Ontwikkeling van de Gedragsobservatieschaal Psychomotorische therapie voor demente ouderen (GPMT-dem)

De Gedragsobservatieschaal voor de Psychomotorische Therapie voor demente ouderen (GPMTdem) werd ontwikkeld om het effect van psychomotorische groepstherapie op het cognitief, sociaal en emotioneel functioneren van ouderen met dementie binnen de therapiesituatie te kunnen evalueren. In het onderzoek dat hier wordt beschreven zijn de interbeoordelaarbetrouwbaarheid en interne consistentie van de tien subschalen en drie domeinen, alsmede de samenhang met andere observatieschalen (criteriumvaliditeit) onderzocht in twee verschillende patiëntgroepen. De eerste onderzoeksgroep bestond uit cliënten die psychomotorische therapie ontvingen in een verpleeghuis of psychiatrisch ziekenhuis (N = 130). Interbeoordelaarbetrouwbaarheid (Cohens kappa) varieerde van 0,27 tot 1,00, de interne consistentie van de subschalen (Cronbachs alfa) tussen 0,46 en 0,86 en die van de domeinen tussen 0,76 en 0,81. Op basis van dit onderzoek zijn van de oorspronkelijke 88 items vijftien items verwijderd, vijf items verplaatst naar een andere subschaal en is de tekst van twee items gewijzigd. De interne consistentie van de subschalen en criteriumvaliditeit van deze gemodificeerde (73-item versie) GPMT-dem is vervolgens onderzocht bij 41 ouderen die deelnamen aan een ondersteuningsprogramma in Ontmoetingscentra voor mensen met dementie en hun verzorgers. Cronbachs alfa van de subschalen bleek in deze studie tussen de 0,47 en 0,86. Ter bepaling van de criteriumvaliditeit is de GPMTdem vergeleken met (subschalen van) de Beoordelingsschaal voor Oudere Patiënten (BOP), Gedragsobservatieschaal voor de Intramurale Psychogeriatrie (GIP), Brief Cognitive Rating Scale (BCRS) en de Cornell Rating Scale for Depression in Dementia. De correlaties met gerelateerde subschalen van de GPMT-dem varieerde tussen de 0,38 en 0,75. Geconcludeerd wordt dat de huidige 73- item versie van de GPMT-dem een bevredigende interbeoordelaarbetrouwbaarheid en criteriumvaliditeit bezit. Zes subschalen zijn voldoende intern consistent te noemen en er worden aanbevelingen gedaan om de interne consistentie van de overige subschalen te verbeteren. In vervolgonderzoek zou de unidimensionaliteit en schaalbaarheid van de subschalen van de GPMT-dem getoetst moeten worden, alsmede het effect van de aanbevolen herformulering en verwijdering van items. Voordat de GPMT-dem in de praktijk kan worden toegepast dienen de psychometrische eigenschappen van de GPMT-dem73 bij een grotere en in ernst van dementie meer heterogene onderzoeksgroep verder te worden onderzocht, zodat ook uitspraken kunnen worden gedaan over de te hanteren normen in verschillende subgroepen van ouderen met dementie

Assistive technology for memory support in dementia

BACKGROUND: The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user-friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking. Such a review would guide people with dementia and their informal and professional carers in selecting appropriate AT devices. Objectives PRIMARY OBJECTIVE: To assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care. SECONDARY OBJECTIVE: To assess the impact of AT on: users (autonomy, usefulness and user-friendliness, adoption of AT); cognitive function and neuropsychiatric symptoms; need for informal and formal care; perceived quality of life; informal carer burden, self-esteem and feelings of competence; formal carer work satisfaction, workload and feelings of competence; and adverse events. SEARCH METHODS: We searched ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), on 10 November 2016. ALOIS is maintained by the Information Specialists of the CDCIG and contains studies in the areas of dementia prevention, dementia treatment and cognitive enhancement in healthy people. We also searched the following list of databases, adapting the search strategy as necessary: Centre for Reviews and Dissemination (CRD) Databases, up to May 2016; The Collection of Computer Science Bibliographies; DBLP Computer Science Bibliography; HCI Bibliography: Human-Computer Interaction Resources; and AgeInfo, all to June 2016; PiCarta; Inspec; Springer Link Lecture Notes; Social Care Online; and IEEE Computer Society Digital Library, all to October 2016; J-STAGE: Japan Science and Technology Information Aggregator, Electronic; and Networked Computer Science Technical Reference Library (NCSTRL), both to November 2016; Computing Research Repository (CoRR) up to December 2016; and OT seeker; and ADEAR, both to February 2017. In addition, we searched Google Scholar and OpenSIGLE for grey literature. SELECTION CRITERIA: We intended to review randomised controlled trials (RCTs) and clustered randomised trials with blinded assessment of outcomes that evaluated an electronic assistive device used with the single aim of supporting memory function in people diagnosed with dementia. The control interventions could either be 'care (or treatment) as usual' or non-technological psychosocial interventions (including interventions that use non-electronic assistive devices) also specifically aimed at supporting memory. Outcome measures included activities of daily living, level of dependency, clinical and care-related outcomes (for example admission to long-term care), perceived quality of life and well-being, and adverse events resulting from the use of AT; as well as the effects of AT on carers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all titles and abstracts identified by the search. MAIN RESULTS: We identified no studies which met the inclusion criteria. Authors' conclusions This review highlights the current lack of high-quality evidence to determine whether AT is effective in supporting people with dementia to manage their memory problems

Read and accepted? Scoping the cognitive accessibility of privacy policies of health apps and websites in three European countries

Objective Trust and accessibility are vital to adoption of health and wellness apps. This research scoped three elements of cognitive accessibility of health app privacy policies: availability, ease of navigation, and readability. Methods For this cross-sectional study, quantitative data collected in the Netherlands, Sweden, and the United Kingdom included: whether privacy information was in a country's official language (availability); number of distracting visual elements (ease of navigation); word count and Common European Framework of Reference (CEFR) reading level (readability). Health app privacy policies were compared to policies from a purposively selected sample of websites, and to benchmarks, including CEFR reading level B1. Results Health app privacy policies were less often available in countries’ official languages compared to sampled websites (Chi-Square [1, 180]  =  57.470, p < 0.001) but contained fewer distracting visual elements. More UK privacy policies were in the country's official language, whereas Swedish privacy policies contained fewest words and fewest potentially distracting design elements. Only one privacy policy met the CEFR reading level benchmark. Conclusions Lack of privacy information in non-Anglophone app-users’ native languages and high reading levels may be major barriers to cognitive accessibility. Web and app developers should consider recommendations arising from this study, to stimulate trust in and adoption of health and wellness apps

Facilitators and Barriers to Adaptive Implementation of the Meeting Centers Support Program (MCSP) in Three European Countries; the Process Evaluation Within the MEETINGDEM Study

Background: In the MEETINGDEM project, the Meeting Centers Support Program (MCSP) was adaptively implemented and evaluated in three European countries: Italy, Poland, and the United Kingdom. The aim of this study was to investigate overall and country-specific facilitators and barriers to the implementation of MCSP in these European countries. Methods: A qualitative multiple case study design was used. Based on the theoretical model of adaptive implementation, a checklist was composed of potential facilitators and barriers to the implementation of MCSP. This checklist was administered among stakeholders involved in the implementation of MCSP to trace the experienced facilitators and barriers. Twenty-eight checklists were completed. Results: Main similarities between countries were related to the presence of suitable staff, management, and a project manager, and the fact that the MCSP is attuned to needs and wishes of people with dementia and informal caregivers. Main differences between countries were related to: communication with potential referrers, setting up an inter-organizational collaboration network, receiving support of national organizations, having clear discharge criteria for the MCSP and continuous PR in the region. Conclusion: The results of this study provide insight into generic and country specific factors that can influence the implementation of MCSP in different European countries. This study informs further implementation and dissemination of MCSP in Europe and may also serve as an example for the dissemination and implementation of other effective psychosocial support interventions for people with dementia and their informal caregivers across and beyond Europe

Transitie van een psychogeriatrische dagbehandeling in het verpleeghuis naar een laagdrempelige dagbehandeling in de wijk: een pilotonderzoek

Achtergrond In deze studie wordt de transitie van een reguliere psychogeriatrische dagbehandeling in het verpleeghuis naar laagdrempelige psychogeriatrische dagbehandeling met mantelzorgondersteuning (LPD-plus MO) in de wijk op de voet gevolgd. Het bewezen effectieve Model Ontmoetingscentra vormde het uitgangspunt bij de transitie. Methode Door middel van kwalitatieve analyse van documenten en interviews met sleutelfiguren (n = 11) worden factoren opgespoord die de overgang van de oude naar de nieuwe vorm van dagbehandeling bevorderen of belemmeren. Bij deelnemers en mantelzorgers die langer dan 6 maanden gebruik maken van het ondersteuningsaanbod wordt de tevredenheid over het nieuwe aanbod gepeild. Resultaten Verschillende kenmerken van LPD-plus MO blijken de samenwerking met andere zorg- en welzijnsaanbieders in de regio te bevorderen, zoals: de laagdrempelige locatie, de sociale integratie in de buurt en de focus op gecombineerde ondersteuning van zowel de persoon met dementie als de mantelzorger. Een goede samenwerking met andere zorg- en welzijnsorganisaties, en een geschikte locatie vergemakkelijken de implementatie. De aanwezigheid van concurrerend aanbod in de regio, zoals ontmoetingscentra voor mensen met dementie en hun mantelzorgers, belemmeren de werving van deelnemers voor de LPDplus MO. Deelnemers en mantelzorgers zijn over het algemeen tevreden over het ondersteuningsprogramma. Conclusie en discussie De transitie is succesvol verlopen en levert andere reguliere dagbehandelingen tips op voor de transitie naar LPD-plus MO

Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial

Contains fulltext : 81435.pdf (publisher's version ) (Open Access)BACKGROUND: Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD). The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study. METHODS AND DESIGN: In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses) have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads) coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives. DISCUSSION: A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in costs in the management of dementia. Implementation on a national level will be started if the SCPD proves to be efficient. TRIAL REGISTRATION: NCT00147693

The Impact of the Implementation of the Dutch Combined Meeting Centres Support Programme for Family Caregivers of People with Dementia in Italy, Poland and UK

Objectives: The MEETINGDEM research project aimed to implement the combined Dutch Meeting Centre Support Programme (MCSP) for community-dwelling people with dementia and caregivers within Italy, Poland and UK and to assess whether comparable benefits were found in these countries as in the Netherlands. Method: Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared to usual care (UC) on caregiver outcomes measuring competence (SSCQ), mental health (GHQ-12), emotional distress (NPI-Q) and loneliness (UCLA) analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial. Interviews using standardised measures were completed with caregivers. Results: Pre/post data were collected for 93 caregivers receiving MCSP and 74 receiving UC. No statistically significant differences on the outcome measures were found overall. At a country level MC caregivers in Italy showed significant better general mental health (p=0.04, d=0.55) and less caregiver distress (p=0.02, d=0.62) at post-test than the UC group. Caregiver satisfaction was rated on a sample at 3 months (n=81) and 6 months (n=84). The majority of caregivers reported feeling less burdened and more supported by participating in MCSP. Conclusion: The moderate positive effect on sense of competence and the greater mental health benefit for lonely caregivers using the MCSP compared to UC as found in the original Dutch studies were not replicated. However, subject to study limitations, caregivers in Italy using MCSP benefitted more regarding their mental health and emotional distress than caregivers using UC. Further evaluation of the benefits of MCSP within these countries in larger study samples is recommended