Möglichkeiten und Grenzen der Messung von Lebensqualität bei Menschen mit einer Alzheimer Demenz - Analyse ausgewähler Gütekriterien des QoL-AD-Proxy

Hintergrund Die Erhaltung der Lebensqualität bei MmD ist ein wichtiges Ziel von professionell tätigen Pflegefachpersonen. Das QoL-AD-Proxy soll eine Aussage über die Lebensqualität von MmD treffen und ist weltweit verbreitet. In Deutschland wird es ebenfalls verwendet. Bisher wurde es noch nicht auf seine testtheoretische Güte getestet. Mithilfe dieser Arbeit soll erstmals eine Aussage über die Konstruktvalidität und Interne Konsistenz der deutschsprachigen Variante des QoL-AD-Proxy zu getroffen werden. Methode Um eine Aussage über die Validität und Reliabilität des QoL-AD-Proxy in der deutschsprachigen Version treffen zu können, werden zusammengefasste Daten aus der Leben QD I und LebenQD II Studie einer Sekundärdatenanlyse unterzogen. Dabei werden Daten von insgesamt 234 Patienten-Proxy Paaren aus 9 Senioreneinrichtungen ausgewertet. Hierbei wird die Konstruktvalidität in Form von Faktorenanalysen überprüft. Zusätzlich wird die Interne Konsistenz berechnet. Ergebnisse Das QoL-AD-Proxy konnte auf zwei Dimensionen reduziert werden. Den ersten Faktor bildet die physische und psychische Gesundheit. Beim zweiten Faktor wird eine Aussage über das soziales Netzwerk und Lebensverhältnisse getroffen. Bei der Überprüfung der Faktorladungen durch 50% randomisierte Subsamples nach Probanden haben sieben Items auf einen anderen Faktor geladen. Eine erneute 50% Randomisierung nach Proxyratern brachte noch drei gesprungene Items hervor. Der Interne Konsistenz liegt bei dem ersten Faktor bei 0.81 und beim zweiten bei 0.65. Schlussfolgerungen Aus dieser Arbeit gehen erste Hinweise zur Konstruktvalidität des QoL-AD-Proxy hervor. Die Interne Konsistenz der beiden ermittelten Faktoren ist hoch (Faktor 1) bzw. mittelmäßig (Faktor 2). Die 50% randomisierten Subsamples geben Hinweise darauf, dass die Rater die Items des QoL-AD-Proxy unterschiedlich verstanden haben. Mit einem Update des originalen Rater-Manual, das die einzelnen Items noch präziser für Proxyanwender definiert, könnten noch besser vergleichbare Ergebnisse der Rater erzielt werden. Aktuell ist das QoL-AD-Proxy noch kein geeignetes Assessment für die Praxis in Deutschland, da es mit dieser Arbeit zum ersten Mal auf seine Konstruktvalidität überprüft wurde und noch nicht genügend Wissen existiert, um es als valides und reliables Instrument einsetzen zu können.Background The appropriate maintenance of Quality of Life (QoL) according to people who are suffering from dementia is a major aim for professional nurses. There exists a lot of different assessment instruments to measure QoL. These instruments are giving directions on what nurses have to promote. QoL-AD-Proxy is an assessment instrument which is used all over the world. In Germany it’s also used in different contexts. Until now it wasn’t tested on the test theoretical quality. The results of this Bachelor Thesis give notes about the construct quality and internal consistency of the German version of QoL-AD-Proxy. Methods To fulfill a statement about the construct validity and internal consistency, data of the Leben QD I and Leben QD II study were used. This data were taken in the form of a secondary data analysis. A total of 234 patient-proxy pairs out of 9 retirement homes were used for analysis. The construct validity was checked with prinicipal component alnalysis. In addition the internal consistency were determined. Results The QoL-AD-Proxy could be reduced into two dimensions. The first factor is physical and psychic health. The second factor is the social network and living conditions. At the confirmatory examination of the two dimensions with 50% randomized subsamples to probands, on one subsample 7 items loaded on the opposite factor. Another 50% randomization to proxyrater showed that 3 items of one subsample loaded on the opposite factor. The Internal Consistency of the first factor was 0.81 and for the second 0.65. Conclusion This Bachelor Thesis allows statements about the German version of QoL-AD-Proxy for the first time. The internal consistency for both factors is high (factor 1) respectively middle (factor 2.) The 50% randomized subsamples showed that rater had understood the items in different ways. Updating the original rater manual will define the items more clearly and precisely for users. Thus scientists in other countries and cultural contexts could use the update for their versions and produce more comparable proxy results for evaluation. Until now the QoL-AD-Proxy is not an appropriate tool for nurses in Germany because there is not enough knowledge to use it as a valid and reliable instrument in this context

Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review

Background: Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents. Methods: This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies' methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials. Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria. Results: A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories daytime activities, nighttime activities, staff training, and light exposure. The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories. Conclusions: The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged

Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review.

Wilfling D, Hylla J, Berg A, et al. Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review. International psychogeriatrics. 2020.BACKGROUND: Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents.; METHODS: This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies' methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria.; RESULTS: A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories "daytime activities," "nighttime activities," "staff training," and "light exposure." The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories.; CONCLUSIONS: The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged

Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial

Background Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no gold standard intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. Methods This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two sleep nurses as change agents per nursing home, (3) a basic education course for nursing staff: Sleep problems in dementia, (4) an advanced education course for nursing staff: Tailored problem-solving (two workshops), (5) workshops: Development of an institutional sleep-promoting concept (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and One Minute Wonder poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. Conclusions It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems