Occupational therapy at home for older individuals with mild to moderate cognitive impairments and their primary caregivers: A pilot study

The objective of this pilot study was to explore the effects of occupational therapy on the performance of daily activities by older individuals with cognitive impairments and on the sense of competence of their primary caregivers. The design was a single group design. Older individuals with cognitive impairments and their primary caregivers were assessed prior to the first occupational therapy visit in hospital and after 5 weeks of occupational therapy at home. Participants were older individuals with mild to moderate cognitive impairments living at home (n = 12) and their primary caregivers (n = 12). These older clients with cognitive impairments and their primary caregivers received an occupational therapy intervention in hospital and at home after discharge in accordance with an occupational therapy guideline. This guideline is client-centered and makes use of collaborative, psychosocial, and environmental approaches. The main outcome measures were older clients' motor and process skills, initiative, need for assistance, self-perception in occupational performance, and satisfaction with this performance in daily activities and primary caregivers' sense of competence. The results of this study indicated that older clients' motor and process skills and self-perception in occupational performance improved and that they needed less help. The sense of competence of their primary caregivers also improved. This study provides preliminary evidence for the effectiveness of occupational therapy in older individuals with cognitive impairments and their primary caregivers, which should be tested in a randomized, controlled trial

Palliative care consultation in the Netherlands: A nationwide evaluation study

Palliative care in The Netherlands is mainly provided by generalist professionals who are part of the regular health care system. In order to provide good quality palliative care, they need options for training and consultation. Therefore, Palliative Care Consultation (PCC) teams were established, which inform, support, and advise professional caregivers involved with patients in palliative care without taking over responsibility. This study is the first nationwide study on PCC teams. Investigated was the nature and effect of consultations by registration and evaluation of consultations given by 19 PCC teams during a one-year period. Sixty-one percent of the requesting caregivers were primary care professionals and the problems discussed covered the entire field of palliative care, although physical problems played a dominant role. Although the patient was often not seen by the consultant, the consultant appeared to be able to identify more problems than initially discussed by the requesting professional. The types of problems discussed were hardly related to patient characteristics but more related to the discipline of the professional caregiver. According to the requesting professionals, consultation was helpful and contributed to improving the quality of palliative care

More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes

Item does not contain fulltextABSTRACT Background: Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms. Methods: Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Results: Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, -0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, -0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, -0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, -0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35). Conclusions: Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs

A practical instrument to explore patients' needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version.

Contains fulltext : 51818.pdf (publisher's version ) (Closed access)OBJECTIVE: Short and convenient checklists are necessary tools to support and structure needs assessments in daily palliative practice. This study aims to develop a short version of the Problems and Needs in Palliative Care questionnaire (PNPC-sv); a self-report questionnaire for patients covering all dimensions of palliative care, to investigate their problems and (unmet) needs. METHODS: The original Problems and Needs in Palliative Care questionnaire (PNPC) instrument is a comprehensive checklist of problems and needs for palliative care, and has shown validity and reliability. With its 90 items, however, it is not always practical. Thus it was abridged to a short version with 33 items. The validity and reliability are established with its item response, its internal consistency, and with its correlations with the original PNPC and with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and COOP/WONCA quality-of-life measures. A secondary analysis was done with data from 94 patients with metastatic cancer who had completed the long version. RESULTS: Each item in the PNPC represents a problem relevant to 25% of the patients or more. High correlations of PNPC-sv and PNPC domains demonstrate construct validity. The dimension reliability was satisfactory (Cronbach's alpha > 0.70), while two problem-aspect domains were less coherent. The PNPC-sv domains show convergent validity with corresponding health-related quality-of-life domains. CONCLUSION: The PNPC-sv is a concise, patient-centred tool that helps to identify the problems affecting the patient's quality of life and needs for care. It identifies prevalent needs for care and appears reliable. Further research should study the clinical effects of integrating the questionnaire into daily palliative-care practice

Predictors of the Time to Institutionalization in Young- Versus Late-Onset Dementia: Results From the Needs in Young Onset Dementia (NeedYD) Study

Item does not contain fulltextOBJECTIVE: To investigate the time from symptom onset to institutionalization in persons with young-onset dementia (YOD) and compare these findings with late-onset dementia (LOD), and to determine which factors predict institutionalization in persons with YOD compared with LOD. DESIGN/SETTING: Longitudinal study of community-dwelling patients with YOD and LOD and their caregivers. PARTICIPANTS: A total of 226 patients with YOD and 102 with LOD and their informal caregivers were recruited through memory clinics and health care facilities. MEASUREMENTS: Cox proportional hazard models were used to relate covariates with time to institutionalization. The main outcome was time from symptom onset to institutionalization. Key predictors were cohort (YOD or LOD), neuropsychiatric symptoms, caregiver distress caused by neuropsychiatric symptoms, and caregivers' sense of competence (Short Sense of Competence Questionnaire total score). RESULTS: The time from symptom onset to institutionalization was nearly 9 years for patients with YOD compared with approximately 4 years for patients with LOD. In the YOD group, apathy significantly predicted time of institutionalization. Furthermore, the caregiver's competence in caring for the person with dementia significantly predicted institutionalization in both groups. CONCLUSIONS: Patients with YOD are cared for at home for a longer period than patients with LOD. The results of this study underline the importance of a timely diagnosis for these patients and their families to facilitate the initiation of appropriate care and support. Support programs aimed at enhancing the caregivers' sense of competence and ability to deal with neuropsychiatric symptoms, especially apathy, may postpone the institutionalization of the patient

The Use of Formal and Informal Care in Early Onset Dementia: Results From the NeedYD Study

Item does not contain fulltextOBJECTIVE: Early onset dementia (EOD) poses specific challenges and issues for both the patient and (in)formal care. This study explores the use of (in)formal care prior to institutionalization, and its association with patient and caregiver characteristics. DESIGN/SETTING: Participants were part of a community-based prospective longitudinal study of 215 patients and their informal caregivers. PARTICIPANTS: Baseline data of a subsample of 215 patient-caregiver dyads were analyzed. MEASUREMENTS: Analyses of covariance were performed to determine correlates of (in)formal care use assessed with the Resource Utilization in Dementia (RUD)-Lite questionnaire. RESULTS: Informal care had a 3:1 ratio with formal care. Supervision/surveillance constituted the largest part of informal care. In more than half of cases, patients had only one informal caregiver. The amount of informal care was associated with disease severity, showing more informal care hours in advanced disease stages. Fewer informal care hours were related to more caregiver working hours, especially in younger patients. The amount of formal care was related to disease severity, behavioral problems, and initiative for activities of daily living. CONCLUSION: In EOD, it appears that family members provide most of the care. However, other social roles still have to be fulfilled. Especially in spousal caregivers of younger patients in advanced disease stages, there is a double burden of work and care responsibilities. This finding also indicates that even within the EOD group there might be important age-related differences. The relatively higher amount of formal care use during advanced disease stages suggests a postponement in the use of formal care