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P16. Residential care

Detailed programme, abstracts and presentations

P16.1. Proxy-rated quality of life in residential dementia care – Identification of influencing factors

Gräske Johannes, Meyer Saskia, Wolf-Ostermann Karin

Objectives: Dementia is a major reason, for relocation into residential care facilities. Because of a lack of curable treatment, it is considered that quality of life (QoL) is a major outcome in dementia care. However, a “Gold Standard” for measuring QoL in dementia care is lacking, yet. A broad consensus is, that self-ratings are the most appropriate way to evaluate QoL. In various studies confounding factors of a valid self-rating were identified. However, in later stages of dementia, proxy-ratings, e.g. by nurses, are the way of choice. This method is less critical discussed. Influencing factors on proxy-ratings, like caregivers´ QoL or burn-out, are hardly investigated. The aim of the present study is to identify resident-related and nurses-related characteristics influencing a nurses-rated QoL of people with dementia in long-term care facilities.

Methods: A cross-sectional study was conducted in five nursing homes with altogether ten special care units for people with dementia using written standardised questionnaires. Nurses were asked to rate each residents’ QoL using the QUALIDEM and the ADRQL. In addition to socio-demographic characteristics of the residents, we examined the functional status (Barthel Index, BI), need-driven behaviour (Cohen-Mansfield Agitation Inventory, CMAI) and severity of dementia (Global Deterioration Scale, GDS). Furthermore we assessed the circumstances of the QoL-evaluation (e.g. beginning of the shift) and staff characteristics, e.g. socio-demographic data, burn-out (Maslach Burn-Out Inventory, MBI), satisfaction with life (SWLS) and attitude towards people with dementia (Approach to Dementia Questionnaire, ADQ). Multivariate ANCOVA-models were used to analyse confounding factors and to estimate their impact on the QoL-ratings.

Results: 130 residents (81% female, on average 85 years old) were included into the study. Predominantly, the residents are with a severe level of dementia (GDS 7). More than 50% of the residents showed at least one need-driven behaviour. 88 nurses (84% female, on average 37 years old) rated the residents’ QoL moderately. The circumstances of the evaluations differ, e.g. done at home, or during the shift. Overall, we found great variations in the staff-rated QoL of single residents. Explaining factors for the QUALIDEM total score (ANCOVA: p < 0.001; R2 = 0.165) and ADRQL total score (ANCOVA: p < 0.001; R2 = 0.244) are among others burn-out (MBI) and the nurses’ satisfaction with life (SWLS). Further results will be presented at the conference.

Conclusion: The results give an understanding, how nursing staffs perceive residents’ QoL. This is a precondition to obtain more valid proxy-ratings of QoL for people with dementia and finally also a basis to provide tailored care.

P16.2. Gardens: living spaces for the well being of people with dementia and their relatives

Villez Marion, Guisset-Martinez Marie-Jo

Since 2003, there has been a growing interest for outdoor spaces in care settings for people with dementia. They became a key issue in public policies and for the staff. In this context, the Fondation Médéric Alzheimer decided to conduct a study on gardens in day care centers, nursing homes and geriatric hospitals.

This qualitative study includes 21 projects, in France and abroad, and is based on field investigations through direct observations, interviews of people with dementia, families and staff members. In addition, our work has been enriched by the learnings of a national seminar of professionals to confront and share their practices. This research is not about defining an exclusive type of garden, or setting up guidelines and standards. Rather, it enhances knowledge about the wealth and variety of gardens observed from the experience of project leaders who have made outdoor spaces more attractive and lively. The analysis of the diversity of practices and outcomes of the gardens, in terms of well-being, social life and quality of life constitutes the key issue of this work. To describe the various initiatives, we built a typology of nine garden categories according to their main distinctive features. We also studied the motivations of the staff to be committed in a garden project and the processes of designing and setting up such a place.

The free access to nature and to a sensory experience (fresh air, water, trees, plants, animals, etc.), the pleasure of gardening are some of the treasures provided by gardens. Such gardens can also become spaces that everyone can take over in his own way. It is also an appropriate support to empower people with dementia, to strengthen social and family bonds, and to connect the inside and outside of the setting. To make all this possible, some conditions have to be fulfilled: taking into account the wishes of the people with dementia, promoting commitment of the whole team (manager and staff), sharing a common vision of dementia care, and dedicating some financial resources.

P16.3. Multimodal non-drug therapy on dementia symptoms in nursing home residents with degenerative dementia in Thailand

Chankrachang Siwaporn, Singhanetr Sasiwimol

Objectives: To determine the effect of multimodal, non-drug therapy on depressive symptoms in Nursing Home residents with degenerative dementia.

Design: Observational study in one nursing home in Chiang Mai province.

Participants: Nursing home residents with primary degenerative dementia (Mini-Mental State Examination score < 24).

Intervention:  The intervention comprised three components: motor stimulation, activities of daily living, and sensory stimulation.

Measurements: Overall geriatric symptoms were recorded using the Nurses' Observation Scale for Geriatric Patients, ADL functional independence using the Barthel Index, and caregiver evaluation.

Results: 38 were included in the intention-to-treat analysis At early at 1 week, results of the per-protocol analysis (n = 37) showed improvement of the caregiver happiness index. The total care time per case is also reduced.

Conclusion: As early as 1 week the multimodal intervention improved behavioural symptoms in nursing home residents, especially in social behaviour and IADL capabilities.

P16.4. Social interaction and dementia: how people with dementia behave when they are put in social situations? An observational study

Mabire Jean-Bernard, Garitte Catherine, Vernooij-Dassen Myrra, Octave-Rolland Coralie, Gay Marie-Claire

Effective communication processing is central for the development and maintenance of social interactions. In dementia, social interactions are less obvious because of the nature of the disease, which involves difficulties in words finding and in verbal comprehension. We have little information about the nature of social interactions of people with dementia, especially in nursing home. This is surprising, since they constantly meet each other in such structures. How do they communicate to each other? The main objective of this study is to investigate social interactions between people with dementia who first meet, using direct observation.

Methodology: 54 residents with dementia, living in a French nursing home and volunteered to participate were drawn lots, matched by age, gender, socio-cultural level and severity of disease in 9 groups of 6 residents. Each group is invited to a meeting of 30 minutes and their behaviours are filmed. We constructed an ethogram of observation to evaluate auto and hetero centred behaviours like facial expressions, look or verbal interactions for example. All the data were analysed by two raters to have a satisfactory agreement score of video coding. Analysis of the results is in progress. The auto-centred behaviours and social interactions observed will be presented in descriptive ways and in terms of frequency of occurrence. The perspectives of this study are: 1. To give information about social interactions of people with dementia living in nursing home when they are put together. 2. To propose an observational tool to analyse social interactions of people with dementia. 3. To have some tracks of practical applications to improve social interactions between people with dementia living in nursing homes. 

P16.5. Data collection and processing in care of persons with dementia

Holmerová Iva, Mátlová Martina, Hýblová Pavla, Janečková Hana, Vaňková Hana, Wija Petr

The long-term care is one of the main problems of public health and health policy in Europe. International documents define long-term care (LTC) as spectrum of services provided to persons with long-term limited self-sufficiency  who are dependent on the assistance of others and their ability to perform basal and instrumental activities of daily living is limited (over the extended period of time). This situation may occur in any age, however there are mainly persons of older age, who suffer more frequently from degenerative and neurodegenerative diseases, mainly dementia.  The quality of care for persons with dementia provided by some institutions is insufficient. This situation is known also in the Czech Republic as the term „long-term care hospital“ (LDN in the Czech abbreviation) has become generally synonym of bad quality of care or bad quality of life of persons who live there The situation of LTC provision is  complicated by the fact that it is not sufficiently defined, nor in the legislation, LTC services are provided in the health care system by different institutions (LTC hospitals, departments of aftercare, psychogeriatric departments, continuing stays in health instiutions because of social reasons etc.) and also by different social care institutions (so called nursing departments in homes for seniors, homes with specific regime etc.). As we have mentioned above the legislation is not clear, has many gaps with severe impact in practice and does not provide clear guidance for the LTC. There are many organisational problems and system failures LTC care provision. Official control and supervision systems do not address needs of persons with dementia in the institutional care.

Czech Alzheimer Society developed the quality criteria for care of persons with dementia and  system  of quality certification „Vazka“ (according to the logo of the society). This system which includes criteria of care, environment and staff and method of  its evaluation will be presented in the lecture. This research project is supported by the grant NT11325 of the Ministry of Health of the Czech Republic.

P16.6. Integrated sensor-based monitoring for people with dementia in a nursing home to promote a person-centered care

Basel Kikhia, Karlsson Eva

The increase in average lifespan across the world has been accompanied by an unprecedented upsurge in the occurrence of dementia with high socio-economic costs. This abstract presents a comprehensive personal health system for use in nursing homes as well as in private homes. The system, called Dem@Care, monitors daily activities and behaviours by evaluating a combination of clinical parameters related to people with dementia. The system assesses the current condition of the person with dementia and then determines abnormalities in the daily life patterns, which can be used to alert the responsible nursing home staff. Caregivers and clinicians can thus maintain a comprehensive view of the health status and the progression of the cognitive decline, which in turn enable a personalization of care interventions. The aim of the study in the Nursing Home is to evaluate the usability and effectiveness of such a service to support a person centered care of people with dementia in Nursing Homes.

Five significant clinical phenomena have been explored in depth in terms of what technology can offer to better understand the person with dementia: Sleep, Exercise, Eating, Social Interaction and Mood. A person with dementia may face challenges in one or more of these areas, which suggests that a personalised approach to addressing these problems is much preferable. Innovative bracelets for mood detection together with sleep and monitoring sensors placed in the person’s room will be used to observe the behaviour of the person. The usability, acceptability and functionality of the sensorised system will be evaluated through a qualitative approach, which is continued through the phases of the evaluation. In this process the experience of the users will be documented in a systematic way and regularly be fed back to the technical partners in order to further develop the Dem@Care prototypes. The validation and assessment of the Dem@Care technology will be done through a three-staged evaluation process to ensure the saliency and effectiveness of the system being developed. The first evaluation in the Nursing Home will start in June 2013, and the authors will have preliminary results to present at the Alzheimer Europe Conference.

Acknowledgment: This work is part of the European Dem@Care integrated project, funded by the European Union, Seventh Framework Programme (FP7/2007-2013 grant agreement number 288199). The content of this abstract reflects only the views of the authors.



Last Updated: Monday 04 November 2013


  • Acknowledgements

    The 23rd Alzheimer Europe Conference in St. Julian's, Malta received funding from the European Union, in the framework of the Health Programme. Alzheimer Europe and the Malta Dementia Society gratefully acknowledge the additional support provided by foundations and companies.
  • European Union