Reviewing the definition of crisis in dementia care

<p>Abstract</p> <p>Background</p> <p>Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice.</p> <p>Methods</p> <p>We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings.</p> <p>Results</p> <p>Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as <it>a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis</it>. <it>If the crisis is not resolved, the cycle continues.</it> Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia.</p> <p>Conclusions</p> <p>This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.</p

Determinants of health-related quality of life in older patients after acute hospitalisation

To assess the association between demographics, comorbidity, geriatric conditions, and three health-related quality of life (HRQOL) outcomes one year after acute hospitalisation in older patients. A prospective cohort study conducted between 2006 and 2009 with one-year follow-up in 11 medical wards at two university hospitals and one teaching hospital in the Netherlands. Participants were 473 patients of 65 years and older, acutely hospitalised for more than 48 hours. Demographics, Charlson Comorbidity Index (CCI), and data on 18 geriatric conditions were collected at baseline. At baseline and 12 months post-admission, the EuroQol-5D was administered. Based on a population-derived valuation (Dutch EuroQol-5D tariff), utilities (range -0.38-1.00) were determined, which were used to calculate quality-adjusted life years (QALY) over one year (max QALY score 1). The EuroQol-5D visual analogue scale (VAS) (range 0-100) was also used. Linear regression analyses were performed to explore the association between the independent variables and the three HRQOL outcomes. CCI was most consistently significantly associated with HRQOL outcomes: Beta -0.05 (95% CI -0.06--0.03) for utility, -0.04 (95% CI -0.05-0.03) for QALY, -1.03 (95% CI -2.06-0.00) for VAS, p < 0.001, < 0.001, 0.05, respectively). Baseline utility was significantly associated with one-year utility (beta 0.25, 95% CI 0.11-0.39, p < 0.01) and QALY (beta 0.31, 95% CI 0.17-0.45, p < 0.001). The number of geriatric conditions at baseline was more strongly associated with one-year utility than any individual geriatric condition. Less comorbidity, better utility and less geriatric conditions at baseline were associated with better HRQOL one year after acute hospitalisation in older patient

Cost-effectiveness of tailored print communication, telephone motivational interviewing, and a combination of the two: results of an economic evaluation alongside the Vitalum randomized controlled trial

The aim of the present study was to evaluate the cost-effectiveness of tailored print communication (TPC), telephone motivational interviewing (TMI), a combination of the two, and no intervention on two outcomes in adults aged 45 to 70, half of them having hypertension: increasing the number of public health guidelines met for three behaviors (physical activity and fruit and vegetable consumption), and impact on quality adjusted life years (QALYs). Participants (n = 1,629) from 23 Dutch general practices were randomized into one of four groups, which received 4 TPCs, 4 TMIs, 2 of each (combined), or no intervention (control), respectively. The self-reported outcomes, measured at baseline and 73 weeks follow-up (7 months after the last intervention component), were difference in total number of guidelines met at follow-up compared to baseline, and number of QALYs experienced over 73 weeks. The costs of implementing the intervention were estimated using a bottom-up approach. At 73 weeks follow-up participants showed increased adherence with 0.62 (TPC), 0.40 (TMI), 0.50 (combined), and 0.26 (control) guidelines compared to baseline, and experienced 1.09, 1.08, 1.08, and 1.07 QALYs, respectively. The costs for the control group were considered to be zero. TMI was more expensive (€107 per person) than both the combined intervention (€80) and TPC (€57). The control condition was most cost-effective for lower ceiling ratios, while TPC had the highest probability of being most cost-effective for higher ceiling ratios (more than €160 per additional guideline met, and €2,851 for each individual QALY). For low society's willingness to pay, the control group was most cost-effective for the number of QALYs experienced over 73 weeks. This also applied to the increase in the number of guidelines met at lower ceiling ratios, whereas at higher ceiling ratios, TPC had a higher probability of being more cost-effective than the TMI, combined or control conditions. This also seemed to apply for QALYs experienced over 73 weeks. More research is needed on the long-term efficacy of both TPC and TMI, as well as on how to increase their cost-effectiveness

Cell-Free DNA: An Upcoming Biomarker in Transplantation

Transplantation and autoimmunit

Community-Dwelling Patients With Dementia and Their Informal Caregivers With and Without Case Management: 2-Year Outcomes of a Pragmatic Trial

Objective: To evaluate outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group). Design: A pragmatic trial using a prospective, observational, controlled, cohort study. Setting: Community care in the Netherlands. Participants: A total of 521 dyads. Intervention: Case management provided within one care organization (ICMM), case management where multiple case management organizations are present within one region (LM), and a group with no access to case management (control). Measurements: Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric Inventory (NPI) and psychological health in informal caregivers as measured with the General Health Questionnaire (GHQ-12). Secondary outcomes included care and support needs, quality of life, and institutionalization. Comparability of groups at baseline was secured by inverse-propensity-score-weighted mixed models. Results: No significant differences in changes in total NPI or GHQ-12 scores between the groups over 2 years were found. Secondary outcomes showed better quality-of-life scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet care needs were significantly less in the ICMM compared with the control group. Conclusion: Neither case management type affected clinical outcomes of dyads meaningfully. The ICMM has positive impact on caregivers' quality of life and patient's number of needs compared with persons in LM and persons without access to case management respectively