De weg naar een bandenloze zorg in Nederland

Vrijheidsbeperkende maatregelen worden vaak toegepast in de intramurale ouderenzorg. Tegelijkertijd weten we dat de toepassing van restrictieve vrijheidsbeperkende maatregelen zoals banden veel nadelige gevolgen heeft voor bewoners en hun gezondheid schade toe brengt. Toch leidt deze kennis niet tot een vermindering van het aantal maatregelen. Deze bijdrage beschrijft de zoektocht naar een interventie (EXBELT) om banden in verpleeghuizen veilig te verminderen en te voorkomen. EXBELT omvat een instellingsverbod op bandengebruik, een intensief scholingsprogramma, beschikbaarheid van alternatieve interventies en een gespecialiseerde verpleegkundige als consultant. In effectevaluaties blijkt EXBELT zowel op de korte, middellange als lange termijn effectief te zijn. Uit een procesevaluatie komt naar voren dat de interventie grotendeels volgens protocol is uitgevoerd en positief wordt gewaardeerd door medewerkers in verpleeghuizen en familie van bewoners. Tegelijkertijd wordt vastgesteld dat het reduceren van vrijheidsbeperkende maatregelen in Nederland traag verloopt en blijvende aandacht noodzakelijk is om bandengebruik in verpleeghuizen terug te dringen en in de thuiszorg te voorkomen

Efectos de un programa de eliminación de sujeciones físicas sobre personas mayores con demencia en residencias

Objetivo: Analizar los resultados de eliminar las sujeciones físicas en mayores con demencia que viven en residencias. Este objetivo se enmarca en un proceso más amplio de modificación del modelo de atención residencial. Método: Estudio cuasi experimental en dos residencias desde mayo de 2010 hasta mayo de 2012. Se recoge información en 7 momentos temporales y se efectúa un análisis longitudinal. Tras formar al personal se retiraron progresivamente las sujeciones físicas en el centro El Puig, mientras que en el centro Conarda se mantuvieron las sujeciones. Las variables principales medidas fueron: caídas, psicofármacos administrados, así como diversos indicadores de estado mental y funcional (Norton, NPI, Minimental,Tinetti, Barthel).Resultados: En el centro en el que se eliminan todas las sujeciones físicas (El Puig), se observa una ligera mejoría en el número de caídas y sus consecuencias mejoran levemente, aunque no son estadísticamente significativas. Los ANOVA mostraron mejoras significativas en el centro que ha eliminado las sujeciones respecto a la prescripción de psicofármacos, al deterioro cognitivo y a las alteraciones de conducta.Discusión: Se constata que retirar sujeciones físicas no repercute negativamente en las caídas y sin embargo mejora ciertos aspectos del bienestar y la autonomía de los mayores (alteraciones de conducta y deterioro mental). Además, se evidencia que este programa debe ser complementado con un programa de desatar químico (retirada de psicofármacos)

Belt restraint reduction in nursing homes: design of a quasi-experimental study

<p>Abstract</p> <p>Background</p> <p>The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes.</p> <p>Methods and design</p> <p>Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT.</p> <p>Discussion</p> <p>A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented.</p> <p>Trial registration</p> <p>(NTR2140)</p

Anxiety disorders and figural fluency: A measure of executive function

Background: Anxiety possibly interferes with executive functioning, although most studies rely on anxiety symptoms or lack control for comorbid depression. The objective of the present study is to examine the association between executive functioning and (individual) anxiety disorders with ak, ld without controlling for depression. Method: Generalized anxiety disorder (GAD), panic disorder with and without agoraphobia, agoraphobia, social phobia, as well as depressive disorder according to DSM-IV criteria were assessed with the Mini International Neuropsychiatric Interview in 82,360 community-dwelling people participating in the Lifelines cohort. Figural fluency as a measure of executive functioning was assessed with the Ruff Figural Fluency Test (RFTT). Linear regression analyses with the RFFT score as the dependent variable and psychiatric diagnosis as independent variables (dummies) were performed, adjusted for potential confounders. Multivariate results are presented with and without adjustment for depression. Results: Presence of any anxiety disorder was associated with worse performance on the RFFT (B = - 0.78, SE = 0.32, p = .015), independent of depression. No dose-response relationship with the number of anxiety disorders was found. Only agoraphobia and generalized anxiety disorder were significantly associated with the RFFT score in the multivariate models. Agoraphobia remained significant when further adjusted for depressive disorder (B = -1.14, SE = 0.41, p Limitations: Executive function was tested by only one measure, namely figural fluency. Conclusion: Agoraphobia is associated with worse executive functioning. Treatment of agoraphobia could be influenced by the executive dysfunction which clinicians should be aware of when regular treatment fails