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P31. Home and residential care II

Detailed programme, abstracts and presentations

P31.1. Care co-ordination in the community for people with dementia in Midlothian: An appreciative inquiry into the critical success factors

MILLER Michelle1, FLANNIGAN Lynn1, CARSON Jill2, LEAK Paul3, MCLERNON Elaine4, MOONEY Andrew5

1Healthcare Improvement Scotland, Glasgow, United Kingdom, 2Alzheimer Scotland, Glasgow, United Kingdom, 3Scottish Government, Edinburgh, United Kingdom, 4NHS Lothian, Edinburgh, United Kingdom, 5NHS Services Scotland, Edinburgh, United Kingdom

Integrated co-ordinated care and support for people with dementia, carers and families is crucial in avoiding fragmented care which can result in duplication of effort and poor experience and outcomes for people with dementia and their carers.

Midlothian Health and Social Care Partnership in Scotland were identified as an exemplar site in the evaluation of the Alzheimer Scotland 8 Pillars Model and the partnership has attracted much attention from other areas in Scotland and internationally to learn how they have sustained an approach to integrated care co-ordination for people with dementia and carers. 

Our aims were to:

  • To understand the current context in Midlothian which has led to sustaining care co-ordination, building on the previous evaluation of testing the 8 Pillars model, and to understand any further developments
  • To analyse data in Midlothian in order to provide evidence of and improve understanding of care co-ordination in practice and benefits and outcomes being achieved
  • To produce a report of findings so that they can be shared across Europe

The project took an appreciative inquiry approach which included focus groups and staff interviews. We also worked with data colleagues to conduct a quantitative analysis linking together health and social care data.  This has allowed us to model the care pathways of individuals with dementia to see how they access services and better understand how they flow through the care system.

The qualitative and quantitative data reinforces Midlothian’s position as an exemplar. We identified 12 critical success factors during the inquiry which have been written up in the form of a report. By extrapolating the 12 critical success factors and sharing them with other areas there is an opportunity to inspire improvements in care coordination for people with dementia and their carers across Europe.

P31.2. The experiences and perceptions of personhood for people with dementia in formal care: A qualitative evidence synthesis

HENNELLY Niamh1, COONEY Adeline2, HOUGHTON Catherine3, O'SHEA Eamon1

1Centre for Economic and Social Research on Dementia, NUI Galway, Galway, Ireland, 2Centre for Teaching and Learning, Maynooth University, Maynooth, Ireland, 3School of Nursing and Midwifery, NUI Galway, Galway, Ireland

Background: Personhood is a key element of person-centred care for people with dementia. The use of person-centred care models is now common in dementia care meaning that research into the components of personhood, especially as interpreted and narrated by people with dementia, is crucial to developing and furthering best practice. However, little research to date has synthesised studies on personhood in dementia. This evidence synthesis examines the experiences and perceptions of people with dementia on personhood in dementia care.

Methods: 8 databases were systematically searched for qualitative studies on personhood in dementia in formal care. Title/abstract and full text screening were conducted independently by two authors. A CART analysis was used to carry out further screening based on the relevance of the studies. Thematic synthesis was conducted on the included studies. Confidence in the review findings was examined using GRADE CERQual.

Results: In total 9,150 articles were screened with twenty studies included in the synthesis. The synthesis found 3 main themes: living with change, managing care arrangements and maintaining sense of self. People with dementia experience many changes because of dementia and the experience of being cared for in different settings. They also have varied experiences of adapting to such changes. Both familial and care relationships are important to people with dementia as personhood is affirmed through interactions with family, friends, other care recipients and formal caregivers, as well as through continued engagement in social and occupational roles.

Conclusions: The review raises important implications for dementia care practice, policy and regulation. Care should protect the self rather than undermine it and relationships should be enhanced not diminished by the care process. Creating opportunities for people with dementia to affirm the self through interactions with others and engaging in occupational and social roles is crucial in dementia practice and policy.

P31.3. Daily physical activity level as a predictor of general cognition, depressive symptoms, and quality of life in institutionalised persons with dementia

WOLF Evelien, MILDERS Maarten, DRENT Madeleine, SCHERDER Erik

Vrije Universiteit, Amsterdam, Netherlands

Introduction:This study examined whether general activity (all activities while a person is awake) and daily physical activity only can predict cognition, depressive symptoms as well as quality of life (QoL) in institutionalised persons with dementia (PwD).

Methods:154 institutionalised PwD participated in this study. We used an adjusted version of the Physical Activity Survey in Long-Term Care (PAS-LTC) to measure activity level, Mini-Mental State Examination (MMSE), Severe Impairment Battery Short version (SIB-S), Eight Word Test (8-WT), Category Fluency Task (CFT), and Digit Span Backwards (DSB) to measure cognition; Cornell Scale for Depression in Dementia (CSDD) to measure depressive symptoms; and Qualidem to measure QoL. Mixed model analyses were used to examine the relationships between general activity/ daily physical activity and cognition, depressive symptoms, and QoL.

Results:More general activity and daily physical activity significantly predicted better general cognition as measured with MMSE, and SIB-S. More daily physical activity also predicted better total QoL. More general activity only predicted better functioning on certain QoL domains, but not on total QoL. For daily physical activity, there was a flattening curve in the relationships with general cognition and total QoL. From around 200 (of 540) minutes of daily physical activity, more activity was not necessarily better. Number of depressive symptoms was predicted by daily physical activity, but not by general activity. Up to around 200 (of 540) minutes of physical activity, more physical activity predicted less depressive symptoms. From around 300 minutes of physical activity, however, more physical activity predicted more depressive symptoms.

Discussion:Our results suggest that daily physical activity is more important as a predictor of cognition, depressive symptoms, and QoL in institutionalised PwD than general activity.

Conclusions and implications:We suggest that increasing the daily physical activity level in the daily routine could benefit institutionalised PwD.

P31.4. The Cognitive Daisy: A tool for informing care related decisions and increasing dementia care competence


University of Lincoln, Lincoln, United Kingdom

The Cognitive Daisy (COG-D; Hudson & Pollux, 2017) is a visual profiling system for enhancing care and support of people with neurological cognitive impairment. 

The COG-D comprises a flower head consisting of 15 colour coded petals depicting information about five cognitive domains: visual-spatial perception, comprehension, communication, memory and attention. The level of impairment in each of these areas is determined by a specific test and denoted by the number of coloured petals. 

An online training programme illustrates the COG-D to users and a Petal-By-Petal guide highlights common problems associated with each petal and suggests strategies that might be useful in everyday situations. 

We examined the practicality and utility of the COG-D assessment protocol for evaluating cognition in older adults in residential care and assessed the benefits of the COG-D for care staff (n = 39) and older adults (n = 62) over 3 months. In focus groups and pre-post intervention measures, care staff provided information about their knowledge of cognitive dysfunction in dementia, approaches to dementia (Lintern, 2009) and competence (Schepers et al., 2014). We also examined the effectiveness of the COG-D to directly inform care-related decisions in care staff (n = 41). 

Mixed methods analysis showed that COG-D training increased both knowledge of cognitive dysfunction in dementia and a sense of competence in dementia care staff. Increased awareness in care staff of different cognitive profiles in residents was shown to inform care-related decision making and was reported to markedly improve the delivery of person-centred care.

Overall our findings indicate that the COG-D is a practical and effective intervention for residential care. Cognitive impairment is a precipitating factor for many dementia-related behavioural problems. By making cognitive strengths and difficulties visible the COG-D empowers care staff with the potential to predict and avert behavioural problems and increases dementia care competence.

P31.5. Physical restraint in nursing homes: Focusing on nurses’ decision-making process

DEBIASI Martina1, AMBROSI Elisa2, CANZAN Federica1, MORTARI luigina1, SAIANI Luisa1, BRUGNOLLI Anna1

1univeristy of Verona, Verona, Italy, 2University of Bologna, Verona, Italy

Background: Although the goal of a restraint free environment has been considered the most desirable, the use of physical restraint (PR) in nursing homes is still very common in Italy. The residential care facilities are popular setting were elderly and people with cognitive impairment (dementia, Alzheimer disease and/or people with behavioural disorders) lived. Currently, an ethical and political debate is underway regarding PR use.

Aim: to explore the experience of nurses’ decision - making about restraint or not-restraint¬.

Study design: A qualitative study based on a phenomenological approach was performed

Settings: this study was conducted in ten nursing homes in the North of Italy.

Participants: A purposive sampling of 100 nurses who have been working for more than one year in the involved residential care facilities, was recruited.

Methods: Face-to-face semi-structured interviews were conducted to collect data focusing on residential nurses' experience. Data were analysed using Giorgi’s (1975) seven-step phenomenological method.

Results: Three points of interest were identified: phenomenology based on facts (what happens, reasons for using restraints, monitoring and surveillance); mental phenomenology (feelings of family, feelings of patients, experience and feelings of nurses, judgments on restraint and conceptualizations); phenomenology of alternative actions (actionable actions, and desirable actions good for future policies).

Conclusion: Although the prescription of restraints is a medical act, nurses play a key role in decision-making processes regarding PR. The decision-making process on the use of PR is a result of a complex trajectory, for ethical implications and integration with other professionals. Nurses often do not use the restraints as a first option but evaluate and activate other alternative strategies. The factors influencing the decision-making process of nurses concern the characteristics of patients, nurses’ experiences and context variables.

P31.6. Living alone with dementia: related use of drugs


Queen's University Belfast, Belfast, United Kingdom

Approximately one-third of community-dwelling people with dementia in the United Kingdom and the United States, and 51% of people with dementia in Germany live alone. In 2010, there were 141,460 people with dementia living alone in the UK. Research has explored differences between people with dementia living alone with those who live with an informal caregiver. No difference was found in drug-related problems, nutrition, quality of life, cognitive and functional impairment; however, people living alone used professional services, such as home care, more often. Other research explored the unmet needs for people with dementia who live alone. These unmet needs include help with looking after home, help with self-care, and having company. In Sweden, people with Alzheimer’s disease who live alone were more likely to receive antidepressants, antipsychotics, hypnotics and sedative drugs compared to people who live with an informal caregiver. On the other hand, people living with a caregiver were more likely to receive cholinesterase inhibitors and cardiovascular medications. A significant difference was also found in dementia medication because people living with a caregiver were more likely to receive memantine than people living alone.

This study explores medication differences between people with dementia living alone, or living with an informal caregiver, or people with dementia living in care homes in Northern Ireland. Data from over 25,000 people with dementia from national databases in Northern Ireland are retrospectively analysed. The results will inform health care professionals and practices about the effect of living arrangements in prescribing medication for dementia and comorbidities.



Last Updated: Tuesday 10 December 2019


  • Acknowledgements

    The 29th AE Conference in The Hague received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimer Nederlands gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche