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P16. Psychosocial interventions 1

Detailed programme and abstracts

P16.1. Which type of case management best meets the needs of persons with dementia: The COMPAS study

VAN HOUT Hein1, MEILAND Franka1, SMAARDIJK Veerle2, JOLING Karlijn1, VAN DER ROEST Henriette1, MACNEIL-VROOMEN Janet1

1Amsterdam University medical center, Amsterdam, Netherlands, 2Tilburg University, Tilburg, Netherlands

Background:Persons with dementia and their close relatives have needs in multiple areas including environmental, physical, and psychosocial domains. Case management may address these needs. It is not clear whether some forms of case management are better able to meet unmet needs than others.

Objective: The aim of the study was to evaluate the impact of two forms of case management on the type and course of unmet needs of persons with dementia and their informal caregivers over two years. We hypothesized that dementia case management organized in an integrated way (IC) compared collaboration of multiple organizations (CC), and usual (fragmented) community care (UC) would lead to a better response to and course of unmet needs over time.

Methods: The COMPAS study was a prospective, controlled cohort study, with 2-year follow-up of 521 dyads of community dwelling persons with dementia and their informal caregivers recruited in regions with and without case management.

Outcomes: were unmet needs on four domains (environmental, physical, psychological, and social) composed of 24 items from the Camberwell Assessment of Need for the Elderly (CANE), as reported by informal caregivers every 6 months. We adjusted for group differences at baseline by propensity score matching. We compare changes in the four domains and on specific unmet needs between two case management models and usual care group through GEE-analyses.

Results: Compared to usual care, IC positively impacted the psychological and social domains, including four specific care needs: ‘Dealing with Eyesight, hearing or communication’, ‘Memory support’, ‘Having daytime activities’, and ‘Receiving Information’, while CC impacted two specific needs ‘Managing medication’, and ‘Behavior’.

Conclusions:Compared to usual care, both forms of case management contributed to meeting unmet needs. Integrated forms had more impact, especially on psychological and social domains, compared to collaborative forms.

P16.2. Exergaming for people with dementia in day care centres: Results of a randomized controlled trial

VAN SANTEN Joeke1, DRÖES Rose-Marie1, BOSMANS Judith2, BLANSON HENKEMANS Olivier3, SCHOONE Marian3, VAN BOMMEL Sjef4, HAKVOORT Esther5, VALK Ronald6, SCHOLTEN Carla7, WIERSINGA Joris8, SMIT Marjolein8, VAN STRATEN Annemieke9, MEILAND Franka1

1Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, Netherlands, 2Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, Netherlands, 3Healthy Living, TNO, Leiden, Netherlands, 4Sjef van Bommel Management & Support, Amsterdam, Netherlands, 5Scientific Committee Evean, Purmerend, Netherlands, 6HilverZorg – Day-care center Zonnehoeve, Hilversum, Netherlands, 7Embedded Fitness B.V., Vlierden, Netherlands, 8SilverFit B.V., Woerden, Netherlands, 9Department of Clinical- neuro- and developmental Psychology, Faculty of Behaviour and Movement Sciences, VU University Amsterdam , Amsterdam, Netherlands

Background: Everyone can benefit from physical activity. However, people living with dementia (PwD) experience several barriers, such as risk of falls and orientation issues. Exergaming (“physical exercise interactively combined with cognitive stimulation in a gaming environment”) is relatively new and may help overcome these barriers. This study evaluates the (cost-)effectiveness of exergaming compared to regular activities in day-care centres (DC’s) for PwD and informal caregivers (IC). Facilitators and barriers to implementation of exergames are also investigated.

Methods: A cluster Randomized Controlled Trial (RCT), with a process evaluation alongside. PwD and IC were interviewed at baseline, and at 3 and 6 months. Primary outcomes were mobility and physical activities of PwD. Secondary outcomes for both PwD and IC were physical, cognitive, social and emotional functioning, and quality of life. Additionally, for IC: subjective burden and positive care experiences. Mixed model analyses were conducted. The economic evaluation was done for the primary outcome measures. For the process evaluation, thematic analysis was performed on data from online surveys, qualitative interviews and focus groups.

Results: Twenty DC’s (11 exp, 9 control) in the Netherlands and 112 dyads (PwD/IC; 73 exp, 39 control) participated in the study. Preliminary results show that there was a tendency for exergaming to be beneficial regarding the emotional burden of the IC. Also, cost-effectiveness analyses showed (non-significant) positive tendencies. Exergaming was highly appreciated by participants, family and staff. Facilitators for successful implementation were a.o. easy accessibility of equipment, support from management and colleagues, and finances. Further results will be discussed at the conference.

Discussion: This study contributes to the evidence base of innovative exercise interventions for people living with dementia. Safe opportunities for enjoyable physical exercise and insight into its benefits will enable and motivate PwD to be more physically active. Guidelines are given to promote successful implementation of exergaming.

P16.3. Perspectives of non-drug-therapies in dementia – Results of the multicomponent maks - Intervention

PENDERGRASS Anna1, BEHRNDT Elisa-Marie2, LUTTENBERGER Katharina, GRAESSEL Elmar

1Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany, 2Erlangen, Germany

Background: Multi-component interventions seem to have the biggest impact on different outcomes for people with dementia. Unstructured and non-evidence based interventions are commonly used in German day care centers (DCCs). In this study, we investigated the multicomponent MAKS-therapy in DCCs, after it has already been evaluated in German nursing homes. The MAKS- therapy is a highly standardized intervention consisting of four components: motor stimulation, practice of activities of daily living (ADLs), cognitive stimulation, and social-communicative component.

Methods: A cluster-randomized, controlled, single-blinded trial involving a 6-month intervention phase was performed. 362 cognitively impaired people in 32 German DCCs took part in the trial. Multiple regression analyses were used to determine whether MAKS therapy led to any statistically significant and clinically relevant improvement over time (compared to membership in the control group) in these persons’ cognitive abilities and activities of daily living (ADL) abilities.

Results: The multimodal non-drug therapy of dementia resulted in stabilization of the cognitive ability and the ability to perform ADLs in the intervention group, whereas both abilities in the control group decreased. So in the primary per-protocol analysis at 6 months, the intervention group had significantly better cognitive ability scores (MMSE) and ADL scores (ETAM) than the control group (Cohen’s d, 0.26 and 0.21, respectively; p = 0.012 for both). The same was found in the ITT analysis at 6 months (Cohen’s d = 0.21, p = 0.033; and Cohen’s d = 0.20, p = 0.019, respectively).

Conclusion: MAKS therapy is effective for persons with cognitive impairment ranging from mild cognitive impairment (MCI) to moderate dementia who live at home and regularly visit a day care center. More effects on secondary outcomes of the cognitively impaired people (e. g. neuropsychiatric symptoms, transfers to nursing homes) and the impact on their caregivers will be discussed as well.

P16.4. What is important to people with dementia living at home? A core outcome set for community interventions

REILLY Siobhan1, MORBEY Hazel1, FARAZ Ahmed1, LEROI Ira2, DAVIES Linda3, WILLIAMSON Paula4, SWARBRICK Caroline1, KEADY John3, HARDING Andrew1

1Lancaster University, Lancaster, United Kingdom, 2Trinity College Dublin, Dublin, Ireland, 3University of Manchester, Manchester, United Kingdom, 4Liverpool University, Liverpool, United Kingdom

Background: High variability in outcomes in dementia care trials impedes comparisons of effectiveness and makes the interpretation of results difficult. One way for trialists to address these problems is to use and report a core outcome set (COS) - a list of core outcomes which should be measured and reported as a minimum across all relevant effectiveness trials. Consultation with people living with dementia regarding the outcomes that matter most would also help to avoid research waste associated with poor outcome selection.  The key aim of this study is to establish an agreed standardised core outcome set (COS) for use when evaluating non-pharmacological health and social care interventions for people with dementia living at home.  

Methods: We developed a modified two-round 54 item Delphi survey to attain consensus on core outcomes from key stakeholders from the UK. We finalised the core outcome set in a face-to-face consensus meeting in 2018.

Results: Of the 288 participants who completed round 1 (21 people living with dementia, 58 care partners, 137 relevant health and social care professionals, 60 researchers, 12 policy makers) 246 completed round 2 (85% response rate). Ten items met the inclusion criteria for the COS. From 24 items that were discussed by participants attending the consensus meeting a further three items were voted in. Respondents living with dementia who rated these 13 outcomes as very important in the second round of the Delphi ranged from 50% to 95%. 

Conclusions: Providing there are adequate measures, the 13 outcome items should be included and reported in trials on the effectiveness of non-pharmacological interventions and community-based interventions for people with dementia living at home and in their neighbourhood. An additional abstract reports a systematic review of existing outcome measurement instruments so that we can recommend ‘how to measure’ the 13 outcome items.

P16.5. Barriers and facilitators to implementing Dementia Care Mapping™ in care homes: Results from the EPIC trial

GRIFFITHS Alys1, KELLEY Rachael1, GARROD Lucy2, PERFECT Devon3, ROBINSON Olivia1, SHOESMITH Emily1, MCDERMID Joanne4, BURNLEY Natasha1, SURR Claire1

1Leeds Beckett University, Leeds, United Kingdom, 2Oxford Health NHS Foundation Trust, Oxford, United Kingdom, 3University of Birmingham, Birmingham, United Kingdom, 4King's College London, London, United Kingdom

Many people living with dementia in care homes have complex behaviour and care needs, such as agitation and other neuropsychiatric symptoms. Psychosocial person-centred interventions are considered best practice for addressing these needs, to improve people’s quality of life. Dementia Care Mapping™(DCM) is an established practice development tool that aims to support staff in the delivery of person-centred care. To date, a limited number of studies have evaluated the efficacy of DCM and have found mixed results. This may be due to differences in intervention implementation. For example, the studies implemented DCM in different ways, using staff led and researcher led approaches, across several countries. A randomized controlled trial (the EPIC trial) was conducted, which evaluated the effectiveness and cost-effectiveness of DCM within 50 UK care homes (31 interventions: 19 control). Eighteen of the 31 DCM intervention care homes participated in the embedded process evaluation. Semi-structured interviews were conducted with 83 participants, consisting of care home managers, trained DCM users (mappers), expert external mappers, staff members, relatives, and residents. The findings demonstrated that barriers and facilitators to DCM implementation were found at the mapper level (e.g. motivation and confidence), the DCM intervention level (e.g. complex nature of DCM) and the care home level (e.g. openness to change, manager support). Further barriers caused by the burden of trial participation were also identified (e.g. input from expert mappers). Implementing DCM is complex and challenging within care homes, and a greater consideration of potential barriers and facilitators is needed in future studies and practice. This would help improve implementation, which is associated with increased effectiveness. Additionally, sharing best practice models of implementation with practitioners and research teams is crucial to support future use of DCM.

P16.6. Change in daily behaviour in carers of people with dementia: Mechanisms in an experience sampling intervention

BARTELS Sara Laureen1, VAN KNIPPENBERG R.1, VIECHTBAUER W.1, SIMONS C.1, PONDS R.1, MYIN-GERMEYS I.2, VERHEY F.1, DE VUGT M.1

1Maastricht University, Maastricht, Netherlands, 2KU Leuven, Leuven, Belgium

The six-week ‘Partner in Sight’ intervention for carers of people with dementia was based on the Experience Sampling Method (ESM), meaning carers self-monitored own affect and behaviours ten times/day via a mobile device. Additionally, the experimental group received personalized feedback focused on behaviors related to high positive affect to raise awareness for those, while the pseudo-experimental group performed self-monitoring only. Furthermore, a control group (care as usual) was included. The randomized controlled trial showed a pre-to-post change in emotional well-being in both intervention groups with increased sense of competence (SoC), decreased perceived stress and reduced negative affect (NA)). The present study evaluated if the intervention also led to behavioral changes. Furthermore, the link between daily behaviors, affect, activity-related stress, as well as carers’ SoC over the course of the intervention was investigated. Therefore, ESM-data of 72 carers was post-hoc analyzed. The experimental group reported significant increases in passive relaxation activities over the six weeks(B=.28, SE=.12, Z= 2.43, p<.05). Passive relaxation in this group was negatively associated with NA (r=-.50, p=.01) and positively associated with activity-related stress (r=.52, p=.007) from baseline to post-intervention. The other groups did not report significant behavioral changes. The results indicate that personalized feedback is a crucial element in an ESM intervention for carers to facilitate a change in daily behaviors. The process of behavioral change seems to be aligned with mixed emotions. ESM-data describes the complexity of caregiving and the acknowledgement of both positive and negative affect might be necessary for sustained coping during caregiving.

 

 
 

Last Updated: Wednesday 19 June 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
 
 

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