuals with a range of options which empower people to direct their care - to have informed choice and control about how their support is provided.

The Scottish Government provided 2 years funding for a pilot to support people with dementia at risk of going into care to use SDS as an alternative, to assist them to remain at home.  In 2009 there were only 97 people with dementia in Scotland using SDS.  As a result there was little evidence of the effectiveness of SDS, or if there was a desire amongst people with dementia and their families to use SDS.

Numerous barriers were identified for people with dementia and their families to accessing SDS. The pilot identified cultural, legal, financial, attitudinal and knowledge barriers which made accessing SDS particularly challenging for people with dementia. 

69 people with dementia and their families participated in the pilot, consultation took place with over 200 people and 31 families supported to apply for SDS, of which 23 were successful. 

The pilot has helped to promote and publicise the benefits of SDS for people with dementia which has enabled them to have more choice, control and flexibility over how their care needs are met and people who used SDS reported being able to remain at home for longer, have a better quality of life, higher levels of satisfaction with their formal support services and families felt more able to balance their caring role with other responsibilities. 

The presentation will highlight the key findings from the pilot, these include, better outcomes for people with dementia and their families; reduced admissions to hospital and delayed admission to care homes; overcoming barriers to SDS; and how learning and knowledge was shared to improve the access to greater choice and control through SDS.

P23.5. Developing International Rural Dementia Care Service Excellence

Clare Cutler, Anthea Innes, Michelle Board, Marilyn Cash, Peter Birkett, Debra Morgan, David Edvardsson, Amit Dias, Allison Cammer

There is an international void of examples of effective and innovative rural dementia services and no central repository for networking and support. Whilst there is a growing body of research focusing on rural dementia care there is a need for instant access to such information by practitioners, educators, service commissioners and providers, and academics for translation into their specific country or regional context.

This study seeks to develop the idea and concept of establishing an International Gateway (for international rural initiatives in dementia) to best practice and research evidence which would be assessable to practitioners, policy makers and academics worldwide. This platform of knowledge would give access to evidence for rural services across countries to enable new and effective ideas to be used and applied for better outcomes for rural people with dementia. GRIID would be the catalyst to bring research and innovation into the rural sector, improve client outcomes and raise the profile of rural dementia care. This paper will focus on the first steps in developing such a gateway and will discuss the findings from a survey of Alzheimer’s Associations worldwide.

P23.6. Evolving Nurse Practice – a family-centred approach to specialist dementia care nursing

Karen Harrison-Dening, Penny Hibberd

5.4 million people in the European Union currently have a form of dementia. It is predicted that this number will double in Western Europe and triple in Eastern Europe by the 21st century (Ferri et.al. 2005; Hoffman et.al. 1991). The impact on services to the growing numbers of people with dementia has been the relentless scrutiny of quality care. In the UK this has been particular of nursing in relation to core values, attitudes, knowledge and specialist skills (DH 2009). The practice of the specialist nursing service discussed in this presentation is underpinned by recent completed doctoral work that clearly articulates the principles and values for a family-centred dementia care specialist nursing role (Hibberd 2011).

This presentation will discuss:

  • An appreciative inquiry approach to developing the core principles of a family-centred approach to specialist dementia care nursing. Four core principles were defined, attributes (1), meeting the needs of the carer (2), knowledge and skills (3), and working across organisations (4). Within each core principle a set of nurse values were identified for example, kindness, friendliness, trust, continuity, flexibility, knowledge and therapeutic skills.
  • The model ‘caring relationships’ that was developed alongside the core principles that provides a framework for specialist dementia care nursing. The model underpins the flexible family-centred approach to this specialist nursing role which supports the values and principles. 
  • The structure of practice development and supervision that have supported the evolvement of this specialist dementia care nursing practice by embedding the core principles and family-centred model.

 

 
 

Last Updated: Thursday 15 November 2012

 

 
 

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