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P17. Preventing behavioural problems and hospitalisation

Detailed programme, abstracts and presentations

P17.1. Fire and rescue service and Age UK collaborate to keep people with dementia safe, well and independent

Morris Evan, Clemens Ken

Cheshire and Rescue Service and Age UK Cheshire have worked together for a number of years to help older people stay safe from fire in the home and to access the advice and support they need to live independent and fulfilling lives. This unique partnership, known as Springboard, targets at-risk individuals through UK national health service (NHS) information supplied under a groundbreaking data-sharing agreement.

In what is thought to be a national first, Springboard has recently employed a specialist dementia adviser. The post is half-funded by the fire and rescue service and half by the NHS, commissioning through Age UK Cheshire. The collaboration recognises that there are now more than 4,200 people living with dementia in western Cheshire, but also that more than half of all fire deaths and injury in the home nationally are among people aged 60 and over. Recent research has also shown that impairment, disability and dementia are a substantial factor in increasing someone’s risk of injury or death from fire in the home.

Since her appointment in June 2012, the adviser has supported 140 individuals. Experience gained from UK Department of Health trials show that those living with dementia require practical and emotional support to enable them to live well and safely in their own homes and avoid hospital admission. As such, she signposts to a diverse range of services that maintain independence - such as those advising on employment, access to benefits, support networks, home environment, falls prevention, assistive technology and community equipment. Evaluation is ongoing, but we have had powerful feedback direct from carers about the significant difference the adviser is making to their lives. Early discussions are also underway about appointing a second adviser in eastern Cheshire, as agencies begin to recognise the potential savings that can be gained from avoiding admission to hospital or residential care.

P17.2. A management plan for people with dementia:  an experience of a special care unit

Bonora Annalisa, Bevilacqua Petra, Turci Marina, Fabbo Andrea

The main problem in dementia illness that caregivers have to afford usually concerns the management of behavioural problems. The Mirandola dementia care unit provides temporary admissions to dementia patients to study problems and find proper solutions especially working with non pharmacological strategies like gentle care, occupational therapy and multisensory stimulation. The analysis of benefits was based on a multidimensional evaluation of patients obtained by comparing the data at the entrance, at discharge and at periodic follow-ups (6, 12, and 18 months after discharge). Among other data we measured the NPI scores (Neuropsychiatric Inventory) and the consumption of sedative drugs. Patients had moderate-severe dementia diagnosis and behaviour disorders for an NPI score higher than 24 at the entrance. The study was developed on 63 cases71% of the people hospitalised in the NA was discharged with a domiciliary project. The comparison made between the average NPI scores obtained at the entrance (44.66) shows a significant reduction in behavioural disorders at discharge (30.45, p <0.05) which was maintained at a distance of 6 (28.81; t = 3.663, p <0.05) and 12 months (21.29, t = 2.743, p <0.05). These outcomes suggest that it is possible to plan a home care for dementia patients in their average and late stage with behavioural disorders. This is promoted in the dementia care unit by the prevention of situations that can generate agitation and aggression in these people. These benefits seem to last even after a period of 12 months after discharge.

P17.3. The UK Memory Services National Accreditation Programme (MSNAP)

Orrell Martin

Background: The lack of a consistent model means that the quality and characteristics of memory services can vary greatly. A nationally agreed set of quality standards would help improve UK memory services.

Objectives: To develop and implement standards for memory services as part of a national quality improvement programme.

Method: The development of the standards involved a literature review/content analysis; key stakeholder workshop; stakeholder consultations; consensus meeting; and a final consultation process obtaining endorsements from key organisations. Thirteen memory services participated in the pilot programme using draft set of quality standards through the processes of self- and peer review.

Results: The MSNAP standards consisted of 148 quality standards covering: management; resources for assessment and diagnosis; processes of assessment and diagnosis; and ongoing care management and follow up. The pilot stage highlighted common areas where improvements had been made, such as finding out whether the patient wished to know their diagnosis, and areas where attention was still required, for example surveying referrers, patients and carers about their experiences of the service.

Conclusion: It was possible to develop and field test nationally agreed quality standards for memory services. Seventy UK services have now joined MSNAP and this will improve the quality of UK memory services. MSNAP has recently been endorsed by the UK Prime Minister as part of his Challenge on Dementia.

P17.4. Preventing aggressive behaviour and BPSD – a multicomponent method and organisational model

Andersen Knud D.

Background: As a part of the Danish National Dementia Plan, the project has developed a multicomponent method that will help care homes leaders and employees, to better analyse and meet the needs of persons with dementia, who might develop aggressive behaviour.

Objective: To develop and test a new method and an organisational model for good care and support for persons with dementia and challenging behavior. Furthermore, it identifies how leaders and experts in the care homes are to work together, both inside and outside the carehome: with psychiatrists, general practitioners, and other specialists, and with the staff. In order to deliver focus on the person, and finding ways to give the right care, in order to minimise the aggressive behaviour. Thereby the specialised knowledge is taken in consideration and the organisational structure, that constitutes a well equipped care environment, is thoroughly outlined.

Design: The method describes both the roles, responsibilities and tasks of leaders, experts in care homes, and of front personnel. It enables them to better deal with challenging behaviour. It defines key aspects, where staff will need special skills and knowledge, in order to obtain the right competences. It also describes a model with specific procedures that must be followed, so leaders and caregivers can deliver the best care for persons with dementia. The goal throughout is to ensure implementation and foundation of the method and organisation as a natural part of the care.

The target group: Behavioural issues are mainly seen as a symptom of insufficient or unhelpful factors in the surrounding care environment, and as a way for the person to communicate their needs. On the other hand, the model is very focused on making leaders and caregivers better suited for this very complex job that is in many respects different from “normal” dementia care. This makes the care homes better equipped to deliver the best possible care, to persons with severe dementia (often of the frontotemporal variants). The project uses both qualitative and quantitative methods to monitor the impact of the project on behaviour in care homes, and in the way the personnel thrives.

The activities: The project followed nine care homes in three different municipalities in Denmark. In all three, leaders, care managers and dementia experts and coordinators are involved in the project. Up to 50 staffers are given at least 8 days of courses, in order to upgrade their skills.

P17.5. Caregiver needs analysis for product development of an assistive technology system in dementia care

Megges Herlind, Jankowski Natalie, Peters Oliver

Background: Our research focuses on suitable methods for the product development of an assistive technology system in dementia caregiving. It is a challenge to manage the interdisciplinary work, as many professions, such as designers, informatics, gerontologists and psychologists are part of the development process of such a product. Furthermore, to successfully develop the technical devices that provide a real relief for caregivers and people with dementia, it is inevitable to include the users in the development process.

Aims: The main focus in our studies was to figure out the wishes and needs of caregivers regarding an assistive technology system. The issue of how the functional needs of caregivers correlate with different stress-factors and resources was investigated. Later on we evaluated a prototype version with experts. In this study we focussed on usability and technological reliability.

Methods: We refer to usability-research-methods to serve the user-designer interface adequately. To evaluate the different prototype versions we used a mixed-methods design. Descriptive statistics, inter-correlation analyses and regression analyses were performed. For qualitative examination a content analysis was accomplished.

Results: Regression analysis of the user test with the caregivers (N=20) revealed that especially older caregivers (ß=-.69,*p<.05) who felt unhealthy (ß=-.46,*p<.05) are less interested in community and information features (R²=.50, p=.006). Younger caregivers who are not living together with the care recipient, can benefit of community and organisation features. Regression models for security functions and the overall evaluation of the system were not significant. Features concerning security, such as locating and fall-detection assistance do have a high potential and are essential for all caregivers regardless of other factors. The results of the expert-based evaluation (N=17) demonstrated the high relevance of usability factors. Prevalently the appraisals emphasized the need to reduce the spectrum of features for potential users and to significantly improve the design and the technical functioning.

Conclusion: For the further development of the system the results of our research provide important implications which can also be used by related science departments. It is the most relevant task to implement security features. Furthermore it is required to develop modularised and individual assistive technology solutions to address the diverse needs of caregivers.

P17.6. Cochrane Review: Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

Qazi Afifa, Orgeta Vasiliki, Spector Aimee, Orrell Martin

Background: Anxiety and depressive symptoms are very common in people with dementia or mild cognitive impairment and reduce quality of life. However antidepressants have only limited effectiveness and there have been few psychological treatment studies try and improve mood. The studies included individual or group interventions and most are based on established psychological models such as cognitive behavioural therapy. 

Aim: The aim of this systematic review was to examine the evidence of effectiveness for psychological treatments in reducing anxiety and depression for people with dementia or MCI.

Design: We searched the Cochrane Dementia and Cognitive Improvement Group's Specialised Register and additional sources for both published and unpublished data. Randomised controlled trials in people with dementia or MCI comparing a psychological intervention with a control or comparison group receiving no specific psychological intervention were included. Two review authors (AQ, VO) worked independently to select trials, extracting data and assessing studies for risk of bias using a data extraction form. We contacted authors when further information was not available from the published articles.

Results: Four randomised controlled trials involving 374 participants met the inclusion criteria. The studies evaluated counselling, psychodynamic approaches, or multimodal interventions combining exercise, CBT and support groups. The meta-analysis of the data favoured psychological treatments but the difference was not statistically significant, and the overall improvement was small. Only one study measured outcomes for anxiety. No adverse events were either reported or identified. The two studies using counselling approaches found a reduction in depression in people with dementia. The 2 studies that used psychodynamic or multimodal CBT approach found no differences between treatment and usual care in depression outcomes. Most of the trials included people in mild stages of the disease, although one of the trials included people with severe dementia.

Discussion: There were some suggestions that psychological interventions could improve mood but overall there was no clinical benefit relative to the control group. Limitations include the great variability in the nature of the psychological interventions used, the small sample sizes and differing methodologies. Further randomised controlled trials are needed to evaluate the effectiveness of psychological interventions in reducing anxiety and depression in people with dementia and mild cognitive impairment.



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