Sensitivity of the Mini-Mental State Examination, Montreal Cognitive Assessment and the Addenbrooke’s Cognitive Examination III to everyday activity impairments in dementia: An exploratory study

Objective: The Mini-Mental State Examination (MMSE) is one of the most frequently used cognitive measures for dementia severity, and linked to deficits in everyday functioning. Recently, the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination III (ACE-III) increasingly substitute for the MMSE. However, there are no specific cut offs in the ACE-III for mild dementia. The objectives of this exploratory study were to assess the sensitivity of each scale to everyday functioning and to examine the cut offs between mild and moderate dementia on the ACE-III. Methods: People with mild dementia completed the MMSE, MoCA and ACE-III, whilst informal carers completed the Revised Interview for Deteriorations in Daily Living Activities for Dementia to rate their relative’s initiative and performance of instrumental activities of daily living, and the Katz activities of daily living scale. Data were analysed using correlation analysis, raw score comparisons, Cohen’s kappa and Receiver Operating Characteristics analysis. Results: Thirty-three dyads completed the measures. The ACE-III was the most sensitive tool for everyday functioning performance, whilst its language sub-scale was specifically related to initiation of activities. The most suitable cut off on the ACE-III between mild and moderate dementia was 61. Conclusions: Findings suggest ACE-III more efficiently identifies everyday functional impairments. Further research is required to confirm these exploratory analyses of the cut off between mild and moderate dementia on the ACE-III. Both functional impairment and stage of dementia are needed in the diagnostic process and in the clinical assessment of people with dementia

Evaluating the effectiveness of different approaches to home support for people in later stage dementia:A protocol for an observational study

Background: Dementia is a major health problem with a growing number of people affected by the condition, both directly and indirectly through caring for someone with dementia. Many live at home but little is known about the range and intensity of the support they receive. Previous studies have mainly reported on discrete services within a single geographical area. This paper presents a protocol for study of different services across several sites in England. The aim is to explore the presence, effects and cost-effectiveness of approaches to home support for people in later stage dementia and their carers. Methods: This is a prospective observational study employing mixed methods. At least 300 participants (people with dementia and their carers) from geographical areas with demonstrably different ranges of services available for people with dementia will be selected. Within each area, participants will be recruited from a range of services. Participants will be interviewed on two occasions and data will be collected on: their characteristics and circumstances; quality of life; carer health and burden; and informal and formal support for the person with dementia. The structured interviews will also collect qualitative data to explore the perceptions of older people and carers. Conclusions: This national study will explore the components of appropriate and effective home support for people with late stage dementia and their carers. It aims to inform commissioners and service providers across health and social care

Stair-case in the north trancept, Cathedral of Burgos [Material gráfico]

Copia digital. Valladolid : Junta de Castilla y León. Consejería de Cultura y Turismo, 2009-201

Routine use of a standardised assessment instrument for measuring the outcome of social care

This study had as its primary aim determining the extent to which standardised assessment can contribute to monitoring the outcomes of social care. It also addressed the comparison of resource use between individual clients, groups of clients with similar characteristics and between Social Service Departments (SSD's). An important part of the study was exploring the views of Social Workers and Care Managers on assessment in general and standardised assessment and the MDS-HC in particular. It has succeeded in achieving the majority of its goals and its findings have been incorporated into a revised MDS-HC assessment system including the development of a simplified screening assessment. It has also identified how attitudes to assessment, the manner in which assessment is done, and the organisation of assessment and on going management of services provided was significantly different between the two social service departments that took part in the study. Some of the issues identified are important for the development of policy on assessment in community care. It is likely that the findings are widely generalisable

Comparing how to compare: an evaluation of alternative performance measurement systems in the field of social care

Comparative performance evaluation has taken different forms depending upon the purposes of performance monitoring and the types of measures available. This paper investigates the different performance measurement systems in place in the social care setting, in particular for older people receiving community care services. In England, earlier systems to assist performance management within organizations have been eclipsed by national systems of regulation with top- down implementation of standards and measures. In Northern Ireland, by contrast, organizations have been compared descriptively without the use of national targets. Internationally, in Japan, organizations arranging similar services have had more local information available collected in a bottom-up fashion with greater employment of service user-level data. These differences in performance evaluation are located within an analytical framework permitting comparisons of system design and the use of measures. Conclusions are drawn concerning the breadth of evidence available for successfully monitoring service provision in this setting. © The Author(s) 2010

What makes extra care housing an appropriate setting for people with dementia? An exploration of staff decision-making.

Extra care housing facilities in the UK are intended to offer a community-based alternative to care home placement. However, little is known about staff’s views of the appropriateness of extra care housing for people with dementia. This paper describes a mixed-methods study which explored this issue using statistical modelling of frontline staff’s recommendations of the best care setting for care home entrants; thematic analysis of transcripts from a simulated Resource Allocation Management Panel meeting; and content analysis of care coordinators’ reasons for not considering extra care housing in actual care home applications. Frontline practitioners saw extra care housing as a valuable alternative for a significant minority of care home entrants. However, extra care housing was not recommended if people needed care at night. Social care managers expressed general support for the idea of extra care housing, but appeared overwhelmingly focused on maintaining people at home and unsure where in the care pathway extra care housing sat. More evidence is needed on whether extra care housing can be an alternative to care homes and how services should be arranged to meet the needs of people living in extra care housing

Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties

Abstract Background Person-centredness is promoted as a central feature of the long-term care of older adults. Measures are needed to assist researchers, service planners and regulators in assessing this feature of quality. However, no systematic review exists to identify potential instruments and to provide a critical appraisal of their measurement properties. Method A systematic review of measures of person-centredness was undertaken. Inclusion criteria restricted references to multi-item instruments designed for older adult services, or otherwise with measurement properties tested in an older adult population. A two-stage critical appraisal was conducted. First, the methodological quality of included references was assessed using the COSMIN toolkit. Second, seven measurement properties were rated using widely-recognised thresholds of acceptability. These results were then synthesised to provide an overall appraisal of the strength of evidence for each measurement property for each instrument. Results Eleven measures tested in 22 references were included. Six instruments were designed principally for use in long-stay residential facilities, and four were for ambulatory hospital or clinic-based services. Only one measure was designed mainly for completion by users of home care services. No measure could be assessed across all seven measurement properties. Despite some instruments having promising measurement properties, this was consistently undermined by the poor methodological quality underpinning them. Testing of hypotheses to support construct validity was of particularly low quality, whilst measurement error was rarely assessed. Two measures were identified as having been the subject of the most rigorous testing. Conclusion The review is unable to unequivocally recommend any measures of person-centredness for use in older adult care. Researchers are advised to improve methodological rigour when testing instruments. Efforts may be best focused on testing a narrower range of measurement properties but to a higher standard, and ensuring that translations to new languages are resisted until strong measurement properties are demonstrated in the original tongue. Limitations of the review include inevitable semantic and conceptual challenges involved in defining ‘person-centredness’. The review protocol was registered with PROSPERO (ref: CRD42014005935)

The Luminosity of SN 1999by in NGC 2841 and the Nature of `Peculiar' Type Ia Supernovae

We present UBVRIJHK photometry and optical spectroscopy of the so-called 'peculiar' Type Ia supernova 1999by in NGC 2841. The observations began one week before visual maximum light which is well-defined by daily observations. The light curves and spectra are similar to those of the prototypical subluminous event SN 1991bg. We find that maximum light in B occurred on 1999 May 10.3 UT (JD 2,451,308.8 +/- 0.3) with B=13.66 +/- 0.02 mag and a color of B_max-V_max=0.51 +/- 0.03 mag. The late-time color implies minimal dust extinction from the host galaxy. Our photometry, when combined with the recent Cepheid distance to NGC 2841 (Macri et al. 2001), gives a peak absolute magnitude of M_B=-17.15 +/- 0.23 mag, making SN 1999by one of the least luminous Type Ia events ever observed. We estimate a decline rate parameter of dm15(B)=1.90 mag, versus 1.93 for SN 1991bg, where 1.10 is typical for so-called 'normal' events. We compare SN 1999by with other subluminous events and find that the B_max-V_max color correlates strongly with the decline rate and may be a more sensitive indicator of luminosity than the fading rate for these objects. We find a good correlation between luminosity and the depth of the spectral feature at 580 nm, which had been attributed solely to Si II. We show that in cooler photospheres the 580 nm feature is dominated by Ti II, which provides a simple physical explanation for the correlation. Using only subluminous Type Ia supernovae we derive a Hubble parameter of H_0=75 +12 -11 km/s Mpc, consistent with values found from brighter events.Comment: 36 preprint pages including 18 figures. Near-IR photometry of the SN has been added to the paper. Scheduled to appear in ApJ vol. 613 (September 2004). High-resolution version available from http://www.nd.edu/~pgarnavi/sn99by/sn99by.p