Effects of Psychiatric Consultation on Medical Consumption in Medical Outpatients With Abdominal Pain

A randomized controlled clinical trial was conducted in an outpatient clinic of internal medicine to test the hypothesis that a protocol of cooperation and communication between internist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption in a group of medical outpatients with abdominal pain (N = 106). A reduction in medical consumption could not be demonstrated. However, a great variation in protocol adherence was found, partly related to the severity of the psychological problems. There is some evidence that the protocol, if restricted to cases with more severe psychiatric comorbidity, might reduce medical consumption

How do people with dementia and their carers evaluate the meeting centers support programme?

Background. The Meeting Centers Support Programme (MCSP) offers information and practical, emotional and social support to persons with dementia and their carers in local community centers. In this study the support programme was evaluated by participants (persons with dementia and carers) who utilized the MCSP for at least three months. Methods. Data collection took place within the framework of an implementation study in 11 meeting centers. 148 persons with dementia and 148 carers participated in the study. Data were collected after three and seven months of participation by means of questionnaires. Results. In general the persons with dementia and the carers were satisfied to very satisfied with the different elements of the support programme, the enrolment procedure, the contact with personnel, the location, and the facilities the centers have to offer. Half of the persons with dementia and one third of all carers indicated that they had made new acquaintances and friends at the center. Though satisfied with the programme, a majority of the persons with dementia (67% after three months and 58% after seven months) said that they were never asked what they wanted to do. The large majority of the carers feel somewhat less (42%) or much less (46%) burdened as a result of participating in the programme. This reduction of experienced burden proved to be related to satisfaction about the total programme (rs=0.35, p<0.005), experienced understanding for the own situation in informative meetings (rs=0.19, p=0.05), and experienced emotional support in contacts with other carers (rs=0.19, p=0.03). Conclusion. The satisfaction of the persons with dementia and their carers about the MCSP, and the percentage of carers who experienced a reduction of burden thanks to the support they received are high. However, the fact that two thirds of the persons with dementia say that they were never asked what they want to do indicates that the methods used by the staff need to be improved

Focus and effectiveness of psychosocial interventions for people with dementia in institutional care settings from the perspective of coping with the disease

Introduction: The care for persons with dementia with chronic diseases has changed much in the past decades. This counts for the care for people with dementia as well. The care presently offered is not merely aimed at improving or stabilizing the medicalcondition of the person, but also at improving their quality of life by supporting the person in accepting his disease and coping with the consequences of it. Based on this perspective, many psychosocial interventions were developed in the past decades. The aim of this study was to get insight in the effectiveness of these interventions in thedifferent adaptation areas.Method: Several literature reviews into psychosocial interventions offered in institutional care to people with dementia were analysed. The reviews covered the period from 1970 until 2007. The interventions were categorised according to their aim tosupport people in coping with one or more adaptive tasks, as described in the Adaptationcoping model (Dröes, 1991; Finnema et al., 2000).Results: Most of the investigated psychosocial interventions were aimed atsupporting people with dementia in Maintaining an emotional balance and Coping with disabilities. Regarding Maintaining an emotional balance psychomotor therapy, music therapy, adapting the living environment, validation, snoezelen en pet therapy are most frequently investigated and have shown to be able to positively influence behaviour symptoms, such as: agression, apathy, restlessness, depressive and anxious behavior. In the area of Coping with own disabilities interventions such as reality orientation, activity groups, normalising living pattern and structuring daily activities have shown to be effective in improving cognitive functioning and conducting daily activities. Alsorelatively many studies are conducted into Maintaining social relationships and Coping with the care environment (e.g. homely environment with enough privacy and normal living pattern). Few studies investigated interventions to help people Develop an adequate care relationship with professional carers and to Preserve a positive selfimage. No studies were found into interventions to help people Cope with an uncertain future. The most broad effects were found with pet therapy, snoezelen, psychomotortherapy, normal living pattern and creating a homely environment. Conclusion: Psychosocial interventions can be utilised for adaptation problems in several areas. For each area several interventions are available. Choices for individual treatment need to be based on the individual needs, personal characteristics, preferences and goal behaviour of the person with dementia. Future research should focus on better designed studies (RCT's) and predictors of effective psychosocial interventions for the treatment of different adaptation problems

Mantelzorg bij dementie en de kracht van sociale gezondheid

• In this article, we describe the current state of affairs with respect to informal care for people with dementia. We focus on the impact of informal care on the caregiver, caregiving strategies and effective ways to support informal caregivers, including e-health and technological support. • Informal care for people with dementia is intense and has consequences, both positive and negative: 78% of informal caregivers has good feelings about the care they give, but 15% feels heavily burdened. • A stimulating and supportive approach creates a positive and safe environment. Person-centred interventions providing several types of support are most effective for people with dementia and their informal caregivers. • E-health and technological interventions have favourable effects on trust, concern and depressive symptoms of informal caregivers. • New interventions should focus more on social health: interactions between people with dementia and their informal caregivers and encouragement of both to use their abilities

The use of the waiting list in a fair selection of patients for nursing home care

When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was studied. Qualitative research took place in two regions in the Netherlands, where scarcity exists in nursing home care. Selection meetings were attended and 39 health care workers were interviewed. Not only did waiting list criteria like urgency and chronology determine the final selection decision, but also efficiency and quality of care considerations (patients' preferences for particular nursing homes and nursing homes' considerations of matching the unit and work load). These considerations, their relative importance, and the resulting need for enforcement of the decision-making procedures, should be part of the discussion of patient selection. This acknowledges the complexity of the selection of patients

Subjective needs of people with dementia: A review of the literature

Objective: Insight into the individual care needs of the growing number of people with dementia is necessary to deliver more customized care. Our study aims to provide an overview of the literature on the subjective needs of people with dementia. Method: Electronic databases were searched for publications on subjective needs between January 1985 and July 2005, and reference lists were cross-referenced. Extracts of needs were classified within problem areas of the (Dutch) National Dementia Program and quality of life domains, and the extracts were classified as a "need" (an implicitly communicated felt state of deprivation), "want" (expression of a need) or "demand" (suitable solution to fulfill a need). Results: Subjective needs were found in 34 studies with various research aims, such as awareness and coping. Few studies aimed to measure needs of people with dementia. The most frequently reported needs of people with dementia were the need to be accepted and respected as they are, the need to find adequate strategies to cope with disabilities, and the need to come to terms with their situation. Explicit wants or demands were reported less frequently than needs. Conclusion: The high number of reported needs and the limited number of wants and demands show that people with dementia do not frequently mention how they want their needs to be met. Most reported needs are not instrumental, but are related to well-being and coping. Further research to inventory these needs could help achieve more demand-directed and better attuned care in the future

Effects of Exergaming on Cognitive and Social Functioning of People with Dementia:A Randomized Controlled Trial

Objectives: Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). Design: A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. Setting and Participants: A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. Methods: All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. Secondary outcomes: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. Results: Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P = .007; and Trail Making Test part A (TMT-A): r = −28.98, 95% CI: −54.89, −3.08, P = .029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = −1.86, 95% CI: −3.56, −0.17, P = .031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = −3.30, 95% CI: −6.57, −0.03, P = .048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P = .005). Conclusions and Implications: Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation

Is socially integrated community day care for people with dementia associated with higher user satisfaction and a higher job satisfaction of staff compared to nursing home-based day care?

Objectives: To investigate whether community-based (CO) day care with carer support according to the proven effective Meeting Centres Support Programme model is associated with higher satisfaction of people with dementia (PwD) and their informal caregivers (CG) and with a higher job satisfaction among care staff compared to traditional nursing home-based (NH) day care. Method: Data were collected in 11 NH day care centres and 11 CO day care centres. User satisfaction of PwD and CG was evaluated in the 11 NH day care centres (nPwD = 41, nCG = 39) and 11 CO day care centres (nPwD = 28, nCG = 36) with a survey after six months of participation. Job satisfaction was measured only in the six NH day care centres that recently transformed to CO day care, with two standard questionnaires before (nSTAFF = 35), and six months after the transition (nSTAFF = 35). Results: PwD were more positive about the communication and listening skills of staff and the atmosphere and activities at the CO day care centre. Also, CG valued the communication with, and expertise of, staff in CO day care higher, and were more satisfied with the received emotional, social and practical support. After the transition, satisfaction of staff with the work pace increased, but satisfaction with learning opportunities decreased. Conclusion: PwD and CG were more satisfied about the communication with the staff and the received support in CO day care than in NH day care. Overall job satisfaction was not higher, except satisfaction about work pace