Effect of meeting centres support program on feelings of competence of family carers and delay of institutionalization of people with dementia

The study tested the hypotheses that integrated support, in which patients and carers are both supported by one professional staff member, will be more effective in reducing the feelings of (over)burden of carers and in positively influencing some potential determinants of experienced burden than non-integrated support, such as psychogeriatric day-care. A quasi-experimental pre-test/post-test control group design was applied with matched groups and measurements at baseline and after seven months. Fifty-five of the eighty dyads (31% dropped out) of persons with mild-to-moderate dementia and their carers who presented for four community meeting centres and three day-care centres in nursing homes over an 18 month period, were included in the study. The carers in the Meeting Centres Support (MCS) Program participated in an integrated family support program together with the persons with dementia, while the carers in the control group only received respite through psychogeriatric day-care. Standardized questionnaires were applied to measure some indicators of burden experienced by the carers (feelings of stress, life dissatisfaction, psychological and psychosomatic complaints), as well as some potential determinants of experienced burden (feeling of competence, coping strategies, experienced support and loneliness). Furthermore, as an indicator of feelings of (over)burden of the carer, the time between start of participation in one of the programs and institutionalization in a nursing home was calculated. After seven months the carers in the MCS group (n = 36), compared to the carers in regular psychogeriatric day-care (n = 19), showed a moderate positive effect on the feeling of competence (effect size 0.45). No effect was found on feelings of stress, dissatisfaction or psychological and psychosomatic complaints. However, as compared to the control group in regular day-care, the persons with dementia in the MCS Program participated for a longer period of time before they were placed in a nursing home. The MCS Program proved more effective than psychogeriatric day-care in influencing the feeling of competence of the carers, and seems to lead to an increased delay of nursing home placement of the person with dementia, as compared to regular day-care. Because of the small sample and limited power of the study, and the possible influence of the selection of carers on the study outcome, further research into the value of meeting centres for carers of people with dementia is recommended

Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia

Background: Tailor-made care in dementia requires an individual needs assessment. The Camberwell Assessment of Need for the Elderly (CANE) was developed to assess needs of older people with mental disorders. In this study the validity and reliability of the Dutch version of the CANE were studied among community-dwelling persons with dementia and their informal carers. Method: Interviews were carried out with 236 people with mild to severe dementia and 322 informal carers; 69 informal carers were interviewed twice. Construct and criterion validity and test-retest reliability of the CANE were studied using data for informal carers. Construct validity was also studied for CANE ratings of people with dementia. Results: The construct validity of the CANE was good among people with dementia and informal carers. Criterion validity could be studied for 76.9% of the CANE items, and all significant correlations were convergent. Test-retest reliability of the CANE varied from poor to very good and was best on domains where needs were explicit and problems well defined. Conclusions: Use of the Dutch version of the CANE among community-dwelling people with dementia and their carers is supported by the study results, with the study showing acceptable construct and criterion validity and test-retest reliability of the CANE. © 2008 International Psychogeriatric Association

Casemanagement bij beginnende dementie.

Doel: Men neemt algemeen aan dat vroegtijdige diagnose en casemanagement leiden tot betere zorg voor thuiswonende ouderen met dementie, vooral doordat de mantelzorger betere ondersteuning krijgt. Dat klinkt plausibel, maar het is niet bewezen. In een gerandomiseerd gecontroleerd klinisch onderzoek (RCT) gingen wij na of ouderen met de eerste symptomen van cognitieve achteruitgang en hun mantelzorgers daadwerkelijk beter af zijn met casemanagement dan met de gebruikelijke zorg die de huisarts biedt. Methode: De deelnemers aan ons onderzoek waren 99 patiënten uit Westfriese huisartsenpraktijken, met hun belangrijkste mantelzorger. De patiënten waren 65 jaar of ouder, woonden thuis en hadden symptomen van cognitieve achteruitgang. Wij randomiseerden de koppels in een groep die casemanagement kreeg en een groep die de gebruikelijke huisartsenzorg ontving, en maten bij de mantelzorgers de ervaren competentie, zorgbelasting, kwaliteit van leven en mate van somberheid. De patiënten ondervroegen we over hun ervaren kwaliteit van leven. Dit deden we op drie meetmomenten: voorafgaand aan de randomisatie, na zes en na twaalf maanden. Resultaten: We vonden geen verschillen tussen de interventie- en de controlegroep. Conclusie: Wij hebben de meerwaarde van casemanagement vooralsnog niet kunnen aantonen, maar op basis van deze ene RCT is het nog te vroeg voor een definitief oordeel. Daarvoor is meer onderzoek nodig. (aut. ref.