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P6. Care in the community

Detailed programme, abstracts and presentations

P6.1. Knowledge and therapeutic management of Alzheimer’s disease among community pharmacists in the Maltese islands

Zerafa Natalie, Scerri Charles

In view of the projected increase in the elderly population in the coming years and the inevitable associated rise in the incidence and prevalence of neurological illnesses, healthcare professionals need to have a better understanding in the various aspects of care and management of Alzheimer’s disease (AD). Notwithstanding the ever-increasing role of community pharmacists towards the optimisation of service provision to individuals with AD, their caregivers and family members, little is known on their level of knowledge about the disease process and its pharmacotherapeutic management. In the present study, all community pharmacists practising in the Maltese islands were invited to participate in a survey aimed at measuring knowledge, attitudes, pharmacotherapy and level of services available to individuals with AD in the community. The overall findings (56.8% response rate) showed that increased age, number of years working as community pharmacist and increase in the number of years since graduation were negatively correlated with knowledge on AD. There was significant lack of awareness on AD pharmacotherapy including the use of antipsychotics in the management of challenging behaviour in AD. Most community pharmacists are not familiar with the services available for these individuals and that communication between the various health professions is almost inexistent. Considering that community pharmacists come into frequent contact with individuals with AD, these results show a need for increasing knowledge about AD among these healthcare professionals in the hope of enhancing high-quality dementia care in the community.

P6.2. Delivering integrated dementia care in Scotland: The 8 pillars model of community support

Pearson James

Scotland is currently moving towards integration of health and social care.  The Scottish Government plans to introduce a new legal framework creating new Health and Social Care Partnerships, which will give shared responsibility to National Health Service (NHS) Boards and Scottish Local Authorities. In September 2012, AlzheimerScotlandpublished, Delivering Integrated Dementia Care: The 8 Pillars model of Community Support.  The report sits within this integration agenda and sets out a blueprint for a more effective, structured, coordinated and strategic approach to the use of existing resources for the delivery of integrated dementia care and better outcomes of people with dementia and those who care for them.

The 8 Pillars Model builds on the significant progress of Scotland’s National Dementia Strategy (2010-2013) in addressing the priority areas of improvements in acute hospital care and post diagnostic support. In particular the model builds upon the ground breaking commitment to provide every person diagnosed with dementia with a minimum guarantee of one years post diagnostic support based on a model developed by Alzheimer Scotland.  Scotland is currently developing a revised strategy for 2013-2016 and this includes a commitment to test the 8 Pillar Model in sites across Scotland. The model contains eight key pillars. These are:

  1. A Dementia Practice Coordinator
  2. Therapeutic interventions to tackle the symptoms of dementia
  3. General health care and treatment
  4. Mental Health Care and Treatment
  5. Personalised Support
  6. Support for carers
  7. Environment
  8. Community Connections.

This presentation begins by setting out the underlying human rights principles of the 8 Pillars Model. Next the presentation explains how the model enables health and social care interventions to work hand in hand to deliver coordinated, therapeutic and personalised community supports which tackle the symptoms of dementia and support people with dementia to continue to live at home, in their own communities, for as long as they choose. Finally, the presentation will provide up to date findings from the 8 Pillars Model test sites across Scotland.

P6.3. Evaluation of the transition of institutional psychogeriatric day care into easy-access community-based support centres for people with dementia and their carers; a multicenter study

van Dijk Marijke, Meiland Franka, Dröes Rose-Marie

Background: Quality of care is not only determined by its efficacy, but also by its accessibility, efficiency and patient-centeredness. An example of good care addressing these quality criteria is the Meeting Centres Support Programme (MCSP) for people with dementia and their carers. MCSP offers proven (cost-)effective support, attuned to the needs of participants and is offered in socially integrated easy-access community centres. In this implementation study, six traditional psychogeriatric day care centres in nursing homes made the transition to easy-access community-based psychogeriatric day care centres according to the MCSP-model. The transition process and potential surplus value are evaluated.

Method: Data were collected in six day care centres before and after the transition. The (cost-) effectiveness of new day care centres is studied by a pretest-posttest control group design with standard questionnaires among people with dementia and their informal carers. Measurements took place at the start of participation, and after 3 and 6 months (in both conditions). User satisfaction was measured after 6 months. A process evaluation of the transition is performed by means of interviews with key figures (n=34) who were involved in making the transition from traditional day care centres to easy-access community-based day care centres. The interview data were independently coded by two researchers and analysed, using the computer programme Atlas TI.

Results: Six institutional day centers are succesfully transformed to easy-access community-based support centres for people with dementia and their carers. First results of the process evaluation show that close cooperation with regional care and welfare organisations, additional financing by the municipality, the possibility to adjust the MCSP-model to the local situation, and a suitable location facilitate a successful transition. Staff members having difficulties with working according to the new person-centered care model, and other meeting centres in the vicinity, impeded the transition. Preliminary results of our study on user- and staff satisfaction before and after the transition, will also be presented. 

Conclusion: Traditional psychogeriatric day centers are able to transform succesfully to a more easy-accessible, socially-integrated and combined MCSP-approach for people with dementia and their carers, and first results show that these new day care centres are highly valued by its users. Based on final analysis of the interviews with key figures in August2013, atransition model is presented to support other traditional psychogeriatric day cares to make this transition.

P6.4. Singular and socially oriented group living for persons with dementia vs traditional nursing home - a pilot study

Span Ursula, Span Edith, Auer Stefanie

Introduction: The appropriate stage specific care of Persons with dementia (PwD) in institutional settings is becoming a specialty and specific knowledge is required. Creative and affordable ideas for optimising the quality of life for PwD, the care team and the involved relatives are now needed. In the development of new concepts, the appropriate balance between physical/medical care and social care concepts seem important. There is some evidence in the literature that small-scale and homelike facilities with a socially oriented care concept may be a more appropriate living environment for PwD. In this pilot study we compared a newly developed socially oriented group living environment in which care is only provided on demand with no organisational connection to an institution (singular) to traditional care environments.

Methods: In this longitudinal observation design, PwD residing in the group living were matched to PwD in traditional care environments. All persons are assessed at baseline, 3 months and 6 months. A follow up observation after 6 months was set up. As main outcome variables, Quality of life (QOL-AD; Person with dementia version) was chosen for the PwD. For the care team, the main outcome was Work Satisfaction and a global measure of change (CGI), for family members, QOL-AD (family version) and a CGI was used. The pilot study started in July 2012 and will end in July 2013.

Results: 36 PwD in the different stages of the disease were recruited. Results of the study will be presented at the meeting.

P6.5. Motivating and discouraging factors with being a support contact in the dementia care sector: a grounded theory study

Johannessen Aud, Hallberg Ulrika, Möller Anders

Background: People with dementia need different forms of assistance as the disorder progresses. In Norway, support contacts work as “paid friends” and their role can be compared with respite carers or voluntary workers’ in other Western countries. Support contacts may be helpful within the dementia sector, especially in the early stages of the disorder, though they are rarely used.

Aim: The aim of this study was to find out how the support contacts perceive their work.

Method: Grounded theory, a qualitative method, with interviews of 19 participants (14 women and 5 men aged 40-75 years) during 2009-2010, from 12 local authorities.

Findings: This study describes the participants’ motives for becoming a support contact and their encouraging and discouraging experiences while being a support contact, expressed as four sets of opposites; flexibility vs. rigidity; being compensated vs. feeling used; affiliation vs. abandonment; and satisfaction vs. lack of satisfaction.

Conclusion: Greater flexibility, adequate compensation, a sense of affiliation and satisfaction, together with potential for building relationship with families, are factors that will encourage dementia care supporters to continue with their work.

P6.6. Time for Breakfast – an opportunity for meaningful activity in hospitalised persons with dementia

Abela Stephen, Galea Doris, Abela Maria, Dalli James, Baldacchino Kristin, Chetcuti-Galea Roberta

Background and aim: It is well established that people with dementia encounter challenging experiences when admitted to acute hospital settings in view of their complex care needs and the streamlined hospital environment (Cunningham C. and Archibald C., 2006). A previous evaluation of dementia care practices at the Rehabilitation Hospital Karin Grech (Innes A. and Kelly F., 2012) showed missed opportunity for activities especially in relation to everyday routines. The aim of this project was to promote a rehabilitation philosophy during breakfast, increasing mobility, meaningful activity, independence, nutrition and wellbeing of people with dementia.

Methods: A brainstorming meeting was organised between the ward interdisciplinary team members. During this initial meeting, promoting activity during breakfast time was identified for further development. The breakfast group was introduced in February 2013 whereby a small number of semi-independent persons were encouraged to walk to the dining area so that they could help themselves to a buffet-style breakfast. Further evaluation will be carried out to estimate the number of persons participating in this project, their diagnosis, the stage of dementia, functional levels, any problems encountered and a customer feedback questionnaire.

Results: The breakfast group was received positively by ward staff. From the initial SWOT feedback, the main benefits identified were helping clients regain their skills and independence in self-caring, improving nutrition and encouraging socialising. The breakfast group was promoted as serving to help establish a daily routine and positively influence successful home discharge. The main concerns were the risks associated with safety e.g. falls or other injuries. Further results on the outcome of this group over a six-month period will be presented in the final paper.

Conclusions: In a geriatric hospital setting, the breakfast time can be adapted as an opportunity for meaningful activity. This approach can be implemented successfully only through collaborative team work and positive involvement of all grades of staff.

 

 
 

Last Updated: Tuesday 05 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
 
 

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