TY - JOUR

T1 - A controlled trial of Partners in Dementia Care: veteran outcomes after six

and twelve months.
JF - Alzheimer's research & therapy
A1 - Bass DM
A1 - Judge KS
A1 - Snow AL
A1 - Wilson NL
A1 - Morgan RO
A1 - Maslow K
A1 - Randazzo R
A1 - Moye JA
A1 - Odenheimer GL
A1 - Archambault E
A1 - Elbein R
A1 - Pirraglia P
A1 - Teasdale TA
A1 - McCarthy CA
A1 - Looman WJ
A1 - Kunik ME
KW - eppi-reviewer4
PY - 2014
DA - 2014///
Y1 - 2014///
N2 - INTRODUCTION: "Partners in Dementia Care" (PDC) tested the effectiveness of a
care-coordination program integrating healthcare and community services and
supporting veterans with dementia and their caregivers. Delivered via partnerships
between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC
targeted both patients and caregivers, distinguishing it from many non-
pharmacological interventions. Hypotheses posited PDC would improve five veteran
self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3)
isolation, 4) relationship strain and 5) depression. Greater impact was expected
for more impaired veterans. A unique feature was self-reported research data
collected from veterans with dementia. METHODS AND FINDINGS: Five matched
communities were study sites. Two randomly selected sites received PDC for 12
months; comparison sites received usual care. Three structured telephone interviews
were completed every 6 months with veterans who could participate. RESULTS: Of 508
consenting veterans, 333 (65.6%) completed baseline interviews. Among those who
completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194
(58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had
significantly less adverse outcomes than those receiving usual care, particularly
for more impaired veterans after 6 months, including reduced relationship strain (B
= -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p
= 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about
memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had
further reductions in unmet need (B = -0.96; p < 0.01) and embarrassment (B =
-0.05; p = 0.02). Limitations included use of matched comparison sites rather than
within-site randomization and lack of consideration for variation within the PDC
group in amounts and types of assistance provided. CONCLUSIONS: Partnerships
between community and health organizations have the potential to meet the dementia-
related needs and improve the psychosocial functioning of persons with dementia.
TRIAL REGISTRY: NCT00291161.
AB - INTRODUCTION: "Partners in Dementia Care" (PDC) tested the effectiveness of a
care-coordination program integrating healthcare and community services and
supporting veterans with dementia and their caregivers. Delivered via partnerships
between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC
targeted both patients and caregivers, distinguishing it from many non-
pharmacological interventions. Hypotheses posited PDC would improve five veteran
self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3)
isolation, 4) relationship strain and 5) depression. Greater impact was expected
for more impaired veterans. A unique feature was self-reported research data
collected from veterans with dementia. METHODS AND FINDINGS: Five matched
communities were study sites. Two randomly selected sites received PDC for 12
months; comparison sites received usual care. Three structured telephone interviews
were completed every 6 months with veterans who could participate. RESULTS: Of 508
consenting veterans, 333 (65.6%) completed baseline interviews. Among those who
completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194
(58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had
significantly less adverse outcomes than those receiving usual care, particularly
for more impaired veterans after 6 months, including reduced relationship strain (B
= -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p
= 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about
memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had
further reductions in unmet need (B = -0.96; p < 0.01) and embarrassment (B =
-0.05; p = 0.02). Limitations included use of matched comparison sites rather than
within-site randomization and lack of consideration for variation within the PDC
group in amounts and types of assistance provided. CONCLUSIONS: Partnerships
between community and health organizations have the potential to meet the dementia-
related needs and improve the psychosocial functioning of persons with dementia.
TRIAL REGISTRY: NCT00291161.
DO - 10.1186/alzrt242
VL - 6
IS - 1
SP - 9
CY - England
SN - 1758-9193 (Print)
U1 - 34698740
U2 - 24764496
N1 -
ER -

TY - JOUR
T1 - Caregivers' experience of providing care for demented persons living at home.
JF - Scandinavian journal of primary health care
A1 - Bjorkhem K
A1 - Olsson A
A1 - Hallberg IR
A1 - Norberg A
KW - eppi-reviewer4
Adolescent
Adult
Allied Health Personnel
*Caregivers/education
Dementia/*nursing
Female
*Home Care Services
Humans
Interprofessional Relations
*Job Satisfaction
Male
Middle Aged
Nurses
Nurses' Aides
Professional-Family Relations
Social Work
Surveys and Questionnaires
PY - 1992
DA - 1992/03//
Y1 - 1992/03//
N2 - Caregivers providing home-care for demented persons answered a questionnaire
concerning what was satisfactory or problematic when providing home-care. They were
also asked what needs/wishes they had for themselves and for the demented persons.
The findings reflected the impact of a functioning interpersonal relationship
between the caregiver and the demented person and his family. The difficulties in
handling problematic behaviour, and the necessity to be able to stimulate and
provide activities for the demented were also emphasized. Moreover, the caregivers
stressed their role as supporters of the patients' families, their need for more
and better cooperation with the staff of the psychogeriatric clinic, and their need
for training and supervision in how to manage their relationship with the demented
person. Hence, it seems urgent to try to practise and evaluate systematic clinical
guidance to provide knowledge and systematic supervision about how to manage
demented persons in their own social context so that they can stay in their homes.
AB - Caregivers providing home-care for demented persons answered a questionnaire
concerning what was satisfactory or problematic when providing home-care. They were
also asked what needs/wishes they had for themselves and for the demented persons.
The findings reflected the impact of a functioning interpersonal relationship
between the caregiver and the demented person and his family. The difficulties in
handling problematic behaviour, and the necessity to be able to stimulate and
provide activities for the demented were also emphasized. Moreover, the caregivers
stressed their role as supporters of the patients' families, their need for more
and better cooperation with the staff of the psychogeriatric clinic, and their need
for training and supervision in how to manage their relationship with the demented
person. Hence, it seems urgent to try to practise and evaluate systematic clinical
guidance to provide knowledge and systematic supervision about how to manage
demented persons in their own social context so that they can stay in their homes.
VL - 10
IS - 1
SP - 53
EP - 9
CY - United States
SN - 0281-3432 (Linking)
U1 - 34698588
U2 - 1589665
N1 -
ER -

TY - JOUR
T1 - A systematic review of Internet-based supportive interventions for caregivers
of patients with dementia.
JF - International journal of geriatric psychiatry
A1 - Boots LM
A1 - de Vugt ME
A1 - van Knippenberg RJ
A1 - Kempen GI
A1 - Verhey FR
KW - eppi-reviewer4
Caregivers/*psychology
*Counseling/methods
Dementia/*nursing/psychology
Humans
*Internet
Patient Education as Topic/methods
*Social Support
Internet
caregivers
dementia
psychosocial interventions
review literature
PY - 2014
DA - 2014/04//
Y1 - 2014/04//
N2 - OBJECTIVE: Because of the expected increase in the number of dementia
patients, the unlikelihood of a cure in the near future, and the rising cost of
care, there is an increasing need for effective caregiver interventions. Internet
interventions hold considerable promise for meeting the educational and support
needs of informal dementia caregivers at reduced costs. The current study aims to
provide an overview of the evidence for the effectiveness, feasibility, and quality
of Internet interventions for informal caregivers of people with dementia. METHODS:
A systematic literature search of five scientific databases was performed, covering
literature published up to 10 January 2013. Twelve studies were identified. The
quality of the included studies was assessed according to the Cochrane level of
evidence and the criteria list of the Cochrane Back Review Group. RESULTS: The
intervention types, dosage, and duration differed widely, as did the methodological
quality of the included studies. The overall level of evidence was low. However,
the results demonstrate that Internet interventions for informal dementia
caregivers can improve various aspects of caregiver well-being, for example,
confidence, depression, and self-efficacy, provided they comprise multiple
components and are tailored to the individual. Furthermore, caregivers could
benefit from interaction with a coach and other caregivers. CONCLUSIONS: Internet
interventions for informal dementia caregivers may improve caregiver well-being.
However, the available supporting evidence lacks methodological quality. More
randomized controlled studies assessing interventions performed according to
protocol are needed to give stronger statements about the effects of supportive
Internet interventions and their most promising elements.
AB - OBJECTIVE: Because of the expected increase in the number of dementia
patients, the unlikelihood of a cure in the near future, and the rising cost of
care, there is an increasing need for effective caregiver interventions. Internet
interventions hold considerable promise for meeting the educational and support
needs of informal dementia caregivers at reduced costs. The current study aims to
provide an overview of the evidence for the effectiveness, feasibility, and quality
of Internet interventions for informal caregivers of people with dementia. METHODS:
A systematic literature search of five scientific databases was performed, covering
literature published up to 10 January 2013. Twelve studies were identified. The
quality of the included studies was assessed according to the Cochrane level of
evidence and the criteria list of the Cochrane Back Review Group. RESULTS: The
intervention types, dosage, and duration differed widely, as did the methodological
quality of the included studies. The overall level of evidence was low. However,
the results demonstrate that Internet interventions for informal dementia
caregivers can improve various aspects of caregiver well-being, for example,
confidence, depression, and self-efficacy, provided they comprise multiple
components and are tailored to the individual. Furthermore, caregivers could
benefit from interaction with a coach and other caregivers. CONCLUSIONS: Internet
interventions for informal dementia caregivers may improve caregiver well-being.
However, the available supporting evidence lacks methodological quality. More
randomized controlled studies assessing interventions performed according to
protocol are needed to give stronger statements about the effects of supportive
Internet interventions and their most promising elements.
DO - 10.1002/gps.4016
VL - 29
IS - 4
SP - 331
EP - 44
CY - England
SN - 0885-6230 (Linking)
U1 - 34698771
U2 - 23963684
N1 -
ER -

TY - JOUR
T1 - Meta-analysis of psychosocial interventions for caregivers of people with
dementia.
JF - Journal of the American Geriatrics Society
A1 - Brodaty H
A1 - Green A
A1 - Koschera A
KW - eppi-reviewer4
Aged
Caregivers/*psychology
Chi-Square Distribution
Dementia/*nursing
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Quality of Life
Self-Help Groups
Social Support
Spouses/psychology
Stress, Psychological
PY - 2003
DA - 2003/05//
Y1 - 2003/05//
N2 - OBJECTIVES: To review published reports of interventions for caregivers (CGs)
of persons with dementia, excluding respite care, and provide recommendations to
clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles
were searched for controlled trials, preferably randomized, published in English
from 1985 to 2001 inclusive. Thirty studies were located and scored according to
set criteria, and the interventions' research quality and clinical significance
were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal
CGs-persons providing unpaid care at home or in a noninstitutional setting.
MEASUREMENTS: The primary measures were psychological morbidity and burden. Other
varied outcome measures such as CG coping skills and social support were combined
with measures of psychological distress and burden to form a main outcome measure.
RESULTS: The quality of research increased over the 17 years. Results from 30
studies (34 interventions) indicated, at most-current follow-up, significant
benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95%
confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-
0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient
mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-
0.26). There was considerable variability in outcome, partly because of differences
in methodology and intervention technique. Elements of successful interventions
could be identified. Success was more likely if, in addition to CGs, patients were
involved. Four of seven studies indicated delayed nursing home admission.
CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help
people with dementia stay at home longer. Programs that involve the patients and
their families and are more intensive and modified to CGs' needs may be more
successful. Future research should try to improve clinicians' abilities to
prescribe interventions.
AB - OBJECTIVES: To review published reports of interventions for caregivers (CGs)
of persons with dementia, excluding respite care, and provide recommendations to
clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles
were searched for controlled trials, preferably randomized, published in English
from 1985 to 2001 inclusive. Thirty studies were located and scored according to
set criteria, and the interventions' research quality and clinical significance
were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal
CGs-persons providing unpaid care at home or in a noninstitutional setting.
MEASUREMENTS: The primary measures were psychological morbidity and burden. Other
varied outcome measures such as CG coping skills and social support were combined
with measures of psychological distress and burden to form a main outcome measure.
RESULTS: The quality of research increased over the 17 years. Results from 30
studies (34 interventions) indicated, at most-current follow-up, significant
benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95%
confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-
0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient
mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-
0.26). There was considerable variability in outcome, partly because of differences
in methodology and intervention technique. Elements of successful interventions
could be identified. Success was more likely if, in addition to CGs, patients were
involved. Four of seven studies indicated delayed nursing home admission.
CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help
people with dementia stay at home longer. Programs that involve the patients and
their families and are more intensive and modified to CGs' needs may be more
successful. Future research should try to improve clinicians' abilities to
prescribe interventions.
VL - 51
IS - 5
SP - 657
EP - 64
CY - United States
SN - 0002-8614 (Linking)
U1 - 34699022
U2 - 12752841
N1 -
ER -

TY - JOUR
T1 - Providing information for family carers of hospital patients experiencing
dementia.
JF - Dementia (London, England)
A1 - Bronson M
A1 - Toye C
KW - eppi-reviewer4
Attitude of Health Personnel
Caregivers/*education
Consumer Health Information/*methods
Dementia/*nursing
*Hospitalization
Humans
*Nursing Staff, Hospital
Pamphlets
Surveys and Questionnaires
caregivers
dementia
hospitals
nurses
PY - 2015
DA - 2015/03//
Y1 - 2015/03//
N2 - Family carers of people with dementia may take on this role without
understanding how it will evolve or how to obtain support. Hospitalisation of the
person with dementia can not only compound carers' concerns, but also provides an
opportunity for their needs to be addressed. This project involved preparing
hospital based nurses, so they could initiate a dialogue with family carers of
patients diagnosed with dementia, developing a protocol to guide the nurses as they
provided carers with a dementia information booklet, implementing this protocol
during a 12-week trial period, and obtaining feedback from the nurses using a
questionnaire. At least 21 booklets were distributed; 16 nurses provided feedback.
Nurses viewed the practice change positively. Recommendations are to engage ward
based champions to embed this strategy into nursing practice, keep the staff
informed, and ensure that the booklet is kept in a location visible to the staff.
AB - Family carers of people with dementia may take on this role without
understanding how it will evolve or how to obtain support. Hospitalisation of the
person with dementia can not only compound carers' concerns, but also provides an
opportunity for their needs to be addressed. This project involved preparing
hospital based nurses, so they could initiate a dialogue with family carers of
patients diagnosed with dementia, developing a protocol to guide the nurses as they
provided carers with a dementia information booklet, implementing this protocol
during a 12-week trial period, and obtaining feedback from the nurses using a
questionnaire. At least 21 booklets were distributed; 16 nurses provided feedback.
Nurses viewed the practice change positively. Recommendations are to engage ward
based champions to embed this strategy into nursing practice, keep the staff
informed, and ensure that the booklet is kept in a location visible to the staff.
DO - 10.1177/1471301214560240
VL - 14
IS - 2
SP - 267
EP - 72
CY - England
SN - 1471-3012 (Linking)
U1 - 34698720
U2 - 25416176
N1 -
ER -

TY - JOUR
T1 - Family caregivers of patients with frontotemporal dementia: An integrative
review.
JF - International journal of nursing studies
A1 - Caceres BA
A1 - Frank MO
A1 - Jun J
A1 - Martelly MT
A1 - Sadarangani T
A1 - de Sales PC
KW - eppi-reviewer4
Caregivers/*psychology
Family/*psychology
Female
Frontotemporal Dementia/*psychology
Humans
Male
Stress, Psychological
Caregiver burden
Coping strategies
Family caregivers
Family-centered care
Frontotemporal dementia
PY - 2016
DA - 2016/03//
Y1 - 2016/03//
N2 - OBJECTIVES: The purpose of this integrative review is to: (1) identify the
characteristics of family caregivers of patients with frontotemporal dementia, (2)
explore the impact of providing care on family caregivers' health and well-being,
and (3) identify coping strategies used by family caregivers. BACKGROUND:
Frontotemporal dementia is thought to be the second most common form of dementia
after Alzheimer's disease. Family caregivers of patients with frontotemporal
dementia face unique challenges due to its early onset, behavioral symptoms, and
slow progression of decline. However, there is a dearth of research evaluating the
health and wellbeing of family caregivers of patients with frontotemporal dementia.
DESIGN AND DATA SOURCES: An integrative review was conducted using the Whittemore
and Knafl methodology. An electronic search of the literature was conducted using
four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe
Critical Appraisal tool was used to evaluate the quality of the selected articles.
RESULTS: Findings of 11 articles informed this integrative review. Family
caregivers of patients with frontotemporal dementia identify behavioral
disturbances as most troubling. Spouses and female caregivers experience greater
caregiver burden, distress, increased rates of depression, as well as decreased
sleep related to behavior disturbances. Though less explored, providing care to
those with behavioral disturbances may also impact caregiver physical health.
Additionally, female caregivers are most likely to employ coping strategies, most
commonly, adaptation and reframing. Effective interventions to reduce family
caregiver burden are poorly understood but family caregivers suggest education and
internet-based support groups are most helpful. CONCLUSIONS: Family caregivers of
patients with frontotemporal dementia experience significant distress, which
impacts their health and wellbeing. It is important for healthcare providers who
care for patients with frontotemporal dementia to recognize the unique needs of
family caregivers. Future research should focus on examining interventions and
strategies to reduce caregiver burden.
AB - OBJECTIVES: The purpose of this integrative review is to: (1) identify the
characteristics of family caregivers of patients with frontotemporal dementia, (2)
explore the impact of providing care on family caregivers' health and well-being,
and (3) identify coping strategies used by family caregivers. BACKGROUND:
Frontotemporal dementia is thought to be the second most common form of dementia
after Alzheimer's disease. Family caregivers of patients with frontotemporal
dementia face unique challenges due to its early onset, behavioral symptoms, and
slow progression of decline. However, there is a dearth of research evaluating the
health and wellbeing of family caregivers of patients with frontotemporal dementia.
DESIGN AND DATA SOURCES: An integrative review was conducted using the Whittemore
and Knafl methodology. An electronic search of the literature was conducted using
four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe
Critical Appraisal tool was used to evaluate the quality of the selected articles.
RESULTS: Findings of 11 articles informed this integrative review. Family
caregivers of patients with frontotemporal dementia identify behavioral
disturbances as most troubling. Spouses and female caregivers experience greater
caregiver burden, distress, increased rates of depression, as well as decreased
sleep related to behavior disturbances. Though less explored, providing care to
those with behavioral disturbances may also impact caregiver physical health.
Additionally, female caregivers are most likely to employ coping strategies, most
commonly, adaptation and reframing. Effective interventions to reduce family
caregiver burden are poorly understood but family caregivers suggest education and
internet-based support groups are most helpful. CONCLUSIONS: Family caregivers of
patients with frontotemporal dementia experience significant distress, which
impacts their health and wellbeing. It is important for healthcare providers who
care for patients with frontotemporal dementia to recognize the unique needs of
family caregivers. Future research should focus on examining interventions and
strategies to reduce caregiver burden.
DO - 10.1016/j.ijnurstu.2015.10.016
VL - 55
IS -
SP - 71
EP - 84
CY - England
SN - 0020-7489 (Linking)
U1 - 34698678
U2 - 26612696
N1 -
ER -

TY - JOUR
T1 - Alzheimer's disease multiple intervention trial (ADMIT): study protocol for a
randomized controlled clinical trial.
JF - Trials
A1 - Callahan CM
A1 - Boustani MA
A1 - Schmid AA
A1 - Austrom MG
A1 - Miller DK
A1 - Gao S
A1 - Morris CS
A1 - Vogel M
A1 - Hendrie HC
KW - eppi-reviewer4
Activities of Daily Living
Adaptation, Psychological
Aged
Alzheimer Disease/diagnosis/physiopathology/psychology/*therapy
Caregivers/psychology
Exercise Test
*House Calls
Humans
Indiana
Interdisciplinary Communication
Neuropsychological Tests
*Occupational Therapy
*Patient Care Team
*Primary Health Care
Quality of Life
*Research Design
Single-Blind Method
Surveys and Questionnaires
Time Factors
Treatment Outcome
PY - 2012
DA - 2012/06//
Y1 - 2012/06//
N2 - BACKGROUND: Given the current lack of disease-modifying therapies, it is
important to explore new models of longitudinal care for older adults with dementia
that focus on improving quality of life and delaying functional decline. In a
previous clinical trial, we demonstrated that collaborative care for Alzheimer's
disease reduces patients' neuropsychiatric symptoms as well as caregiver stress.
However, these improvements in quality of life were not associated with delays in
subjects' functional decline. TRIAL DESIGN: Parallel randomized controlled clinical
trial with 1:1 allocation. PARTICIPANTS: A total of 180 community-dwelling patients
aged >/=45 years who are diagnosed with possible or probable Alzheimer's disease;
subjects must also have a caregiver willing to participate in the study and be
willing to accept home visits. Subjects and their caregivers are enrolled from the
primary care and geriatric medicine practices of an urban public health system
serving Indianapolis, Indiana, USA. INTERVENTIONS: All patients receive best
practices primary care including collaborative care by a dementia care manager over
two years; this best practices primary care program represents the local adaptation
and implementation of our prior collaborative care intervention in the urban public
health system. Intervention patients also receive in-home occupational therapy
delivered in twenty-four sessions over two years in addition to best practices
primary care. The focus of the occupational therapy intervention is delaying
functional decline and helping both subjects and caregivers adapt to functional
impairments. The in-home sessions are tailored to the specific needs and goals of
each patient-caregiver dyad; these needs are expected to change over the course of
the study. OBJECTIVE: To determine whether best practices primary care plus home-
based occupational therapy delays functional decline among patients with
Alzheimer's disease compared to subjects treated in the control group. OUTCOMES:
The primary outcome is the Alzheimer's Disease Cooperative Studies Group Activities
of Daily Living Scale; secondary outcome measures are two performance-based
measures including the Short Physical Performance Battery and Short Portable
Sarcopenia Measure. Outcome assessments for both the caregiver-reported scale and
subjects' physical performance scales are completed in the subject's home.
RANDOMIZATION: Eligible patient-care giver dyads will be stratified by clinic type
and block randomized with a computer developed randomization scheme using a 1:1
allocation ratio. BLINDING: Single blinded. Research assistants completing the
outcome assessments were blinded to the subjects' treatment group. TRIAL STATUS:
Ongoing CLINICALTRIAL.GOV IDENTIFIER: NCT01314950; date of completed registration
10 March 2011; date first patient randomized 9 March 2011.
AB - BACKGROUND: Given the current lack of disease-modifying therapies, it is
important to explore new models of longitudinal care for older adults with dementia
that focus on improving quality of life and delaying functional decline. In a
previous clinical trial, we demonstrated that collaborative care for Alzheimer's
disease reduces patients' neuropsychiatric symptoms as well as caregiver stress.
However, these improvements in quality of life were not associated with delays in
subjects' functional decline. TRIAL DESIGN: Parallel randomized controlled clinical
trial with 1:1 allocation. PARTICIPANTS: A total of 180 community-dwelling patients
aged >/=45 years who are diagnosed with possible or probable Alzheimer's disease;
subjects must also have a caregiver willing to participate in the study and be
willing to accept home visits. Subjects and their caregivers are enrolled from the
primary care and geriatric medicine practices of an urban public health system
serving Indianapolis, Indiana, USA. INTERVENTIONS: All patients receive best
practices primary care including collaborative care by a dementia care manager over
two years; this best practices primary care program represents the local adaptation
and implementation of our prior collaborative care intervention in the urban public
health system. Intervention patients also receive in-home occupational therapy
delivered in twenty-four sessions over two years in addition to best practices
primary care. The focus of the occupational therapy intervention is delaying
functional decline and helping both subjects and caregivers adapt to functional
impairments. The in-home sessions are tailored to the specific needs and goals of
each patient-caregiver dyad; these needs are expected to change over the course of
the study. OBJECTIVE: To determine whether best practices primary care plus home-
based occupational therapy delays functional decline among patients with
Alzheimer's disease compared to subjects treated in the control group. OUTCOMES:
The primary outcome is the Alzheimer's Disease Cooperative Studies Group Activities
of Daily Living Scale; secondary outcome measures are two performance-based
measures including the Short Physical Performance Battery and Short Portable
Sarcopenia Measure. Outcome assessments for both the caregiver-reported scale and
subjects' physical performance scales are completed in the subject's home.
RANDOMIZATION: Eligible patient-care giver dyads will be stratified by clinic type
and block randomized with a computer developed randomization scheme using a 1:1
allocation ratio. BLINDING: Single blinded. Research assistants completing the
outcome assessments were blinded to the subjects' treatment group. TRIAL STATUS:
Ongoing CLINICALTRIAL.GOV IDENTIFIER: NCT01314950; date of completed registration
10 March 2011; date first patient randomized 9 March 2011.
DO - 10.1186/1745-6215-13-92
VL - 13
IS -
SP - 92
CY - England
SN - 1745-6215 (Linking)
U1 - 34698818
U2 - 22737979
N1 -
ER -

TY - JOUR
T1 - Caregiver- and patient-directed interventions for dementia: an evidence-based
analysis.
JF - Ontario health technology assessment series
KW - eppi-reviewer4
PY - 2008
DA - 2008///
Y1 - 2008///
N2 - UNLABELLED: In early August 2007, the Medical Advisory Secretariat began work
on the Aging in the Community project, an evidence-based review of the literature
surrounding healthy aging in the community. The Health System Strategy Division at
the Ministry of Health and Long-Term Care subsequently asked the secretariat to
provide an evidentiary platform for the ministry's newly released Aging at Home
Strategy.After a broad literature review and consultation with experts, the
secretariat identified 4 key areas that strongly predict an elderly person's
transition from independent community living to a long-term care home. Evidence-
based analyses have been prepared for each of these 4 areas: falls and fall-related
injuries, urinary incontinence, dementia, and social isolation. For the first area,
falls and fall-related injuries, an economic model is described in a separate
report.Please visit the Medical Advisory Secretariat Web site,
http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review
these titles within the Aging in the Community series.AGING IN THE COMMUNITY:
Summary of Evidence-Based AnalysesPrevention of Falls and Fall-Related Injuries in
Community-Dwelling Seniors: An Evidence-Based AnalysisBehavioural Interventions for
Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based
AnalysisCaregiver- and Patient-Directed Interventions for Dementia: An Evidence-
Based AnalysisSocial Isolation in Community-Dwelling Seniors: An Evidence-Based
AnalysisThe Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and
Over (FEMOR)This report features the evidence-based analysis on caregiver- and
patient-directed interventions for dementia and is broken down into 4 sections:
IntroductionCaregiver-Directed Interventions for DementiaPatient-Directed
Interventions for DementiaEconomic Analysis of Caregiver- and Patient-Directed
Interventions for Dementia CAREGIVER-DIRECTED INTERVENTIONS FOR DEMENTIA:
OBJECTIVE: To identify interventions that may be effective in supporting the well-
being of unpaid caregivers of seniors with dementia living in the community.
CLINICAL NEED: TARGET POPULATION AND CONDITION Dementia is a progressive and
largely irreversible syndrome that is characterized by a loss of cognitive function
severe enough to impact social or occupational functioning. The components of
cognitive function affected include memory and learning, attention, concentration
and orientation, problem-solving, calculation, language, and geographic
orientation. Dementia was identified as one of the key predictors in a senior's
transition from independent community living to admission to a long-term care (LTC)
home, in that approximately 90% of individuals diagnosed with dementia will be
institutionalized before death. In addition, cognitive decline linked to dementia
is one of the most commonly cited reasons for institutionalization. Prevalence
estimates of dementia in the Ontario population have largely been extrapolated from
the Canadian Study of Health and Aging conducted in 1991. Based on these estimates,
it is projected that there will be approximately 165,000 dementia cases in Ontario
in the year 2008, and by 2010 the number of cases will increase by nearly 17% over
2005 levels. By 2020 the number of cases is expected to increase by nearly 55%, due
to a rise in the number of people in the age categories with the highest prevalence
(85+). With the increase in the aging population, dementia will continue to have a
significant economic impact on the Canadian health care system. In 1991, the total
costs associated with dementia in Canada were $3.9 billion (Cdn) with $2.18 billion
coming from LTC. Caregivers play a crucial role in the management of individuals
with dementia because of the high level of dependency and morbidity associated with
the condition. It has been documented that a greater demand is faced by dementia
caregivers compared with caregivers of persons with other chronic diseases. The
increased burden of caregiving contributes to a host of chronic health problems
seen among many informal caregivers of persons with dementia. Much of this burden
results from managing the behavioural and psychological symptoms of dementia
(BPSD), which have been established as a predictor of institutionalization for
elderly patients with dementia. It is recognized that for some patients with
dementia, an LTC facility can provide the most appropriate care; however, many
patients move into LTC unnecessarily. For individuals with dementia to remain in
the community longer, caregivers require many types of formal and informal support
services to alleviate the stress of caregiving. These include both respite care and
psychosocial interventions. Psychosocial interventions encompass a broad range of
interventions such as psychoeducational interventions, counseling, supportive
therapy, and behavioural interventions. Assuming that 50% of persons with dementia
live in the community, a conservative estimate of the number of informal caregivers
in Ontario is 82,500. Accounting for the fact that 29% of people with dementia live
alone, this leaves a remaining estimate of 58,575 Ontarians providing care for a
person with dementia with whom they reside. DESCRIPTION OF INTERVENTIONS: The 2
main categories of caregiver-directed interventions examined in this review are
respite care and psychosocial interventions. Respite care is defined as a break or
relief for the caregiver. In most cases, respite is provided in the home, through
day programs, or at institutions (usually 30 days or less). Depending on a
caregiver's needs, respite services will vary in delivery and duration. Respite
care is carried out by a variety of individuals, including paid staff, volunteers,
family, or friends. Psychosocial interventions encompass a broad range of
interventions and have been classified in various ways in the literature. This
review will examine educational, behavioural, dementia-specific, supportive, and
coping interventions. The analysis focuses on behavioural interventions, that is,
those designed to help the caregiver manage BPSD. As described earlier, BPSD are
one of the most challenging aspects of caring for a senior with dementia, causing
an increase in caregiver burden. The analysis also examines multicomponent
interventions, which include at least 2 of the above-mentioned interventions.
METHODS OF EVIDENCE-BASED ANALYSIS: A comprehensive search strategy was used to
identify systematic reviews and randomized controlled trials (RCTs) that examined
the effectiveness of interventions for caregivers of dementia patients. QUESTIONS:
Section 2.1 Are respite care services effective in supporting the well-being of
unpaid caregivers of seniors with dementia in the community?Do respite care
services impact on rates of institutionalization of these seniors?Section 2.2 Which
psychosocial interventions are effective in supporting the well-being of unpaid
caregivers of seniors with dementia in the community?Which interventions reduce the
risk for institutionalization of seniors with dementia? OUTCOMES OF INTEREST: any
quantitative measure of caregiver psychological health, including caregiver burden,
depression, quality of life, well-being, strain, mastery (taking control of one's
situation), reactivity to behaviour problems, etc.;rate of institutionalization;
andcost-effectiveness. ASSESSMENT OF QUALITY OF EVIDENCE: The quality of the
evidence was assessed as High, Moderate, Low, or Very low according to the GRADE
methodology and GRADE Working Group. As per GRADE the following definitions apply:
HighFurther research is very unlikely to change confidence in the estimate of
effect.ModerateFurther research is likely to have an important impact on confidence
in the estimate of effect and may change the estimate.LowFurther research is very
likely to have an important impact on confidence in the estimate of effect and is
likely to change the estimate.Very lowAny estimate of effect is very uncertain.
SUMMARY OF FINDINGS: Conclusions in Table 1 are drawn from Sections 2.1 and 2.2 of
the report. Executive Summary Table 1:Summary of Conclusions on Caregiver-Directed
InterventionsSectionInterventionConclusion2.1Respite care for dementia
caregiversAssessing the efficacy of respite care services using standard evidence-
based approaches is difficult.There is limited evidence from RCTs that respite care
is effective in improving outcomes for those caring for seniors with dementia.There
is considerable qualitative evidence of the perceived benefits of respite
care.Respite care is known as one of the key formal support services for
alleviating caregiver burden in those caring for dementia patients.Respite care
services need to be tailored to individual caregiver needs as there are vast
differences among caregivers and patients with dementia (severity, type of
dementia, amount of informal/formal support available, housing situation,
etc.)2.2aBehaviourai interventions (individual >/= 6 sessions)There is moderate- to
high-quality evidence that individual behavioural interventions (>/= 6 sessions),
directed towards the caregiver (or combined with the patient) are effective in
improving psychological health in dementia caregivers.2.2bMulticomponent
interventionsThere is moderate- to high-quality evidence that multicomponent
interventions improve caregiver psychosocial health and may affect rates of
institutionalization of dementia patients.RCT indicates randomized controlled
trial. PATIENT-DIRECTED INTERVENTIONS FOR DEMENTIA: OBJECTIVE: The section on
patient-directed interventions for dementia is broken down into 4 subsections with
the following questions: 3. (ABSTRACT TRUNCATED)
AB - UNLABELLED: In early August 2007, the Medical Advisory Secretariat began work
on the Aging in the Community project, an evidence-based review of the literature
surrounding healthy aging in the community. The Health System Strategy Division at
the Ministry of Health and Long-Term Care subsequently asked the secretariat to
provide an evidentiary platform for the ministry's newly released Aging at Home
Strategy.After a broad literature review and consultation with experts, the
secretariat identified 4 key areas that strongly predict an elderly person's
transition from independent community living to a long-term care home. Evidence-
based analyses have been prepared for each of these 4 areas: falls and fall-related
injuries, urinary incontinence, dementia, and social isolation. For the first area,
falls and fall-related injuries, an economic model is described in a separate
report.Please visit the Medical Advisory Secretariat Web site,
http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review
these titles within the Aging in the Community series.AGING IN THE COMMUNITY:
Summary of Evidence-Based AnalysesPrevention of Falls and Fall-Related Injuries in
Community-Dwelling Seniors: An Evidence-Based AnalysisBehavioural Interventions for
Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based
AnalysisCaregiver- and Patient-Directed Interventions for Dementia: An Evidence-
Based AnalysisSocial Isolation in Community-Dwelling Seniors: An Evidence-Based
AnalysisThe Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and
Over (FEMOR)This report features the evidence-based analysis on caregiver- and
patient-directed interventions for dementia and is broken down into 4 sections:
IntroductionCaregiver-Directed Interventions for DementiaPatient-Directed
Interventions for DementiaEconomic Analysis of Caregiver- and Patient-Directed
Interventions for Dementia CAREGIVER-DIRECTED INTERVENTIONS FOR DEMENTIA:
OBJECTIVE: To identify interventions that may be effective in supporting the well-
being of unpaid caregivers of seniors with dementia living in the community.
CLINICAL NEED: TARGET POPULATION AND CONDITION Dementia is a progressive and
largely irreversible syndrome that is characterized by a loss of cognitive function
severe enough to impact social or occupational functioning. The components of
cognitive function affected include memory and learning, attention, concentration
and orientation, problem-solving, calculation, language, and geographic
orientation. Dementia was identified as one of the key predictors in a senior's
transition from independent community living to admission to a long-term care (LTC)
home, in that approximately 90% of individuals diagnosed with dementia will be
institutionalized before death. In addition, cognitive decline linked to dementia
is one of the most commonly cited reasons for institutionalization. Prevalence
estimates of dementia in the Ontario population have largely been extrapolated from
the Canadian Study of Health and Aging conducted in 1991. Based on these estimates,
it is projected that there will be approximately 165,000 dementia cases in Ontario
in the year 2008, and by 2010 the number of cases will increase by nearly 17% over
2005 levels. By 2020 the number of cases is expected to increase by nearly 55%, due
to a rise in the number of people in the age categories with the highest prevalence
(85+). With the increase in the aging population, dementia will continue to have a
significant economic impact on the Canadian health care system. In 1991, the total
costs associated with dementia in Canada were $3.9 billion (Cdn) with $2.18 billion
coming from LTC. Caregivers play a crucial role in the management of individuals
with dementia because of the high level of dependency and morbidity associated with
the condition. It has been documented that a greater demand is faced by dementia
caregivers compared with caregivers of persons with other chronic diseases. The
increased burden of caregiving contributes to a host of chronic health problems
seen among many informal caregivers of persons with dementia. Much of this burden
results from managing the behavioural and psychological symptoms of dementia
(BPSD), which have been established as a predictor of institutionalization for
elderly patients with dementia. It is recognized that for some patients with
dementia, an LTC facility can provide the most appropriate care; however, many
patients move into LTC unnecessarily. For individuals with dementia to remain in
the community longer, caregivers require many types of formal and informal support
services to alleviate the stress of caregiving. These include both respite care and
psychosocial interventions. Psychosocial interventions encompass a broad range of
interventions such as psychoeducational interventions, counseling, supportive
therapy, and behavioural interventions. Assuming that 50% of persons with dementia
live in the community, a conservative estimate of the number of informal caregivers
in Ontario is 82,500. Accounting for the fact that 29% of people with dementia live
alone, this leaves a remaining estimate of 58,575 Ontarians providing care for a
person with dementia with whom they reside. DESCRIPTION OF INTERVENTIONS: The 2
main categories of caregiver-directed interventions examined in this review are
respite care and psychosocial interventions. Respite care is defined as a break or
relief for the caregiver. In most cases, respite is provided in the home, through
day programs, or at institutions (usually 30 days or less). Depending on a
caregiver's needs, respite services will vary in delivery and duration. Respite
care is carried out by a variety of individuals, including paid staff, volunteers,
family, or friends. Psychosocial interventions encompass a broad range of
interventions and have been classified in various ways in the literature. This
review will examine educational, behavioural, dementia-specific, supportive, and
coping interventions. The analysis focuses on behavioural interventions, that is,
those designed to help the caregiver manage BPSD. As described earlier, BPSD are
one of the most challenging aspects of caring for a senior with dementia, causing
an increase in caregiver burden. The analysis also examines multicomponent
interventions, which include at least 2 of the above-mentioned interventions.
METHODS OF EVIDENCE-BASED ANALYSIS: A comprehensive search strategy was used to
identify systematic reviews and randomized controlled trials (RCTs) that examined
the effectiveness of interventions for caregivers of dementia patients. QUESTIONS:
Section 2.1 Are respite care services effective in supporting the well-being of
unpaid caregivers of seniors with dementia in the community?Do respite care
services impact on rates of institutionalization of these seniors?Section 2.2 Which
psychosocial interventions are effective in supporting the well-being of unpaid
caregivers of seniors with dementia in the community?Which interventions reduce the
risk for institutionalization of seniors with dementia? OUTCOMES OF INTEREST: any
quantitative measure of caregiver psychological health, including caregiver burden,
depression, quality of life, well-being, strain, mastery (taking control of one's
situation), reactivity to behaviour problems, etc.;rate of institutionalization;
andcost-effectiveness. ASSESSMENT OF QUALITY OF EVIDENCE: The quality of the
evidence was assessed as High, Moderate, Low, or Very low according to the GRADE
methodology and GRADE Working Group. As per GRADE the following definitions apply:
HighFurther research is very unlikely to change confidence in the estimate of
effect.ModerateFurther research is likely to have an important impact on confidence
in the estimate of effect and may change the estimate.LowFurther research is very
likely to have an important impact on confidence in the estimate of effect and is
likely to change the estimate.Very lowAny estimate of effect is very uncertain.
SUMMARY OF FINDINGS: Conclusions in Table 1 are drawn from Sections 2.1 and 2.2 of
the report. Executive Summary Table 1:Summary of Conclusions on Caregiver-Directed
InterventionsSectionInterventionConclusion2.1Respite care for dementia
caregiversAssessing the efficacy of respite care services using standard evidence-
based approaches is difficult.There is limited evidence from RCTs that respite care
is effective in improving outcomes for those caring for seniors with dementia.There
is considerable qualitative evidence of the perceived benefits of respite
care.Respite care is known as one of the key formal support services for
alleviating caregiver burden in those caring for dementia patients.Respite care
services need to be tailored to individual caregiver needs as there are vast
differences among caregivers and patients with dementia (severity, type of
dementia, amount of informal/formal support available, housing situation,
etc.)2.2aBehaviourai interventions (individual >/= 6 sessions)There is moderate- to
high-quality evidence that individual behavioural interventions (>/= 6 sessions),
directed towards the caregiver (or combined with the patient) are effective in
improving psychological health in dementia caregivers.2.2bMulticomponent
interventionsThere is moderate- to high-quality evidence that multicomponent
interventions improve caregiver psychosocial health and may affect rates of
institutionalization of dementia patients.RCT indicates randomized controlled
trial. PATIENT-DIRECTED INTERVENTIONS FOR DEMENTIA: OBJECTIVE: The section on
patient-directed interventions for dementia is broken down into 4 subsections with
the following questions: 3. (ABSTRACT TRUNCATED)
VL - 8
IS - 4
SP - 1
EP - 98
CY - Canada
SN - 1915-7398 (Linking)
U1 - 34698954
U2 - 23074509
N1 -
ER -

TY - JOUR
T1 - To what degree does cognitive impairment in Alzheimer's disease predict
dependence of patients on caregivers?
JF - BMC neurology
A1 - Caro J
A1 - Ward A
A1 - Ishak K
A1 - Migliaccio-Walle K
A1 - Getsios D
A1 - Papadopoulos G
A1 - Torfs K
KW - eppi-reviewer4
Aged
Alzheimer Disease/*complications
Caregivers
Cognition Disorders/complications/*diagnosis
*Dependency (Psychology)
Disability Evaluation
Female
Humans
Male
Neuropsychological Tests
Odds Ratio
Predictive Value of Tests
Risk Assessment
Severity of Illness Index
PY - 2002
DA - 2002/08//
Y1 - 2002/08//
N2 - BACKGROUND: Patients with Alzheimer's disease experience a progressive loss
of cognitive function, and the ability to independently perform activities of daily
life. Sometimes a dependent stage is reached quite early in the disease, when
caregivers decide that the patients can no longer be left alone safely. This is an
important aspect of Alzheimer's for patients, their families, and also health care
providers. Understanding the relationship between a patient's current cognitive
status and their need for care may assist clinicians when recommending an
appropriate management plan. In this study, we investigated the relationship of
cognitive function to dependence on caregivers before the patients reach a severe
stage of the disease. METHODS: Data were obtained on 1,289 patients with mild-to-
moderate Alzheimer's disease studied in two randomised clinical trials of
galantamine (ReminylcircledR;). Cognition was assessed using the cognitive part of
the Alzheimer's Disease Assessment Scale (ADAS-cog) and Mini-Mental State
Examination (MMSE). Patients were considered dependent if they required >12 hours
of supervision each day or had high care needs. The Disability Assessment for
Dementia (DAD) scale was also used as a measure of dependence. Disability was
predicted directly using MMSE and ADAS-cog and compared to predictions from
converted scores. RESULTS: The odds ratio of dependence was significantly higher
amongst the patients with worse cognitive impairment, adjusting for age, gender and
antipsychotic medication use. For example, a 4-point difference in ADAS-cog score
was associated with an increase of 17% (95% CI 11-23) in the adjusted odds for >12
hours of supervision, and of 35% (95% CI 28-43) for dependence. Disability
predicted directly using actual ADAS-cog and scores converted from MMSE values had
close agreement using the models developed. CONCLUSION: In patients with mild-to-
moderate Alzheimer's disease, even relatively small degrees of poorer cognitive
function increased the risk of losing the ability to live independently.
AB - BACKGROUND: Patients with Alzheimer's disease experience a progressive loss
of cognitive function, and the ability to independently perform activities of daily
life. Sometimes a dependent stage is reached quite early in the disease, when
caregivers decide that the patients can no longer be left alone safely. This is an
important aspect of Alzheimer's for patients, their families, and also health care
providers. Understanding the relationship between a patient's current cognitive
status and their need for care may assist clinicians when recommending an
appropriate management plan. In this study, we investigated the relationship of
cognitive function to dependence on caregivers before the patients reach a severe
stage of the disease. METHODS: Data were obtained on 1,289 patients with mild-to-
moderate Alzheimer's disease studied in two randomised clinical trials of
galantamine (ReminylcircledR;). Cognition was assessed using the cognitive part of
the Alzheimer's Disease Assessment Scale (ADAS-cog) and Mini-Mental State
Examination (MMSE). Patients were considered dependent if they required >12 hours
of supervision each day or had high care needs. The Disability Assessment for
Dementia (DAD) scale was also used as a measure of dependence. Disability was
predicted directly using MMSE and ADAS-cog and compared to predictions from
converted scores. RESULTS: The odds ratio of dependence was significantly higher
amongst the patients with worse cognitive impairment, adjusting for age, gender and
antipsychotic medication use. For example, a 4-point difference in ADAS-cog score
was associated with an increase of 17% (95% CI 11-23) in the adjusted odds for >12
hours of supervision, and of 35% (95% CI 28-43) for dependence. Disability
predicted directly using actual ADAS-cog and scores converted from MMSE values had
close agreement using the models developed. CONCLUSION: In patients with mild-to-
moderate Alzheimer's disease, even relatively small degrees of poorer cognitive
function increased the risk of losing the ability to live independently.
VL - 2
IS -
SP - 6
CY - England
SN - 1471-2377 (Linking)
U1 - 34699038
U2 - 12184819
N1 -
ER -

TY - JOUR
T1 - An ambient assisted living approach in designing domiciliary services
combined with innovative technologies for patients with Alzheimer's disease: a case
study.
JF - American journal of Alzheimer's disease and other dementias
A1 - Cavallo F
A1 - Aquilano M
A1 - Arvati M
KW - eppi-reviewer4
Aged
Aged, 80 and over
Alzheimer Disease/*nursing
Assisted Living Facilities/*standards
Equipment Design
Female
Humans
Male
Monitoring, Ambulatory/*instrumentation/standards
Self-Help Devices/*standards
Alzheimer disease
ambient assisted living
ambient intelligence
domiciliary assistance
smart environments
PY - 2015
DA - 2015/02//
Y1 - 2015/02//
N2 - BACKGROUND: Alzheimer's disease (AD) is one of the most disabling diseases to
affect large numbers of elderly people worldwide. Because of the characteristics of
this disease, patients with AD require daily assistance from service providers both
in nursing homes and at home. Domiciliary assistance has been demonstrated to be
cost effective and efficient in the first phase of the disease, helping to slow
down the course of the illness, improve the quality of life and care, and extend
independence for patients and caregivers. In this context, the aim of this work is
to demonstrate the technical effectiveness and acceptability of an innovative
domiciliary smart sensor system for providing domiciliary assistance to patients
with AD which has been developed with an Ambient Assisted Living (AAL) approach.
METHODS: The design, development, testing, and evaluation of the innovative
technological solution were performed by a multidisciplinary team. In all, 15
sociomedical operators and 14 patients with AD were directly involved in defining
the end-users' needs and requirements, identifying design principles with
acceptability and usability features and evaluating the technological solutions
before and after the real experimentation. RESULTS: A modular technological system
was produced to help caregivers continuously monitor the health status, safety, and
daily activities of patients with AD. During the experimentation, the
acceptability, utility, usability, and efficacy of this system were evaluated as
quite positive. CONCLUSION: The experience described in this article demonstrated
that AAL technologies are feasible and effective nowadays and can be actively used
in assisting patients with AD in their homes. The extensive involvement of
caregivers in the experimentation allowed to assess that there is, through the use
of the technological system, a proven improvement in care performance and
efficiency of care provision by both formal and informal caregivers and
consequently an increase in the quality of life of patients, their relatives, and
their caregivers.
AB - BACKGROUND: Alzheimer's disease (AD) is one of the most disabling diseases to
affect large numbers of elderly people worldwide. Because of the characteristics of
this disease, patients with AD require daily assistance from service providers both
in nursing homes and at home. Domiciliary assistance has been demonstrated to be
cost effective and efficient in the first phase of the disease, helping to slow
down the course of the illness, improve the quality of life and care, and extend
independence for patients and caregivers. In this context, the aim of this work is
to demonstrate the technical effectiveness and acceptability of an innovative
domiciliary smart sensor system for providing domiciliary assistance to patients
with AD which has been developed with an Ambient Assisted Living (AAL) approach.
METHODS: The design, development, testing, and evaluation of the innovative
technological solution were performed by a multidisciplinary team. In all, 15
sociomedical operators and 14 patients with AD were directly involved in defining
the end-users' needs and requirements, identifying design principles with
acceptability and usability features and evaluating the technological solutions
before and after the real experimentation. RESULTS: A modular technological system
was produced to help caregivers continuously monitor the health status, safety, and
daily activities of patients with AD. During the experimentation, the
acceptability, utility, usability, and efficacy of this system were evaluated as
quite positive. CONCLUSION: The experience described in this article demonstrated
that AAL technologies are feasible and effective nowadays and can be actively used
in assisting patients with AD in their homes. The extensive involvement of
caregivers in the experimentation allowed to assess that there is, through the use
of the technological system, a proven improvement in care performance and
efficiency of care provision by both formal and informal caregivers and
consequently an increase in the quality of life of patients, their relatives, and
their caregivers.
DO - 10.1177/1533317514539724
VL - 30
IS - 1
SP - 69
EP - 77
CY - United States
SN - 1533-3175 (Linking)
U1 - 34698731
U2 - 24951634
N1 -
ER -

TY - JOUR
T1 - Evaluation of a problem-solving (PS) techniques-based intervention for
informal carers of patients with dementia receiving in-home care.
JF - International psychogeriatrics
A1 - Chiu M
A1 - Pauley T
A1 - Wesson V
A1 - Pushpakumar D
A1 - Sadavoy J
KW - eppi-reviewer4
Aged
*Caregivers/psychology
Dementia/psychology/*therapy
Female
Health Services Needs and Demand
*Home Care Services
Humans
Male
Middle Aged
*Problem Solving
cognitive behavioral therapy
PY - 2015
DA - 2015/06//
Y1 - 2015/06//
N2 - BACKGROUND: The value of care provided by informal carers in Canada is
estimated at $26 billion annually (Hollander et al., 2009). However, carers' needs
are often overlooked, limiting their capacity to provide care. Problem-solving
therapy (PST), a structured approach to problem solving (PS) and a core principle
of the Reitman Centre CARERS Program, has been shown to alleviate emotional
distress and improve carers' competence (Chiu et al., 2013). This study evaluated
the effectiveness of problem-solving techniques-based intervention based on adapted
PST methods, in enhancing carers' physical and emotional capacity to care for
relatives with dementia living in the community. METHODS: 56 carers were equally
allocated to a problem-solving techniques-based intervention group or a control
arm. Carers in the intervention group received three 1 hr visits by a care
coordinator (CC) who had been given advanced training in PS techniques-based
intervention. Coping, mastery, competence, burden, and perceived stress of the
carers were evaluated at baseline and post-intervention using standardized
assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA
was performed on the data. RESULTS: Post-intervention measures completion rate was
82% and 92% for the intervention and control groups, respectively. Carers in the
intervention group showed significantly improved task-oriented coping, mastery, and
competence and significantly reduced emotion-oriented coping, burden and stress (p
< 0.01-0.001). Control carers showed no change. CONCLUSION: PS techniques, when
learned and delivered by CCs as a tool to coach carers in their day-to-day
caregiving, improves carers' caregiving competence, coping, burden, and perceived
stress. This may reduce dependence on primary, psychiatric, and institutional care.
Results provide evidence that establishing effective partnerships between inter-
professional clinicians in academic clinical health science centers, and community
agencies can extend the reach of the expertise of specialized health care
institutions.
AB - BACKGROUND: The value of care provided by informal carers in Canada is
estimated at $26 billion annually (Hollander et al., 2009). However, carers' needs
are often overlooked, limiting their capacity to provide care. Problem-solving
therapy (PST), a structured approach to problem solving (PS) and a core principle
of the Reitman Centre CARERS Program, has been shown to alleviate emotional
distress and improve carers' competence (Chiu et al., 2013). This study evaluated
the effectiveness of problem-solving techniques-based intervention based on adapted
PST methods, in enhancing carers' physical and emotional capacity to care for
relatives with dementia living in the community. METHODS: 56 carers were equally
allocated to a problem-solving techniques-based intervention group or a control
arm. Carers in the intervention group received three 1 hr visits by a care
coordinator (CC) who had been given advanced training in PS techniques-based
intervention. Coping, mastery, competence, burden, and perceived stress of the
carers were evaluated at baseline and post-intervention using standardized
assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA
was performed on the data. RESULTS: Post-intervention measures completion rate was
82% and 92% for the intervention and control groups, respectively. Carers in the
intervention group showed significantly improved task-oriented coping, mastery, and
competence and significantly reduced emotion-oriented coping, burden and stress (p
< 0.01-0.001). Control carers showed no change. CONCLUSION: PS techniques, when
learned and delivered by CCs as a tool to coach carers in their day-to-day
caregiving, improves carers' caregiving competence, coping, burden, and perceived
stress. This may reduce dependence on primary, psychiatric, and institutional care.
Results provide evidence that establishing effective partnerships between inter-
professional clinicians in academic clinical health science centers, and community
agencies can extend the reach of the expertise of specialized health care
institutions.
DO - 10.1017/S1041610214002798
VL - 27
IS - 6
SP - 937
EP - 48
CY - England
SN - 1041-6102 (Linking)
U1 - 34698712
U2 - 25615434
N1 -
ER -

TY - JOUR
T1 - A web-based psychoeducational program for informal caregivers of patients
with Alzheimer's disease: a pilot randomized controlled trial.
JF - Journal of medical Internet research
A1 - Cristancho-Lacroix V
A1 - Wrobel J
A1 - Cantegreil-Kallen I
A1 - Dub T
A1 - Rouquette A
A1 - Rigaud AS
KW - eppi-reviewer4
Aged
Alzheimer Disease/*therapy
Caregivers/*psychology
Cognitive Therapy
Depression/prevention & control
Female
Humans
Intention to Treat Analysis
*Internet
Male
Middle Aged
Self Efficacy
Stress, Psychological/epidemiology/*prevention & control
Alzheimer disease
Internet
eHealth
emotional stress
family caregivers
psychological education
qualitative research
randomized controlled trials
PY - 2015
DA - 2015/05//
Y1 - 2015/05//
N2 - BACKGROUND: Although several face-to-face programs are dedicated to informal
caregivers of persons with dementia, they are not always accessible to overburdened
or isolated caregivers. Based on a face-to-face intervention program, we adapted
and designed a Web-based fully automated psychoeducational program (called
Diapason) inspired by a cognitive approach. OBJECTIVE: This study aimed to evaluate
through a pilot unblinded randomized controlled trial the efficacy and
acceptability of a Web-based psychoeducational program for informal caregivers of
persons with Alzheimer's disease (PWAD) based on a mixed methods research design.
METHODS: We recruited and randomized offline 49 informal caregivers of a PWAD in a
day care center in Paris, France. They either received the Web-based intervention
and usual care for 3 months (experimental group, n=25) or only usual care (control
group, n=24). Caregivers' perceived stress (PSS-14, primary outcome), self-
efficacy, burden, perceived health status, and depression (secondary outcomes) were
measured during 3 face-to-face on-site visits: at baseline, at the end of the
program (month 3), and after follow-up (month 6). Additionally, semistructured
interviews were conducted with experimental group caregivers at month 6 and
examined with thematic analysis. RESULTS: Intention-to-treat analysis did not show
significant differences in self-perceived stress between the experimental and
control groups (P=.98). The experimental group significantly improved their
knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25
participants allocated to the experimental group, 17 (71%) finished the protocol
and entirely viewed at least 10 of 12 online sessions. On average, participants
used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD
270.74). The results of the satisfaction questionnaire showed that most
participants considered the program to be useful (95%, 19/20), clear (100%, 20/20),
and comprehensive (85%, 17/20). Significant correlations were found between
relationship and caregivers' program opinion (P=.01). Thus, positive opinions were
provided by husbands and sons (3/3), whereas qualified opinions were primarily
reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral
opinions (1/3). Caregivers expected more dynamic content and further interaction
with staff and peers. CONCLUSIONS: In this study, quantitative results were
inconclusive owing to small sample size. Qualitative results indicated/showed
little acceptance of the program and high expectations from caregivers. Caregivers
did not rule out their interest in this kind of intervention provided that it met
their needs. More dynamic, personalized, and social interventions are desirable.
Our recruitment issues pointed out the necessity of in-depth studies about
caregivers' help-seeking behaviors and readiness factors. TRIAL REGISTRATION:
Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286
(Archived by WebCite at http://www.webcitation/6KxHaRspL).
AB - BACKGROUND: Although several face-to-face programs are dedicated to informal
caregivers of persons with dementia, they are not always accessible to overburdened
or isolated caregivers. Based on a face-to-face intervention program, we adapted
and designed a Web-based fully automated psychoeducational program (called
Diapason) inspired by a cognitive approach. OBJECTIVE: This study aimed to evaluate
through a pilot unblinded randomized controlled trial the efficacy and
acceptability of a Web-based psychoeducational program for informal caregivers of
persons with Alzheimer's disease (PWAD) based on a mixed methods research design.
METHODS: We recruited and randomized offline 49 informal caregivers of a PWAD in a
day care center in Paris, France. They either received the Web-based intervention
and usual care for 3 months (experimental group, n=25) or only usual care (control
group, n=24). Caregivers' perceived stress (PSS-14, primary outcome), self-
efficacy, burden, perceived health status, and depression (secondary outcomes) were
measured during 3 face-to-face on-site visits: at baseline, at the end of the
program (month 3), and after follow-up (month 6). Additionally, semistructured
interviews were conducted with experimental group caregivers at month 6 and
examined with thematic analysis. RESULTS: Intention-to-treat analysis did not show
significant differences in self-perceived stress between the experimental and
control groups (P=.98). The experimental group significantly improved their
knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25
participants allocated to the experimental group, 17 (71%) finished the protocol
and entirely viewed at least 10 of 12 online sessions. On average, participants
used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD
270.74). The results of the satisfaction questionnaire showed that most
participants considered the program to be useful (95%, 19/20), clear (100%, 20/20),
and comprehensive (85%, 17/20). Significant correlations were found between
relationship and caregivers' program opinion (P=.01). Thus, positive opinions were
provided by husbands and sons (3/3), whereas qualified opinions were primarily
reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral
opinions (1/3). Caregivers expected more dynamic content and further interaction
with staff and peers. CONCLUSIONS: In this study, quantitative results were
inconclusive owing to small sample size. Qualitative results indicated/showed
little acceptance of the program and high expectations from caregivers. Caregivers
did not rule out their interest in this kind of intervention provided that it met
their needs. More dynamic, personalized, and social interventions are desirable.
Our recruitment issues pointed out the necessity of in-depth studies about
caregivers' help-seeking behaviors and readiness factors. TRIAL REGISTRATION:
Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286
(Archived by WebCite at http://www.webcitation/6KxHaRspL).
DO - 10.2196/jmir.3717
VL - 17
IS - 5
SP - e117
CY - Canada
SN - 1438-8871 (Linking)
U1 - 34698701
U2 - 25967983
N1 -
ER -

TY - BOOK
T1 - Mobile Applications and Internet-based Approaches for Supporting Non-
professional Caregivers: A Systematic Review
T2 - VA Evidence-based Synthesis Program Reports
A1 - Dyer EA
A1 - Kansagara D
A1 - McInnes DK
A1 - Freeman M
A1 - Woods S
KW - eppi-reviewer4
PY - 2012
DA - 2012/11//
Y1 - 2012/11//
N2 - Non-professional caregivers are an important source of physical, emotional
and other support to ill or injured Veterans. With an increasing number of Veterans
who require care and assistance for traumatic brain injuries (TBI), physical
impairments, or other debilitating disorders such as post-traumatic stress (PTSD)
and dementia, there is a greater growing demand for spouses, parents or other
family members and friends to assume the role of caregiver. Electronic health
applications and tools are increasingly available and have the potential to
facilitate caregiving outside of traditional healthcare settings, especially in the
context of the rising use of smartphones and mobile technologies. Lessons learned
from prior consumer health information technology (CHIT) interventions could help
inform the development of health-related mobile applications. CHIT applications are
defined as electronic tools or technologies intended for use by consumers, by
patients or family members, that interact directly with users for the management of
their health or healthcare, and in which data, information, or other
recommendations are tailored and/or individualized; the system may or may not link
to a health professional or health system services. The Veterans Health
Administration (VA) is currently developing mobile applications intended for use by
seriously injured post-9/11 Veterans and their family caregivers enrolled in the
Comprehensive Assistance for Family Caregivers program. This report was requested
on behalf of the VA offices that are developing these mobile tools. The objectives
of this report are the following: 1) to identify studies of CHIT applications that
aim to support the needs of caregivers; 2) examine the usage and effects of CHIT
applications on caregiver burden outcomes, and patient outcomes, clinical process
measures, and healthcare utilization of interest; 3) discuss parallels that can be
drawn from pediatric literature, and 4) identify gaps in the literature.
AB - Non-professional caregivers are an important source of physical, emotional
and other support to ill or injured Veterans. With an increasing number of Veterans
who require care and assistance for traumatic brain injuries (TBI), physical
impairments, or other debilitating disorders such as post-traumatic stress (PTSD)
and dementia, there is a greater growing demand for spouses, parents or other
family members and friends to assume the role of caregiver. Electronic health
applications and tools are increasingly available and have the potential to
facilitate caregiving outside of traditional healthcare settings, especially in the
context of the rising use of smartphones and mobile technologies. Lessons learned
from prior consumer health information technology (CHIT) interventions could help
inform the development of health-related mobile applications. CHIT applications are
defined as electronic tools or technologies intended for use by consumers, by
patients or family members, that interact directly with users for the management of
their health or healthcare, and in which data, information, or other
recommendations are tailored and/or individualized; the system may or may not link
to a health professional or health system services. The Veterans Health
Administration (VA) is currently developing mobile applications intended for use by
seriously injured post-9/11 Veterans and their family caregivers enrolled in the
Comprehensive Assistance for Family Caregivers program. This report was requested
on behalf of the VA offices that are developing these mobile tools. The objectives
of this report are the following: 1) to identify studies of CHIT applications that
aim to support the needs of caregivers; 2) examine the usage and effects of CHIT
applications on caregiver burden outcomes, and patient outcomes, clinical process
measures, and healthcare utilization of interest; 3) discuss parallels that can be
drawn from pediatric literature, and 4) identify gaps in the literature.
VL -
IS -
CY - Washington (DC)
PB - Department of Veterans Affairs (US)
SN - 23285508
U1 - 34698796
U2 - 23285508
N1 -
ER -

TY - JOUR
T1 - Targeting and managing behavioral symptoms in individuals with dementia: a
randomized trial of a nonpharmacological intervention.
JF - Journal of the American Geriatrics Society
A1 - Gitlin LN
A1 - Winter L
A1 - Dennis MP
A1 - Hodgson N
A1 - Hauck WW
KW - eppi-reviewer4
Adaptation, Psychological
Aged
Aged, 80 and over
Caregivers/*psychology
Dementia/*complications/psychology
Depression/therapy
Environment
Female
Home Care Services
Humans
Male
*Needs Assessment
Occupational Therapy
Stress, Psychological/therapy
Telenursing
PY - 2010
DA - 2010/08//
Y1 - 2010/08//
N2 - OBJECTIVES: To test the effects of an intervention that helps families manage
distressing behaviors in family members with dementia. DESIGN: Two-group randomized
trial. SETTING: In home. PARTICIPANTS: Two hundred seventy-two caregivers and
people with dementia. INTERVENTION: Up to 11 home and telephone contacts over 16
weeks by health professionals who identified potential triggers of patient
behaviors, including communication and environmental factors and patient
undiagnosed medical conditions (by obtaining blood and urine samples) and trained
caregivers in strategies to modify triggers and reduce their upset. Between 16 and
24 weeks, three telephone contacts reinforced strategy use. MEASUREMENTS: Primary
outcomes were frequency of targeted problem behavior and caregiver upset with and
confidence managing it at 16 weeks. Secondary outcomes were caregiver well-being
and management skills at 16 and 24 weeks and caregiver perceived benefits.
Prevalence of medical conditions for intervention patients were also examined.
RESULTS: At 16 weeks, 67.5% of intervention caregivers reported improvement in
targeted problem behavior, compared with 45.8% of caregivers in a no-treatment
control group (P=.002), and reduced upset with (P=.03) and enhanced confidence
managing (P=.01) the behavior. Additionally, intervention caregivers reported less
upset with all problem behaviors (P=.001), less negative communication (P=.02),
less burden (P=.05), and better well-being (P=.001) than controls. Fewer
intervention caregivers had depressive symptoms (53.0%) than control group
caregivers (67.8%, P=.02). Similar caregiver outcomes occurred at 24 weeks.
Intervention caregivers perceived more study benefits (P<.05), including ability to
keep family members home, than controls. Blood and urine samples of intervention
patients with dementia showed that 40 (34.1%) had undiagnosed illnesses requiring
physician follow-up. CONCLUSION: Targeting behaviors upsetting to caregivers and
modifying potential triggers improves symptomatology in people with dementia and
caregiver well-being and skills.
AB - OBJECTIVES: To test the effects of an intervention that helps families manage
distressing behaviors in family members with dementia. DESIGN: Two-group randomized
trial. SETTING: In home. PARTICIPANTS: Two hundred seventy-two caregivers and
people with dementia. INTERVENTION: Up to 11 home and telephone contacts over 16
weeks by health professionals who identified potential triggers of patient
behaviors, including communication and environmental factors and patient
undiagnosed medical conditions (by obtaining blood and urine samples) and trained
caregivers in strategies to modify triggers and reduce their upset. Between 16 and
24 weeks, three telephone contacts reinforced strategy use. MEASUREMENTS: Primary
outcomes were frequency of targeted problem behavior and caregiver upset with and
confidence managing it at 16 weeks. Secondary outcomes were caregiver well-being
and management skills at 16 and 24 weeks and caregiver perceived benefits.
Prevalence of medical conditions for intervention patients were also examined.
RESULTS: At 16 weeks, 67.5% of intervention caregivers reported improvement in
targeted problem behavior, compared with 45.8% of caregivers in a no-treatment
control group (P=.002), and reduced upset with (P=.03) and enhanced confidence
managing (P=.01) the behavior. Additionally, intervention caregivers reported less
upset with all problem behaviors (P=.001), less negative communication (P=.02),
less burden (P=.05), and better well-being (P=.001) than controls. Fewer
intervention caregivers had depressive symptoms (53.0%) than control group
caregivers (67.8%, P=.02). Similar caregiver outcomes occurred at 24 weeks.
Intervention caregivers perceived more study benefits (P<.05), including ability to
keep family members home, than controls. Blood and urine samples of intervention
patients with dementia showed that 40 (34.1%) had undiagnosed illnesses requiring
physician follow-up. CONCLUSION: Targeting behaviors upsetting to caregivers and
modifying potential triggers improves symptomatology in people with dementia and
caregiver well-being and skills.
DO - 10.1111/j.1532-5415.2010.02971.x
VL - 58
IS - 8
SP - 1465
EP - 74
CY - United States
SN - 0002-8614 (Linking)
U1 - 34698879
U2 - 20662955
N1 -
ER -

TY - JOUR
T1 - Helping carers to care: the 10/66 dementia research group's randomized
control trial of a caregiver intervention in Peru.
JF - Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)
A1 - Guerra M
A1 - Ferri CP
A1 - Fonseca M
A1 - Banerjee S
A1 - Prince M
KW - eppi-reviewer4
Aged
Caregivers/*education/psychology
Dementia/*nursing/psychology/therapy
Diagnostic and Statistical Manual of Mental Disorders
Female
Health Care Surveys
Humans
Male
Needs Assessment
Peru
*Quality of Health Care
*Quality of Life
Socioeconomic Factors
Surveys and Questionnaires
PY - 2011
DA - 2011/03//
Y1 - 2011/03//
N2 - OBJECTIVE: There is a need, in the absence of formal services, to design
interventions aimed at improving the lives of people with dementia and their
families. This study tested the effectiveness of the 10/66 caregiver intervention
among people with dementia and their caregivers in Lima, Peru. METHOD:
DESIGN/PARTICIPANTS: a randomized controlled trial was performed involving 58
caregivers of people with dementia that received the intervention in the beginning
of the trial (n = 29) or six months later (n = 29). The intervention consisted of
three modules: 1) assessment (one session); 2) basic education about dementia (two
sessions); and 3) training regarding specific problem behaviors (two sessions).
MAIN OUTCOME MEASURES: Caregivers and patients with dementia were assessed at
baseline and after six months. For caregivers, the measures included strain (Zarit
Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-
BREF). Dementia patients completed scales assessing behavioral and psychological
symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS: Caregivers in the
intervention group reported significantly decreased strain measures six months
after the intervention compared to controls. No group differences were found in
respect to the caregivers' psychological distress and to quality of life in both
caregivers and patients. CONCLUSION: The 10/66 intervention seems to be as
effective as similar interventions used in more developed countries.
AB - OBJECTIVE: There is a need, in the absence of formal services, to design
interventions aimed at improving the lives of people with dementia and their
families. This study tested the effectiveness of the 10/66 caregiver intervention
among people with dementia and their caregivers in Lima, Peru. METHOD:
DESIGN/PARTICIPANTS: a randomized controlled trial was performed involving 58
caregivers of people with dementia that received the intervention in the beginning
of the trial (n = 29) or six months later (n = 29). The intervention consisted of
three modules: 1) assessment (one session); 2) basic education about dementia (two
sessions); and 3) training regarding specific problem behaviors (two sessions).
MAIN OUTCOME MEASURES: Caregivers and patients with dementia were assessed at
baseline and after six months. For caregivers, the measures included strain (Zarit
Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-
BREF). Dementia patients completed scales assessing behavioral and psychological
symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS: Caregivers in the
intervention group reported significantly decreased strain measures six months
after the intervention compared to controls. No group differences were found in
respect to the caregivers' psychological distress and to quality of life in both
caregivers and patients. CONCLUSION: The 10/66 intervention seems to be as
effective as similar interventions used in more developed countries.
VL - 33
IS - 1
SP - 47
EP - 54
CY - Brazil
SN - 1516-4446 (Linking)
U1 - 34698883
U2 - 20602013
N1 -
ER -

TY - JOUR
T1 - Evaluation of a Medical and Mental Health Unit compared with standard care
for older people whose emergency admission to an acute general hospital is
complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM:
Trial of an Elderly Acute care Medical and mental health unit.
JF - Trials
A1 - Harwood RH
A1 - Goldberg SE
A1 - Whittamore KH
A1 - Russell C
A1 - Gladman JR
A1 - Jones RG
A1 - Porock D
A1 - Lewis SA
A1 - Bradshaw LE
A1 - Elliot RA
KW - eppi-reviewer4
Age Factors
Aged
Caregivers/psychology
Cognition
Confusion/diagnosis/economics/psychology/*therapy
Cost-Benefit Analysis
Delirium/diagnosis/economics/psychology/*therapy
Dementia/diagnosis/economics/psychology/*therapy
Disability Evaluation
*Emergency Service, Hospital/economics
England
*Health Services for the Aged/economics
Hospital Costs
*Hospital Units/economics
*Hospitals, General/economics
Humans
Length of Stay
*Mental Health Services/economics
*Patient Admission/economics
Patient Discharge
Patient Readmission
Psychiatric Status Rating Scales
Quality of Life
*Research Design
Surveys and Questionnaires
Time Factors
Treatment Outcome
PY - 2011
DA - 2011/05//
Y1 - 2011/05//
N2 - BACKGROUND: Patients with delirium and dementia admitted to general hospitals
have poor outcomes, and their carers report poor experiences. We developed an acute
geriatric medical ward into a specialist Medical and Mental Health Unit over an
eighteen month period. Additional specialist mental health staff were employed,
other staff were trained in the 'person-centred' dementia care approach, a
programme of meaningful activity was devised, the environment adapted to the needs
of people with cognitive impairment, and attention given to communication with
family carers. We hypothesise that patients managed on this ward will have better
outcomes than those receiving standard care, and that such care will be cost-
effective. METHODS/DESIGN: We will perform a controlled clinical trial comparing
in-patient management on a specialist Medical and Mental Health Unit with standard
care. Study participants are patients over the age of 65, admitted as an emergency
to a single general hospital, and identified on the Acute Medical Admissions Unit
as being 'confused'. Sample size is 300 per group. The evaluation design has been
adapted to accommodate pressures on bed management and patient flows. If beds are
available on the specialist Unit, the clinical service allocates patients at random
between the Unit and standard care on general or geriatric medical wards. Once
admitted, randomised patients and their carers are invited to take part in a follow
up study, and baseline data are collected. Quality of care and patient experience
are assessed in a non-participant observer study. Outcomes are ascertained at a
follow up home visit 90 days after randomisation, by a researcher blind to
allocation. The primary outcome is days spent at home (for those admitted from
home), or days spent in the same care home (if admitted from a care home).
Secondary outcomes include mortality, institutionalisation, resource use, and
scaled outcome measures, including quality of life, cognitive function, disability,
behavioural and psychological symptoms, carer strain and carer satisfaction with
hospital care. Analyses will comprise comparisons of process, outcomes and costs
between the specialist unit and standard care treatment groups. TRIAL REGISTRATION
NUMBER: ClinicalTrials.gov: NCT01136148.
AB - BACKGROUND: Patients with delirium and dementia admitted to general hospitals
have poor outcomes, and their carers report poor experiences. We developed an acute
geriatric medical ward into a specialist Medical and Mental Health Unit over an
eighteen month period. Additional specialist mental health staff were employed,
other staff were trained in the 'person-centred' dementia care approach, a
programme of meaningful activity was devised, the environment adapted to the needs
of people with cognitive impairment, and attention given to communication with
family carers. We hypothesise that patients managed on this ward will have better
outcomes than those receiving standard care, and that such care will be cost-
effective. METHODS/DESIGN: We will perform a controlled clinical trial comparing
in-patient management on a specialist Medical and Mental Health Unit with standard
care. Study participants are patients over the age of 65, admitted as an emergency
to a single general hospital, and identified on the Acute Medical Admissions Unit
as being 'confused'. Sample size is 300 per group. The evaluation design has been
adapted to accommodate pressures on bed management and patient flows. If beds are
available on the specialist Unit, the clinical service allocates patients at random
between the Unit and standard care on general or geriatric medical wards. Once
admitted, randomised patients and their carers are invited to take part in a follow
up study, and baseline data are collected. Quality of care and patient experience
are assessed in a non-participant observer study. Outcomes are ascertained at a
follow up home visit 90 days after randomisation, by a researcher blind to
allocation. The primary outcome is days spent at home (for those admitted from
home), or days spent in the same care home (if admitted from a care home).
Secondary outcomes include mortality, institutionalisation, resource use, and
scaled outcome measures, including quality of life, cognitive function, disability,
behavioural and psychological symptoms, carer strain and carer satisfaction with
hospital care. Analyses will comprise comparisons of process, outcomes and costs
between the specialist unit and standard care treatment groups. TRIAL REGISTRATION
NUMBER: ClinicalTrials.gov: NCT01136148.
DO - 10.1186/1745-6215-12-123
VL - 12
IS -
SP - 123
CY - England
SN - 1745-6215 (Linking)
U1 - 34698858
U2 - 21569471
N1 -
ER -

TY - JOUR
T1 - Family Physician-Case Manager Collaboration and Needs of Patients With
Dementia and Their Caregivers: A Systematic Mixed Studies Review.
JF - Annals of family medicine
A1 - Khanassov V
A1 - Vedel I
KW - eppi-reviewer4
*Caregivers
Case Management/*standards
*Case Managers
Dementia/diagnosis/*therapy
*Health Services Needs and Demand
Humans
*Physicians, Family
Primary Health Care/organization & administration
case management
collaborative care
dementia
patient-centered care
primary care
systematic review
PY - 2016
DA - 2016/03//
Y1 - 2016/03//
N2 - PURPOSE: Dementia case management (CM) in primary care is a complex
intervention aimed at identifying the various needs of patients with dementia and
their caregivers, as well as the organization and coordination of care. A key
element of CM is the collaboration of family physicians with case managers. We
conducted a systematic mixed-studies review to identify the needs of the patient-
caregiver dyad and the effects of CM. METHODS: We searched MEDLINE, PsycINFO, and
EMBASE up to October 2014, regardless of the study design. Our main outcomes were
needs of patients and their caregivers and the effects of CM on these needs. We
used narrative syntheses to develop a taxonomy of needs and to describe the effects
of CM on those needs. We used meta-analysis to calculate the prevalence of needs
and the standardized mean differences to evaluate the effects of CM on the needs
identified. RESULTS: Fifty-four studies were included. We identified needs of the
patient-caregiver dyad and needs of the patient and caregiver individually. CM
addressed the majority of the identified needs. Still, some very common needs (eg,
early diagnosis) are overlooked while other needs (eg, education on the disease)
are well addressed. Fully establishing the value of CM is difficult given the small
number of studies of CM in primary care. CONCLUSIONS: There is good evidence that
case managers, in collaboration with family physicians, have a pivotal role in
addressing the needs of the patient-caregiver dyad.
AB - PURPOSE: Dementia case management (CM) in primary care is a complex
intervention aimed at identifying the various needs of patients with dementia and
their caregivers, as well as the organization and coordination of care. A key
element of CM is the collaboration of family physicians with case managers. We
conducted a systematic mixed-studies review to identify the needs of the patient-
caregiver dyad and the effects of CM. METHODS: We searched MEDLINE, PsycINFO, and
EMBASE up to October 2014, regardless of the study design. Our main outcomes were
needs of patients and their caregivers and the effects of CM on these needs. We
used narrative syntheses to develop a taxonomy of needs and to describe the effects
of CM on those needs. We used meta-analysis to calculate the prevalence of needs
and the standardized mean differences to evaluate the effects of CM on the needs
identified. RESULTS: Fifty-four studies were included. We identified needs of the
patient-caregiver dyad and needs of the patient and caregiver individually. CM
addressed the majority of the identified needs. Still, some very common needs (eg,
early diagnosis) are overlooked while other needs (eg, education on the disease)
are well addressed. Fully establishing the value of CM is difficult given the small
number of studies of CM in primary care. CONCLUSIONS: There is good evidence that
case managers, in collaboration with family physicians, have a pivotal role in
addressing the needs of the patient-caregiver dyad.
DO - 10.1370/afm.1898
VL - 14
IS - 2
SP - 166
EP - 77
CY - United States
SN - 1544-1709 (Linking)
U1 - 34698664
U2 - 26951593
N1 -
ER -

TY - JOUR
T1 - Assistive technologies for managing language disorders in dementia.
JF - Neuropsychiatric disease and treatment
A1 - Klimova B
A1 - Maresova P
A1 - Kuca K
KW - eppi-reviewer4
assistive technologies
dementia
improvement
language impairments
PY - 2016
DA - 2016///
Y1 - 2016///
N2 - At present, the number of elderly people is rapidly increasing, which
represents a significant threat in terms of their care when they fall ill. One of
the most common aging diseases nowadays is dementia, whose symptoms sooner or later
include loss of cognitive functioning. Cognitive disorders can vary from serious
mental retardation to inability to recall things, to the loss or disorder of
specific cognitive functions such as communication. These disorders not only affect
the quality of people's own life but also impose a substantial burden on their
families, particularly on their caregivers. Therefore, the aim of this article is
to highlight the role of assistive technologies (ATs) for managing language
impairments in dementia in order to improve patients' quality of life. In addition,
ATs focused on training patients' memory are also mentioned, since they can help
patients to maintain their language skills. Furthermore, these ATs can delay the
need for institutional care, as well as significantly reduce costs on patient care.
The importance of future research in the area of the development of ATs for
managing the language impairments in dementia is also discussed. There is a general
trend toward the personalization of patient needs and requirements in the area of
ATs. For the purpose of this article, a method of literature review of available
sources defining language disorders and providing characteristic features of
language disorders in dementia is used. In addition, a method of comparison of
different research studies exploring ATs focused on delaying language disorders in
dementia in order to postpone patients' need for institutional care is also
exploited.
AB - At present, the number of elderly people is rapidly increasing, which
represents a significant threat in terms of their care when they fall ill. One of
the most common aging diseases nowadays is dementia, whose symptoms sooner or later
include loss of cognitive functioning. Cognitive disorders can vary from serious
mental retardation to inability to recall things, to the loss or disorder of
specific cognitive functions such as communication. These disorders not only affect
the quality of people's own life but also impose a substantial burden on their
families, particularly on their caregivers. Therefore, the aim of this article is
to highlight the role of assistive technologies (ATs) for managing language
impairments in dementia in order to improve patients' quality of life. In addition,
ATs focused on training patients' memory are also mentioned, since they can help
patients to maintain their language skills. Furthermore, these ATs can delay the
need for institutional care, as well as significantly reduce costs on patient care.
The importance of future research in the area of the development of ATs for
managing the language impairments in dementia is also discussed. There is a general
trend toward the personalization of patient needs and requirements in the area of
ATs. For the purpose of this article, a method of literature review of available
sources defining language disorders and providing characteristic features of
language disorders in dementia is used. In addition, a method of comparison of
different research studies exploring ATs focused on delaying language disorders in
dementia in order to postpone patients' need for institutional care is also
exploited.
DO - 10.2147/NDT.S95903
VL - 12
IS -
SP - 533
EP - 40
CY - New Zealand
SN - 1176-6328 (Linking)
U1 - 34698660
U2 - 27013880
N1 -
ER -

TY - JOUR
T1 - RHAPSODY - Internet-based support for caregivers of people with young onset
dementia: program design and methods of a pilot study.
JF - International psychogeriatrics
A1 - Kurz A
A1 - Bakker C
A1 - Bohm M
A1 - Diehl-Schmid J
A1 - Dubois B
A1 - Ferreira C
A1 - Gage H
A1 - Graff C
A1 - Hergueta T
A1 - Jansen S
A1 - Jones B
A1 - Komar A
A1 - de Mendonca A
A1 - Metcalfe A
A1 - Milecka K
A1 - Millenaar J
A1 - Orrung Wallin A
A1 - Oyebode J
A1 - Schneider-Schelte H
A1 - Saxl S
A1 - de Vugt M
KW - eppi-reviewer4
*Alzheimer Disease/psychology/therapy
*Caregivers/education/psychology
Compassion Fatigue/*prevention & control
Female
*Frontotemporal Dementia/psychology/therapy
Humans
International Cooperation
*Internet
Male
Middle Aged
Professional Competence
*Quality of Life
Research Design
Self Efficacy
*Social Support
*caregiver
*dementia
*e-learning
*early
*education
*guide
*onset
*young
PY - 2016
DA - 2016/12//
Y1 - 2016/12//
N2 - BACKGROUND: Young Onset Dementia (YOD), defined by first symptoms of
cognitive or behavioral decline occurring before the age of 65 years, is relatively
rare compared to dementia of later onset, but it is associated with diagnostic
difficulty and heavy burden on affected individuals and their informal carers.
Existing health and social care structures rarely meet the needs of YOD patients.
Internet-based interventions are a novel format of delivering health-related
education, counseling, and support to this vulnerable yet underserved group.
METHODS: The RHAPSODY (Research to Assess Policies and Strategies for Dementia in
the Young) project is a European initiative to improve care for people with YOD by
providing an internet-based information and skill-building program for family
carers. The e-learning program focuses on managing problem behaviors, dealing with
role change, obtaining support, and looking after oneself. It will be evaluated in
a pilot study in three countries using a randomized unblinded design with a wait-
list control group. Participants will be informal carers of people with dementia in
Alzheimer's disease or behavioral-variant Frontotemporal degeneration with an onset
before the age of 65 years. The primary outcome will be caregiving self-efficacy
after 6 weeks of program use. As secondary outcomes, caregivers' stress and burden,
carer health-related quality of life, caring-related knowledge, patient problem
behaviors, and user satisfaction will be assessed. Program utilization will be
monitored and a health-economic evaluation will also be performed. CONCLUSIONS: The
RHAPSODY project will add to the evidence on the potential and limitations of a
conveniently accessible, user-friendly, and comprehensive internet-based
intervention as an alternative for traditional forms of counseling and support in
healthcare, aiming to optimize care and support for people with YOD and their
informal caregivers.
AB - BACKGROUND: Young Onset Dementia (YOD), defined by first symptoms of
cognitive or behavioral decline occurring before the age of 65 years, is relatively
rare compared to dementia of later onset, but it is associated with diagnostic
difficulty and heavy burden on affected individuals and their informal carers.
Existing health and social care structures rarely meet the needs of YOD patients.
Internet-based interventions are a novel format of delivering health-related
education, counseling, and support to this vulnerable yet underserved group.
METHODS: The RHAPSODY (Research to Assess Policies and Strategies for Dementia in
the Young) project is a European initiative to improve care for people with YOD by
providing an internet-based information and skill-building program for family
carers. The e-learning program focuses on managing problem behaviors, dealing with
role change, obtaining support, and looking after oneself. It will be evaluated in
a pilot study in three countries using a randomized unblinded design with a wait-
list control group. Participants will be informal carers of people with dementia in
Alzheimer's disease or behavioral-variant Frontotemporal degeneration with an onset
before the age of 65 years. The primary outcome will be caregiving self-efficacy
after 6 weeks of program use. As secondary outcomes, caregivers' stress and burden,
carer health-related quality of life, caring-related knowledge, patient problem
behaviors, and user satisfaction will be assessed. Program utilization will be
monitored and a health-economic evaluation will also be performed. CONCLUSIONS: The
RHAPSODY project will add to the evidence on the potential and limitations of a
conveniently accessible, user-friendly, and comprehensive internet-based
intervention as an alternative for traditional forms of counseling and support in
healthcare, aiming to optimize care and support for people with YOD and their
informal caregivers.
DO - 10.1017/S1041610216001186
VL - 28
IS - 12
SP - 2091
EP - 2099
CY - England
SN - 1041-6102 (Linking)
U1 - 34698646
U2 - 27572272
N1 -
ER -

TY - JOUR
T1 - Usages of Computers and Smartphones to Develop Dementia Care Education
Program for Asian American Family Caregivers.
JF - Healthcare informatics research
A1 - Lee JA
A1 - Nguyen H
A1 - Park J
A1 - Tran L
A1 - Nguyen T
A1 - Huynh Y
KW - eppi-reviewer4
Dementia
Education
Family Caregiver
Minority Groups
Smartphones
PY - 2017
DA - 2017/10//
Y1 - 2017/10//
N2 - Objectives: Families of ethnic minority persons with dementia often seek help
at later stages of the disease. Little is known about the effectiveness of various
methods in supporting ethnic minority dementia patients' caregivers. The objective
of the study was to identify smartphone and computer usage among family caregivers
of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-
care education programs for them. Methods: Participants were asked various
questions related to their computer or smartphone usage in conjunction with needs-
assessment interviews. Flyers were distributed at two ethnic minority community
centers in Southern California. Snowball recruitment was also utilized to reach out
to the families of dementia patients dwelling in the community. Results: Thirty-
five family caregivers, including 20 Vietnamese and 15 Korean individuals,
participated in this survey. Thirty participants (30 of 35, 85.7%) were computer
users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30)
claimed to use social media. A majority of the participants (31 of 35, 88.6%)
reported that they owned smartphones. More than half of smartphone users (18 of 29,
62%) claimed to use social media applications. Many participants claimed that they
could not attend in-class education due to caregiving and/or transportation issues.
Conclusions: Most family caregivers of dementia patients use smartphones more often
than computers, and more than half of those caregivers communicate with others
through social media apps. A smartphone-app-based caregiver intervention may serve
as a more effective approach compared to the conventional in-class method. Multiple
modalities for the development of caregiver interventions should be considered.
AB - Objectives: Families of ethnic minority persons with dementia often seek help
at later stages of the disease. Little is known about the effectiveness of various
methods in supporting ethnic minority dementia patients' caregivers. The objective
of the study was to identify smartphone and computer usage among family caregivers
of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-
care education programs for them. Methods: Participants were asked various
questions related to their computer or smartphone usage in conjunction with needs-
assessment interviews. Flyers were distributed at two ethnic minority community
centers in Southern California. Snowball recruitment was also utilized to reach out
to the families of dementia patients dwelling in the community. Results: Thirty-
five family caregivers, including 20 Vietnamese and 15 Korean individuals,
participated in this survey. Thirty participants (30 of 35, 85.7%) were computer
users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30)
claimed to use social media. A majority of the participants (31 of 35, 88.6%)
reported that they owned smartphones. More than half of smartphone users (18 of 29,
62%) claimed to use social media applications. Many participants claimed that they
could not attend in-class education due to caregiving and/or transportation issues.
Conclusions: Most family caregivers of dementia patients use smartphones more often
than computers, and more than half of those caregivers communicate with others
through social media apps. A smartphone-app-based caregiver intervention may serve
as a more effective approach compared to the conventional in-class method. Multiple
modalities for the development of caregiver interventions should be considered.
DO - 10.4258/hir.2017.23.4.338
VL - 23
IS - 4
SP - 338
EP - 342
CY - Korea (South)
SN - 2093-3681 (Linking)
U1 - 34698602
U2 - 29181245
N1 -
ER -

TY - JOUR
T1 - Community-dwelling patients with dementia and their informal caregivers with
and without case management: 2-year outcomes of a pragmatic trial.
JF - Journal of the American Medical Directors Association
A1 - MacNeil Vroomen J
A1 - Bosmans JE
A1 - van de Ven PM
A1 - Joling KJ
A1 - van Mierlo LD
A1 - Meiland FJ
A1 - Moll van Charante EP
A1 - van Hout HP
A1 - de Rooij SE
KW - eppi-reviewer4
Aged
Aged, 80 and over
Case Management/*utilization
Dementia/*nursing
Female
Humans
Independent Living
Longitudinal Studies
Male
Netherlands
Propensity Score
Prospective Studies
Quality of Life
Surveys and Questionnaires
Treatment Outcome
Case management
dementia
informal caregivers
longitudinal study
PY - 2015
DA - 2015/09//
Y1 - 2015/09//
N2 - OBJECTIVE: To evaluate outcomes for persons with dementia and primary
informal caregivers of 2 types of implemented case management (intensive case
management [ICMM] and linkage [LM] models) with no case management (control group).
DESIGN: A pragmatic trial using a prospective, observational, controlled, cohort
study. SETTING: Community care in the Netherlands. PARTICIPANTS: A total of 521
dyads. INTERVENTION: Case management provided within one care organization (ICMM),
case management where multiple case management organizations are present within one
region (LM), and a group with no access to case management (control). MEASUREMENTS:
Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric
Inventory (NPI) and psychological health in informal caregivers as measured with
the General Health Questionnaire (GHQ-12). Secondary outcomes included care and
support needs, quality of life, and institutionalization. Comparability of groups
at baseline was secured by inverse-propensity-score-weighted mixed models. RESULTS:
No significant differences in changes in total NPI or GHQ-12 scores between the
groups over 2 years were found. Secondary outcomes showed better quality-of-life
scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet
care needs were significantly less in the ICMM compared with the control group.
CONCLUSION: Neither case management type affected clinical outcomes of dyads
meaningfully. The ICMM has positive impact on caregivers' quality of life and
patient's number of needs compared with persons in LM and persons without access to
case management respectively.
AB - OBJECTIVE: To evaluate outcomes for persons with dementia and primary
informal caregivers of 2 types of implemented case management (intensive case
management [ICMM] and linkage [LM] models) with no case management (control group).
DESIGN: A pragmatic trial using a prospective, observational, controlled, cohort
study. SETTING: Community care in the Netherlands. PARTICIPANTS: A total of 521
dyads. INTERVENTION: Case management provided within one care organization (ICMM),
case management where multiple case management organizations are present within one
region (LM), and a group with no access to case management (control). MEASUREMENTS:
Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric
Inventory (NPI) and psychological health in informal caregivers as measured with
the General Health Questionnaire (GHQ-12). Secondary outcomes included care and
support needs, quality of life, and institutionalization. Comparability of groups
at baseline was secured by inverse-propensity-score-weighted mixed models. RESULTS:
No significant differences in changes in total NPI or GHQ-12 scores between the
groups over 2 years were found. Secondary outcomes showed better quality-of-life
scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet
care needs were significantly less in the ICMM compared with the control group.
CONCLUSION: Neither case management type affected clinical outcomes of dyads
meaningfully. The ICMM has positive impact on caregivers' quality of life and
patient's number of needs compared with persons in LM and persons without access to
case management respectively.
DO - 10.1016/j.jamda.2015.06.011
VL - 16
IS - 9
SP - 800.e1
EP - 8
CY - United States
SN - 1525-8610 (Linking)
U1 - 34698693
U2 - 26170035
N1 -
ER -

TY - JOUR
T1 - Development and pilot testing of a decision aid for the initiation of
antipsychotic medications in persons with dementia in long-term care using a
systematic approach: a study protocol.
JF - BMJ open
A1 - Malloy-Weir LJ
A1 - Kirk A
KW - eppi-reviewer4
antipsychotic medications
decision aid
dementia
PY - 2017
DA - 2017/10//
Y1 - 2017/10//
N2 - INTRODUCTION: Antipsychotic medications are commonly used in long-term care
to treat neuropsychiatric symptoms of dementia despite concerns that their risks
(eg, infection, falls, death) may outweigh their benefits. This study protocol
outlines the development and pilot testing of a decision aid for antipsychotic
medications that is tailored to the information needs of residents with dementia in
long-term care and family caregivers (or decision makers). The goals of the
decision aid are to help residents and caregivers (1) better understand the risks
and benefits of antipsychotic medications in long-term care, and (2) make informed
decisions about their use (or non-use). METHODS AND ANALYSIS: This multiphased
study is being conducted between October 2016 and September 2018. In phase I, the
decision aid will be developed after consultation with a steering group, review of
scientific evidence on outcomes associated with pharmacological treatments for
neuropsychiatric symptoms of dementia in long-term care, review of guidelines for
the use of antipsychotic medications in long-term care, and review of guidelines
for writing health information for patients and families. The decision aid will
also be alpha-tested and redrafted, as necessary, in phase I. In phase II,
implementation and reporting guidelines for the decision aid will be developed in
collaboration with Directors of Care in long-term care. In phase III, the decision
aid will be (1) beta-tested with residents with dementia in long-term care and
caregivers not involved in the design phase, and (2) assessed by an external panel
of experts. ETHICS AND DISSEMINATION: Ethical approval for this study has been
granted by the Research Ethics Board at the University of Saskatchewan, approval
number Beh 16-465. Findings from this study will be disseminated via conference
presentations, publications, presentations to policy makers and plain language
summaries to residents with dementia in long-term care and their caregivers.
AB - INTRODUCTION: Antipsychotic medications are commonly used in long-term care
to treat neuropsychiatric symptoms of dementia despite concerns that their risks
(eg, infection, falls, death) may outweigh their benefits. This study protocol
outlines the development and pilot testing of a decision aid for antipsychotic
medications that is tailored to the information needs of residents with dementia in
long-term care and family caregivers (or decision makers). The goals of the
decision aid are to help residents and caregivers (1) better understand the risks
and benefits of antipsychotic medications in long-term care, and (2) make informed
decisions about their use (or non-use). METHODS AND ANALYSIS: This multiphased
study is being conducted between October 2016 and September 2018. In phase I, the
decision aid will be developed after consultation with a steering group, review of
scientific evidence on outcomes associated with pharmacological treatments for
neuropsychiatric symptoms of dementia in long-term care, review of guidelines for
the use of antipsychotic medications in long-term care, and review of guidelines
for writing health information for patients and families. The decision aid will
also be alpha-tested and redrafted, as necessary, in phase I. In phase II,
implementation and reporting guidelines for the decision aid will be developed in
collaboration with Directors of Care in long-term care. In phase III, the decision
aid will be (1) beta-tested with residents with dementia in long-term care and
caregivers not involved in the design phase, and (2) assessed by an external panel
of experts. ETHICS AND DISSEMINATION: Ethical approval for this study has been
granted by the Research Ethics Board at the University of Saskatchewan, approval
number Beh 16-465. Findings from this study will be disseminated via conference
presentations, publications, presentations to policy makers and plain language
summaries to residents with dementia in long-term care and their caregivers.
DO - 10.1136/bmjopen-2017-018769
VL - 7
IS - 10
SP - e018769
CY - England
SN - 2044-6055 (Linking)
U1 - 34698605
U2 - 29074519
N1 -
ER -

TY - JOUR
T1 - Shared decision-making on a 'life-and-care plan' in long-term care
facilities: research protocol.
JF - Nursing open
A1 - Mariani E
A1 - Engels Y
A1 - Koopmans R
A1 - Chattat R
A1 - Vernooij-Dassen M
KW - eppi-reviewer4
Care plans
dementia
long-term care
nursing
nursing homes
shared decision-making
PY - 2016
DA - 2016/07//
Y1 - 2016/07//
N2 - AIM: To determine whether the number of residents' preferences and needs
together with the actions taken to satisfy them recorded into their 'life-and-care
plans' will increase and the process of shared decision-making will improve the
residents' psychosocial well-being. BACKGROUND: Shared decision-making is defined
as a process where healthcare professionals and patients make decisions together,
using the best available evidence. The aims of the present study were to assess the
feasibility and acceptability of an SDM framework for care planning in long-term
care facilities and its potential effectiveness on the proportion of dementia
residents whose own preferences and needs and the related actions, are known,
satisfied and documented in their 'life-and-care plans'. DESIGN: The current
project is a feasibility trial and it was approved in November 2013. METHODS:
Research subjects are triads composed of the resident with dementia, a family
caregiver and the professional usually taking care for the resident. Professional
caregivers of two nursing homes, one located in Italy and one in the Netherlands,
will receive a specific training in SDM principles and will guide the SDM interview
in the triad. The primary outcome will be the proportion of residents whose
preferences and needs, together with the related actions to meet them, are known,
documented and satisfied in their 'life-and-care plans'. TRIAL REGISTRATION:
NCT02118701.
AB - AIM: To determine whether the number of residents' preferences and needs
together with the actions taken to satisfy them recorded into their 'life-and-care
plans' will increase and the process of shared decision-making will improve the
residents' psychosocial well-being. BACKGROUND: Shared decision-making is defined
as a process where healthcare professionals and patients make decisions together,
using the best available evidence. The aims of the present study were to assess the
feasibility and acceptability of an SDM framework for care planning in long-term
care facilities and its potential effectiveness on the proportion of dementia
residents whose own preferences and needs and the related actions, are known,
satisfied and documented in their 'life-and-care plans'. DESIGN: The current
project is a feasibility trial and it was approved in November 2013. METHODS:
Research subjects are triads composed of the resident with dementia, a family
caregiver and the professional usually taking care for the resident. Professional
caregivers of two nursing homes, one located in Italy and one in the Netherlands,
will receive a specific training in SDM principles and will guide the SDM interview
in the triad. The primary outcome will be the proportion of residents whose
preferences and needs, together with the related actions to meet them, are known,
documented and satisfied in their 'life-and-care plans'. TRIAL REGISTRATION:
NCT02118701.
DO - 10.1002/nop2.42
VL - 3
IS - 3
SP - 179
EP - 187
CY - United States
SN - 2054-1058 (Linking)
U1 - 34698641
U2 - 27708828
N1 -
ER -

TY - JOUR
T1 - Interventions for caregivers of patients with dementia.
JF - Actas espanolas de psiquiatria
A1 - Martin-Carrasco M
A1 - Ballesteros-Rodriguez J
A1 - Dominguez-Panchon AI
A1 - Munoz-Hermoso P
A1 - Gonzalez-Fraile E
KW - eppi-reviewer4
Anxiety/*therapy
*Caregivers
Cost of Illness
*Dementia
Depression/*therapy
Humans
Randomized Controlled Trials as Topic
PY - 2014
DA - 2014/11//
Y1 - 2014/11//
N2 - INTRODUCTION: With the aging of the population, an increasing number of
people have dementia, most of whom are receiving home care. Caregivers are exposed
to a variety of stressors, which may lead to feeling burdened, or to depression and
anxiety. Various programs or structured interventions have been developed to
prevent or lessen these negative consequences. The efficacy of these interventions
is debated, mainly due to methodological differences between studies. Review
studies so far have presented important discrepancies, thus perpetuating a lack of
clarity regarding this important geriatric care problem. The effectiveness of
interventions designed to prevent or reduce the burden and/or symptoms of anxiety
and depression in informal caregivers are reviewed precisely and rigorously.
METHODS: A systematic review of randomized controlled studies assessing the
efficacy of structured interventions on the variables of burden, depression and
anxiety in informal caregivers of patients with dementia. RESULTS: The literature
search yielded 997 references, of which 35 met the screening criteria. Of these
studies, 51.4% had results that were statistically favorable to intervention. The
methodology used varied widely between studies. CONCLUSIONS: Overall, the available
evidence favors the implementation of structured intervention programs, although
the results are heterogeneous. Psychoeducational interventions yield better results
and can be better adapted to the needs of caregivers.
AB - INTRODUCTION: With the aging of the population, an increasing number of
people have dementia, most of whom are receiving home care. Caregivers are exposed
to a variety of stressors, which may lead to feeling burdened, or to depression and
anxiety. Various programs or structured interventions have been developed to
prevent or lessen these negative consequences. The efficacy of these interventions
is debated, mainly due to methodological differences between studies. Review
studies so far have presented important discrepancies, thus perpetuating a lack of
clarity regarding this important geriatric care problem. The effectiveness of
interventions designed to prevent or reduce the burden and/or symptoms of anxiety
and depression in informal caregivers are reviewed precisely and rigorously.
METHODS: A systematic review of randomized controlled studies assessing the
efficacy of structured interventions on the variables of burden, depression and
anxiety in informal caregivers of patients with dementia. RESULTS: The literature
search yielded 997 references, of which 35 met the screening criteria. Of these
studies, 51.4% had results that were statistically favorable to intervention. The
methodology used varied widely between studies. CONCLUSIONS: Overall, the available
evidence favors the implementation of structured intervention programs, although
the results are heterogeneous. Psychoeducational interventions yield better results
and can be better adapted to the needs of caregivers.
VL - 42
IS - 6
SP - 300
EP - 14
CY - Spain
SN - 1139-9287 (Linking)
U1 - 34698721
U2 - 25388772
N1 -
ER -

TY - JOUR
T1 - Information and Communication Technologies in the Care of the Elderly:
Systematic Review of Applications Aimed at Patients With Dementia and Caregivers.
JF - JMIR rehabilitation and assistive technologies
A1 - Martinez-Alcala CI
A1 - Pliego-Pastrana P
A1 - Rosales-Lagarde A
A1 - Lopez-Noguerola JS
A1 - Molina-Trinidad EM
KW - eppi-reviewer4
Alzheimer's disease
caregiver
eHealth
elderly
information and communication technologies
systematic review
PY - 2016
DA - 2016/05//
Y1 - 2016/05//
N2 - BACKGROUND: The interest in applying information and communications
technology (ICT) in older adult health care is frequently promoted by the
increasing and unsustainable costs of health care services. In turn, the
unprecedented growth of the elderly population around the globe has urged
institutions, companies, industries, and governments to respond to older adults'
medical needs. OBJECTIVE: The aim of this review is to systematically identify the
opportunities that ICT offers to health services, specifically for patients with
dementia and their families. METHODS: A systematic review of the literature about
ICT applications that have been developed to assist patients with Alzheimer's
disease (AD) and their primary caregivers was conducted. The bibliographic search
included works published between January 2005 and July 2015 in the databases
Springer Link, Scopus, and Google Scholar. Of the published papers, 902 were
obtained in the initial search, of which 214 were potentially relevant. Included
studies fulfilled the following inclusion criteria: (1) studies carried out between
the years of 2005 and 2015, (2) studies were published in English or Spanish, (3)
studies with titles containing the keywords, (4) studies with abstracts containing
information on ICT applications and AD, and (5) studies published in indexed
journals, proceedings, and book chapters. RESULTS: A total of 26 studies satisfied
the inclusion criteria for the current review. Among them, 16 were aimed at the
patient with AD and 10 at the primary caregivers and/or family members. The studies
targeted applications that included assistive technology (44%, 7/16), telecare
(37%, 6/16), and telemedicine (31%, 5/16). The information systems (56%, 9/16) and
Internet (44%, 7/16) were the most commonly used enabling technologies for the
studies. Finally, areas of attention more covered by the studies were care (56%,
9/16), treatment (56%, 9/16), and management (50%, 8/16). Furthermore, it was found
that 20 studies (77%, 8/26) evaluated their ICT applications through carrying out
tests with patients with dementia and caregivers. CONCLUSIONS: The key finding of
this systematic review revealed that the use of ICT tools can be strongly
recommended to be used as a lifestyle in the elderly in order to improve the
quality of life for the elderly and their primary caregivers. Since patients with
AD are completely dependent in most activities, it is necessary to give attention
to their primary caregivers to avoid stress and depression. In addition, the use of
ICT in the daily life of caregivers can help them understand the disease process
and manage situations in a way that is beneficial for both parties. It is expected
that future developments concerning technological projects can support this group
of people.
AB - BACKGROUND: The interest in applying information and communications
technology (ICT) in older adult health care is frequently promoted by the
increasing and unsustainable costs of health care services. In turn, the
unprecedented growth of the elderly population around the globe has urged
institutions, companies, industries, and governments to respond to older adults'
medical needs. OBJECTIVE: The aim of this review is to systematically identify the
opportunities that ICT offers to health services, specifically for patients with
dementia and their families. METHODS: A systematic review of the literature about
ICT applications that have been developed to assist patients with Alzheimer's
disease (AD) and their primary caregivers was conducted. The bibliographic search
included works published between January 2005 and July 2015 in the databases
Springer Link, Scopus, and Google Scholar. Of the published papers, 902 were
obtained in the initial search, of which 214 were potentially relevant. Included
studies fulfilled the following inclusion criteria: (1) studies carried out between
the years of 2005 and 2015, (2) studies were published in English or Spanish, (3)
studies with titles containing the keywords, (4) studies with abstracts containing
information on ICT applications and AD, and (5) studies published in indexed
journals, proceedings, and book chapters. RESULTS: A total of 26 studies satisfied
the inclusion criteria for the current review. Among them, 16 were aimed at the
patient with AD and 10 at the primary caregivers and/or family members. The studies
targeted applications that included assistive technology (44%, 7/16), telecare
(37%, 6/16), and telemedicine (31%, 5/16). The information systems (56%, 9/16) and
Internet (44%, 7/16) were the most commonly used enabling technologies for the
studies. Finally, areas of attention more covered by the studies were care (56%,
9/16), treatment (56%, 9/16), and management (50%, 8/16). Furthermore, it was found
that 20 studies (77%, 8/26) evaluated their ICT applications through carrying out
tests with patients with dementia and caregivers. CONCLUSIONS: The key finding of
this systematic review revealed that the use of ICT tools can be strongly
recommended to be used as a lifestyle in the elderly in order to improve the
quality of life for the elderly and their primary caregivers. Since patients with
AD are completely dependent in most activities, it is necessary to give attention
to their primary caregivers to avoid stress and depression. In addition, the use of
ICT in the daily life of caregivers can help them understand the disease process
and manage situations in a way that is beneficial for both parties. It is expected
that future developments concerning technological projects can support this group
of people.
DO - 10.2196/rehab.5226
VL - 3
IS - 1
SP - e6
CY - Canada
SN - 2369-2529 (Linking)
U1 - 34698616
U2 - 28582258
N1 -
ER -

TY - JOUR
T1 - Evaluation of a therapeutic education program for French family caregivers of
elderly people suffering from major neurocognitive disorders: Preliminary study.
JF - Gerontology & geriatrics education
A1 - Monfort E
A1 - Mayol A
A1 - Lissot C
A1 - Couturier P
KW - eppi-reviewer4
Caregiving
dementia
major neurocognitive disorders
therapeutic education
PY - 2016
DA - 2016/12//
Y1 - 2016/12//
N2 - The pertinence of a therapeutic program of education has been studied with
regard to carers of patients suffering from major neurocognitive disorders. The
program, adapted to the needs expressed by the carers, consisted of three workshops
with a view to supplying general information about the pathologies, specific
information on behavioral disorders, and specific aids to identify and manage their
emotional reactions. The results of this preliminary study show a moderate
significant benefit to the level of anxiety in the participants, taking into
account the specific expectations of the carers and bringing to light further
needs.
AB - The pertinence of a therapeutic program of education has been studied with
regard to carers of patients suffering from major neurocognitive disorders. The
program, adapted to the needs expressed by the carers, consisted of three workshops
with a view to supplying general information about the pathologies, specific
information on behavioral disorders, and specific aids to identify and manage their
emotional reactions. The results of this preliminary study show a moderate
significant benefit to the level of anxiety in the participants, taking into
account the specific expectations of the carers and bringing to light further
needs.
DO - 10.1080/02701960.2016.1267640
VL -
IS -
SP - 1
EP - 12
CY - England
SN - 0270-1960 (Linking)
U1 - 34698637
U2 - 27936353
N1 -
ER -

TY - JOUR
T1 - A randomized trial of the impact of a specific care plan in 1120 Alzheimer's
patients (PLASA Study) over a two-year period: design and baseline data.
JF - The journal of nutrition, health & aging
A1 - Nourhashemi F
A1 - Gillette-Guyonnet S
A1 - Andrieu S
A1 - Rolland Y
A1 - Ousset PJ
A1 - Vellas B
KW - eppi-reviewer4
*Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease/*psychology/*therapy
Cluster Analysis
Cohort Studies
Female
Health Services for the Aged/*standards
Humans
Male
Outcome Assessment (Health Care)
Patient Care/*methods/standards
Prospective Studies
Quality of Life
Time Factors
Treatment Outcome
PY - 2008
DA - 2008/04//
Y1 - 2008/04//
N2 - OBJECTIVE: To describe the design anf baseline patient characteristics of a
multicomponent specific care and assistance plan (PLASA) study in Alzheimer's
Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily
looking at change in functional capacity. DESIGN: Two-years prospective cluster
randomized controlled trial comparing PLASA and usual care. SETTING: Forty-nine
hospitals in France. PARTICIPANTS: 1120 community-dwelling AD. INTERVENTION:
Patients in the intervention group are evaluated biannually using a standardized
comprehensive global assessment. In the case of decline in any one domain a
standardized study protocol recommends specific physician directed intervention in
addition to information and training for the caregiver. MEASUREMENTS: Alzheimer
Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in
Dementia scale, Clinical Global Impression of Change. RESULTS: At baseline, the two
groups were similar regarding patient and caregiver characteristics. The mean
patient age was 79.61+5.72 years and the mean MMSE 19.73+4.01 for the whole cohort.
Time since dementia diagnosis was about 1.37+1.65 years in the whole cohort. Almost
a third of the patients lived alone at baseline. Mean monthly time spent in
caregiving in the whole cohort was 52.70+71.83 hours for instrumental activities
and 17.73+51.38 hours for basic activities. CONCLUSION: Persons with dementia
suffer different losses at different stages of the disease and therefore accurate
assessment of abilities and losses is critical to assist the person in planning for
their future and for care needs. The PLASA intervention study is ongoing with 2
year follow-up to be completed in 2007.
AB - OBJECTIVE: To describe the design anf baseline patient characteristics of a
multicomponent specific care and assistance plan (PLASA) study in Alzheimer's
Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily
looking at change in functional capacity. DESIGN: Two-years prospective cluster
randomized controlled trial comparing PLASA and usual care. SETTING: Forty-nine
hospitals in France. PARTICIPANTS: 1120 community-dwelling AD. INTERVENTION:
Patients in the intervention group are evaluated biannually using a standardized
comprehensive global assessment. In the case of decline in any one domain a
standardized study protocol recommends specific physician directed intervention in
addition to information and training for the caregiver. MEASUREMENTS: Alzheimer
Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in
Dementia scale, Clinical Global Impression of Change. RESULTS: At baseline, the two
groups were similar regarding patient and caregiver characteristics. The mean
patient age was 79.61+5.72 years and the mean MMSE 19.73+4.01 for the whole cohort.
Time since dementia diagnosis was about 1.37+1.65 years in the whole cohort. Almost
a third of the patients lived alone at baseline. Mean monthly time spent in
caregiving in the whole cohort was 52.70+71.83 hours for instrumental activities
and 17.73+51.38 hours for basic activities. CONCLUSION: Persons with dementia
suffer different losses at different stages of the disease and therefore accurate
assessment of abilities and losses is critical to assist the person in planning for
their future and for care needs. The PLASA intervention study is ongoing with 2
year follow-up to be completed in 2007.
VL - 12
IS - 4
SP - 263
EP - 71
CY - France
SN - 1279-7707 (Linking)
U1 - 34698944
U2 - 18373036
N1 -
ER -

TY - JOUR
T1 - Effects of educational interventions on primary dementia care: A systematic
review.
JF - International journal of geriatric psychiatry
A1 - Perry M
A1 - Draskovic I
A1 - Lucassen P
A1 - Vernooij-Dassen M
A1 - van Achterberg T
A1 - Rikkert MO
KW - eppi-reviewer4
Attitude of Health Personnel
*Dementia
*Education, Medical, Continuing
Family Practice/*education
Guideline Adherence
Health Knowledge, Attitudes, Practice
Humans
Randomized Controlled Trials as Topic
PY - 2011
DA - 2011/01//
Y1 - 2011/01//
N2 - OBJECTIVE: To determine the effects of educational interventions about
dementia, directed at primary care providers (PCPs). DESIGN: We searched Medline,
Embase, PsycInfo, Cinahl and the Cochrane library for relevant articles. Two
researchers independently assessed the citations identified against the following
inclusion criteria: educational intervention on dementia directed at PCPs and study
designs being randomized controlled trials (RCTs), controlled clinical trials
(CCTs), controlled before and after studies (CBAs) or interrupted time series (ITS)
analyses. Outcomes of interest were PCPs' knowledge and attitude on dementia, and
quality of dementia care at PCP and patient level. RESULTS: Of 3953 citations
identified, six articles representing five studies (four cluster RCTs and one CBA)
were eligible, describing educational interventions directed at 1904 PCPs.
Compliance to the interventions varied from 18 to 100%. Systematic review of the
studies showed moderate positive results. Five articles reported at least some
effects of the interventions. A small group workshop and a decision support system
(DSS) increased dementia detection rates. An interactive 2-h seminar raised GPs'
suspicion of dementia. Adherence to dementia guidelines only improved when an
educational intervention was combined with the appointment of dementia care
managers. This combined intervention also improved patients' and caregivers'
quality of life. Effects on knowledge and attitudes were minor. CONCLUSION:
Educational interventions for PCPs that require active participation improve
detection of dementia. Educational interventions alone do not seem to increase
adherence to dementia guidelines. To effectively change professionals' performance
in primary dementia care, education probably needs to be combined with adequate
reimbursement or other organizational incentives.
AB - OBJECTIVE: To determine the effects of educational interventions about
dementia, directed at primary care providers (PCPs). DESIGN: We searched Medline,
Embase, PsycInfo, Cinahl and the Cochrane library for relevant articles. Two
researchers independently assessed the citations identified against the following
inclusion criteria: educational intervention on dementia directed at PCPs and study
designs being randomized controlled trials (RCTs), controlled clinical trials
(CCTs), controlled before and after studies (CBAs) or interrupted time series (ITS)
analyses. Outcomes of interest were PCPs' knowledge and attitude on dementia, and
quality of dementia care at PCP and patient level. RESULTS: Of 3953 citations
identified, six articles representing five studies (four cluster RCTs and one CBA)
were eligible, describing educational interventions directed at 1904 PCPs.
Compliance to the interventions varied from 18 to 100%. Systematic review of the
studies showed moderate positive results. Five articles reported at least some
effects of the interventions. A small group workshop and a decision support system
(DSS) increased dementia detection rates. An interactive 2-h seminar raised GPs'
suspicion of dementia. Adherence to dementia guidelines only improved when an
educational intervention was combined with the appointment of dementia care
managers. This combined intervention also improved patients' and caregivers'
quality of life. Effects on knowledge and attitudes were minor. CONCLUSION:
Educational interventions for PCPs that require active participation improve
detection of dementia. Educational interventions alone do not seem to increase
adherence to dementia guidelines. To effectively change professionals' performance
in primary dementia care, education probably needs to be combined with adequate
reimbursement or other organizational incentives.
DO - 10.1002/gps.2479
VL - 26
IS - 1
SP - 1
EP - 11
CY - England
SN - 0885-6230 (Linking)
U1 - 34698868
U2 - 21157845
N1 -
ER -

TY - JOUR
T1 - The effects of a multicomponent dyadic intervention on the mood, behavior,
and physical health of people with dementia: a randomized controlled trial.
JF - Clinical interventions in aging
A1 - Prick AE
A1 - de Lange J
A1 - Scherder E
A1 - Twisk J
A1 - Pot AM
KW - eppi-reviewer4
Adult
*Affect
Aged
Aged, 80 and over
Australia
Behavior Therapy/*methods
Caregivers/education/psychology
Dementia/*psychology/*therapy
Exercise Therapy/*methods
Female
Home Care Services
Humans
Linear Models
Male
Mental Health
Middle Aged
Psychiatric Status Rating Scales
Quality of Life
Social Support
Treatment Outcome
caregivers
dementia
intervention
mental health
prevention
PY - 2016
DA - 2016///
Y1 - 2016///
N2 - PURPOSE: The effects of a multicomponent dyadic intervention on the mood,
behavior, and physical health of people with dementia living in the community were
evaluated in a randomized controlled trial. This multicomponent dyadic intervention
is a translated and adapted version of an intervention that has been shown to be
effective for people with dementia in the US. PATIENTS AND METHODS: People with
dementia living in the community and their family caregivers (N=111 caregiver-care
recipient dyads) were randomly assigned to the intervention and comparison group.
The intervention group received home-based physical exercise training, psycho-
education, communication skills training, and pleasant activities training during 3
months directed at both the person with dementia and the caregiver. Mood, behavior,
and physical health were measured at baseline, 3 months, and 6 months. The effects
of the study were determined by using generalized estimating equations based on an
intention-to-treat analysis. RESULTS: Analyses showed no beneficial effects over
time on any of the outcome measures. CONCLUSION: This study showed no effects. The
negative results in this study compared to the study that has been carried out in
the US might be explained by the translation, adaptation, and shortening of the
intervention used in the US, and a different social context. In addition, the
results might be explained by the lack of room for improvement and by experiencing
the intervention as too much of a burden. Furthermore, improving physical health
might only be effective if the physical exercises are of moderate-to-high-intensity
and are tailored in accordance with participants' preferences and needs. For future
studies, because dyads often commented positively about the pleasure and support
they received, it might also be valuable to measure quality of life outcomes such
as relationship quality, pleasure, and self-esteem in dyadic focused interventions.
AB - PURPOSE: The effects of a multicomponent dyadic intervention on the mood,
behavior, and physical health of people with dementia living in the community were
evaluated in a randomized controlled trial. This multicomponent dyadic intervention
is a translated and adapted version of an intervention that has been shown to be
effective for people with dementia in the US. PATIENTS AND METHODS: People with
dementia living in the community and their family caregivers (N=111 caregiver-care
recipient dyads) were randomly assigned to the intervention and comparison group.
The intervention group received home-based physical exercise training, psycho-
education, communication skills training, and pleasant activities training during 3
months directed at both the person with dementia and the caregiver. Mood, behavior,
and physical health were measured at baseline, 3 months, and 6 months. The effects
of the study were determined by using generalized estimating equations based on an
intention-to-treat analysis. RESULTS: Analyses showed no beneficial effects over
time on any of the outcome measures. CONCLUSION: This study showed no effects. The
negative results in this study compared to the study that has been carried out in
the US might be explained by the translation, adaptation, and shortening of the
intervention used in the US, and a different social context. In addition, the
results might be explained by the lack of room for improvement and by experiencing
the intervention as too much of a burden. Furthermore, improving physical health
might only be effective if the physical exercises are of moderate-to-high-intensity
and are tailored in accordance with participants' preferences and needs. For future
studies, because dyads often commented positively about the pleasure and support
they received, it might also be valuable to measure quality of life outcomes such
as relationship quality, pleasure, and self-esteem in dyadic focused interventions.
DO - 10.2147/CIA.S95789
VL - 11
IS -
SP - 383
EP - 95
CY - New Zealand
SN - 1176-9092 (Linking)
U1 - 34698657
U2 - 27099480
N1 -
ER -

TY - JOUR
T1 - Palliative assessment and advance care planning in severe dementia: an
exploratory randomized controlled trial of a complex intervention.
JF - Palliative medicine
A1 - Sampson EL
A1 - Jones L
A1 - Thune-Boyle IC
A1 - Kukkastenvehmas R
A1 - King M
A1 - Leurent B
A1 - Tookman A
A1 - Blanchard MR
KW - eppi-reviewer4
Adult
*Advance Care Planning
Aged
Aged, 80 and over
*Caregivers
Deglutition Disorders/nursing
Dementia/*nursing
Feasibility Studies
Female
Humans
Male
Middle Aged
Pain/nursing
*Palliative Care
Patient Selection
Pilot Projects
Quality of Life
Surveys and Questionnaires
PY - 2011
DA - 2011/04//
Y1 - 2011/04//
N2 - Patients with advanced dementia often receive poor end-of-life care. We aimed
to design and pilot a palliative care and advance care plan (ACP) intervention.
Patients had undergone emergency hospital admission and had severe dementia. The
intervention consisted of a palliative care patient assessment which informed an
ACP discussion with the carer, who was offered the opportunity to write an ACP for
the person with dementia. Carer-patient dyads were randomized to 'usual care' or
the intervention. Carer-related outcome measures included the Kessler Distress
Scale, Decision Satisfaction Inventory, Client Satisfaction Questionnaire and the
Euroqol-5D, measured at baseline, six weeks, six months and three months after
bereavement. The Satisfaction with End of Life Care in Dementia Scale was completed
if the patient died. The 32 patient participants were physically frail and in the
advanced stages of dementia: 62% had pressure damage to the skin, all needed
feeding assistance and 95% were in pain. Nearly 50% died during the six-month
follow-up period. Carers were difficult to recruit during acute admission; 33
patients and carers entered the study (22 intervention arm; 11 control arm). Only
seven carers made ACPs. The care planning discussion was well received, but few
carers wrote an ACP, despite intensive support from an experienced nurse
specialist. Advance care planning is, in theory, a necessary intervention for
people with severe dementia; the reluctance of carers to write plans needs to be
explored further.
AB - Patients with advanced dementia often receive poor end-of-life care. We aimed
to design and pilot a palliative care and advance care plan (ACP) intervention.
Patients had undergone emergency hospital admission and had severe dementia. The
intervention consisted of a palliative care patient assessment which informed an
ACP discussion with the carer, who was offered the opportunity to write an ACP for
the person with dementia. Carer-patient dyads were randomized to 'usual care' or
the intervention. Carer-related outcome measures included the Kessler Distress
Scale, Decision Satisfaction Inventory, Client Satisfaction Questionnaire and the
Euroqol-5D, measured at baseline, six weeks, six months and three months after
bereavement. The Satisfaction with End of Life Care in Dementia Scale was completed
if the patient died. The 32 patient participants were physically frail and in the
advanced stages of dementia: 62% had pressure damage to the skin, all needed
feeding assistance and 95% were in pain. Nearly 50% died during the six-month
follow-up period. Carers were difficult to recruit during acute admission; 33
patients and carers entered the study (22 intervention arm; 11 control arm). Only
seven carers made ACPs. The care planning discussion was well received, but few
carers wrote an ACP, despite intensive support from an experienced nurse
specialist. Advance care planning is, in theory, a necessary intervention for
people with severe dementia; the reluctance of carers to write plans needs to be
explored further.
DO - 10.1177/0269216310391691
VL - 25
IS - 3
SP - 197
EP - 209
CY - England
SN - 0269-2163 (Linking)
U1 - 34698867
U2 - 21228087
N1 -
ER -

TY - JOUR
T1 - Memantine and functional communication in Alzheimer's disease: results of a
12-week, international, randomized clinical trial.
JF - Journal of Alzheimer's disease : JAD
A1 - Saxton J
A1 - Hofbauer RK
A1 - Woodward M
A1 - Gilchrist NL
A1 - Potocnik F
A1 - Hsu HA
A1 - Miller ML
A1 - Pejovic V
A1 - Graham SM
A1 - Perhach JL
KW - eppi-reviewer4
Activities of Daily Living/psychology
Aged
Aged, 80 and over
Alzheimer Disease/*drug therapy/*psychology
*Communication
Double-Blind Method
Female
Humans
Internationality
Male
Memantine/*therapeutic use
Neuropsychological Tests
PY - 2012
DA - 2012///
Y1 - 2012///
N2 - Post hoc analyses suggest that memantine treatment may provide communication-
related benefits in patients with Alzheimer's disease (AD). In this 12-week,
international, randomized, double-blind, placebo-controlled trial of memantine (10
mg bid), the functional communication abilities of patients with AD (MMSE range:
10-19) were assessed using the Functional Linguistic Communication Inventory (FLCI;
primary measure). Two combined subscales (Social Communication and Communication of
Basic Needs) from the American Speech-Language-Hearing Association Functional
Assessment of Communication Skills for Adults (ASHA FACS; secondary measure) were
administered to caregivers. Treatment-emergent adverse events were also recorded.
After 12 weeks, memantine-treated patients (n = 133) demonstrated a non-significant
improvement on the FLCI (placebo: -0.6; memantine: 0.7; p = 0.070, LOCF) and a
significant improvement on the ASHA FACS (placebo: -5.3; memantine: 0.5; p =
0.022), compared with placebo-treated patients (n = 124). Memantine had a low
incidence of adverse events. In patients with moderate AD, memantine treatment
improved functional communication, as recognized by caregivers.
AB - Post hoc analyses suggest that memantine treatment may provide communication-
related benefits in patients with Alzheimer's disease (AD). In this 12-week,
international, randomized, double-blind, placebo-controlled trial of memantine (10
mg bid), the functional communication abilities of patients with AD (MMSE range:
10-19) were assessed using the Functional Linguistic Communication Inventory (FLCI;
primary measure). Two combined subscales (Social Communication and Communication of
Basic Needs) from the American Speech-Language-Hearing Association Functional
Assessment of Communication Skills for Adults (ASHA FACS; secondary measure) were
administered to caregivers. Treatment-emergent adverse events were also recorded.
After 12 weeks, memantine-treated patients (n = 133) demonstrated a non-significant
improvement on the FLCI (placebo: -0.6; memantine: 0.7; p = 0.070, LOCF) and a
significant improvement on the ASHA FACS (placebo: -5.3; memantine: 0.5; p =
0.022), compared with placebo-treated patients (n = 124). Memantine had a low
incidence of adverse events. In patients with moderate AD, memantine treatment
improved functional communication, as recognized by caregivers.
DO - 10.3233/JAD-2011-110947
VL - 28
IS - 1
SP - 109
EP - 18
CY - Netherlands
SN - 1387-2877 (Linking)
U1 - 34698843
U2 - 21955815
N1 -
ER -

TY - JOUR
T1 - Tailored e-Health services for the dementia care setting: a pilot study of
'eHealthMonitor'.
JF - BMC medical informatics and decision making
A1 - Schaller S
A1 - Marinova-Schmidt V
A1 - Gobin J
A1 - Criegee-Rieck M
A1 - Griebel L
A1 - Engel S
A1 - Stein V
A1 - Graessel E
A1 - Kolominsky-Rabas PL
KW - eppi-reviewer4
Adult
Aged
Aged, 80 and over
Caregivers/*psychology
*Decision Support Techniques
Dementia/*nursing
Female
Humans
Internet
Male
*Medical Informatics Applications
Middle Aged
Pilot Projects
Telemedicine/*instrumentation
PY - 2015
DA - 2015/07//
Y1 - 2015/07//
N2 - BACKGROUND: The European eHealthMonitor project (eHM) developed a user-
sensitive and interactive web portal for dementia care: the eHM Dementia Portal
(eHM-DP). It aims to provide targeted and personalized support for informal
caregivers of people with dementia in a home-based care setting. The objective of
the pilot study was to obtain feedback on the eHM-DP from two user perspectives
(caregivers and medical professionals), focusing on caregiver empowerment, decision
aid, and the perceived benefits of the eHM-DP. METHODS: The study on the eHM-DP was
conducted from March 2014 to June 2014. The methodological approach followed a
user-participatory design with a total number of 42 participants. The study
included caregivers of people with dementia and medical professionals (MPs) from
the metropolitan region of Erlangen-Nurnberg (Bavaria, Germany). Study participants
were interviewed face-to-face with semi-structured, written interviews. RESULTS:
Caregivers indicated a high degree of perceived support by the eHM-DP and of
provided decision aid. In total, 89 % of caregivers and 54 % of MPs would use the
eHM-DP if access were provided. The primary benefits participants perceived were
the acquisition of individualized information, computerized interaction between
caregivers and MPs, empowerment in health-related decisions and comprehensive
insights into the progress of the disease. Major recommendations for improving the
eHM-DP encompassed: an active search functionality based on predefined terms, the
implementation of a chatroom for caregivers, an upload function and alerts for MPs,
as well as the overall design. CONCLUSIONS: Our study is the first to have provided
new insights and results on an interactive and needs-oriented web portal,
endeavouring towards empowerment and assistance in decision making for caregivers
as well as MPs within the realm of caring for patients with dementia. The
acceptance and willingness to use the eHM-DP emphasizes the potential of eHealth
services for community-based dementia care settings.
AB - BACKGROUND: The European eHealthMonitor project (eHM) developed a user-
sensitive and interactive web portal for dementia care: the eHM Dementia Portal
(eHM-DP). It aims to provide targeted and personalized support for informal
caregivers of people with dementia in a home-based care setting. The objective of
the pilot study was to obtain feedback on the eHM-DP from two user perspectives
(caregivers and medical professionals), focusing on caregiver empowerment, decision
aid, and the perceived benefits of the eHM-DP. METHODS: The study on the eHM-DP was
conducted from March 2014 to June 2014. The methodological approach followed a
user-participatory design with a total number of 42 participants. The study
included caregivers of people with dementia and medical professionals (MPs) from
the metropolitan region of Erlangen-Nurnberg (Bavaria, Germany). Study participants
were interviewed face-to-face with semi-structured, written interviews. RESULTS:
Caregivers indicated a high degree of perceived support by the eHM-DP and of
provided decision aid. In total, 89 % of caregivers and 54 % of MPs would use the
eHM-DP if access were provided. The primary benefits participants perceived were
the acquisition of individualized information, computerized interaction between
caregivers and MPs, empowerment in health-related decisions and comprehensive
insights into the progress of the disease. Major recommendations for improving the
eHM-DP encompassed: an active search functionality based on predefined terms, the
implementation of a chatroom for caregivers, an upload function and alerts for MPs,
as well as the overall design. CONCLUSIONS: Our study is the first to have provided
new insights and results on an interactive and needs-oriented web portal,
endeavouring towards empowerment and assistance in decision making for caregivers
as well as MPs within the realm of caring for patients with dementia. The
acceptance and willingness to use the eHM-DP emphasizes the potential of eHealth
services for community-based dementia care settings.
DO - 10.1186/s12911-015-0182-2
VL - 15
IS -
SP - 58
CY - England
SN - 1472-6947 (Linking)
U1 - 34698692
U2 - 26215731
N1 -
ER -

TY - JOUR
T1 - Developing an interdisciplinary program of educational support for early-
stage dementia patients and their family members: an investigation based on
learning needs and attitude changes.
JF - Geriatrics & gerontology international
A1 - Seike A
A1 - Sumigaki C
A1 - Takeda A
A1 - Endo H
A1 - Sakurai T
A1 - Toba K
KW - eppi-reviewer4
Aged
*Attitude of Health Personnel
Caregivers/*education
Dementia/*rehabilitation
Family
Female
Geriatrics/*education
Health Knowledge, Attitudes, Practice
Humans
Japan
Male
*Patient Care Team
Patient Education as Topic/*methods
Program Development/*methods
attitude changes
early-stage-dementia
educational support
interdisciplinary
learning needs
medical care content
PY - 2014
DA - 2014/04//
Y1 - 2014/04//
N2 - AIM: The National Center for Geriatrics and Gerontology has begun to provide
educational support for family caregivers through interdisciplinary programs
focusing on patients in the early stage of dementia. These interdisciplinary
programs have established two domains for the purpose of "educational support":
cure domains (medical care, medication) and care domains (nursing care, welfare).
In the present study, we examined the learning needs and post-learning attitude
changes of patients and their families who participated in these programs in order
to assess the effectiveness of an interdisciplinary program of educational support
in each of these domains. METHODS: A total of 170 participants (51 dementia
patients, 119 family members) were included in the study. Data were obtained from
electronic health records, and through a written survey administered before and
immediately after each program. RESULTS: A high percentage of patients and family
members desired knowledge about the progression and symptoms of dementia, as well
as measures to prevent progression, both of which fall under the medical care
content. For patients, education in the medical care content increased their
motivation to live. For families, education in the medical and nursing care
contents promoted their understanding of dementia, while education in medication
and welfare contents improved their skills for handling dementia patients and their
symptoms. CONCLUSION: Both patients and family members expressed a need to learn
medical care content, including the progression and disease symptoms of dementia,
and methods to prevent the progression of dementia symptoms. Their responses showed
that learning medical care was effective for understanding dementia. We suggested
that medical care content was the core of interdisciplinary educational support for
early-stage dementia patients and their family members.
AB - AIM: The National Center for Geriatrics and Gerontology has begun to provide
educational support for family caregivers through interdisciplinary programs
focusing on patients in the early stage of dementia. These interdisciplinary
programs have established two domains for the purpose of "educational support":
cure domains (medical care, medication) and care domains (nursing care, welfare).
In the present study, we examined the learning needs and post-learning attitude
changes of patients and their families who participated in these programs in order
to assess the effectiveness of an interdisciplinary program of educational support
in each of these domains. METHODS: A total of 170 participants (51 dementia
patients, 119 family members) were included in the study. Data were obtained from
electronic health records, and through a written survey administered before and
immediately after each program. RESULTS: A high percentage of patients and family
members desired knowledge about the progression and symptoms of dementia, as well
as measures to prevent progression, both of which fall under the medical care
content. For patients, education in the medical care content increased their
motivation to live. For families, education in the medical and nursing care
contents promoted their understanding of dementia, while education in medication
and welfare contents improved their skills for handling dementia patients and their
symptoms. CONCLUSION: Both patients and family members expressed a need to learn
medical care content, including the progression and disease symptoms of dementia,
and methods to prevent the progression of dementia symptoms. Their responses showed
that learning medical care was effective for understanding dementia. We suggested
that medical care content was the core of interdisciplinary educational support for
early-stage dementia patients and their family members.
DO - 10.1111/ggi.12263
VL - 14 Suppl 2
IS -
SP - 28
EP - 34
CY - Japan
SN - 1447-0594 (Linking)
U1 - 34698555
U2 - 24650063
N1 -
ER -

TY - JOUR
T1 - Systematic care for caregivers of patients with dementia: a multicenter,
cluster-randomized, controlled trial.
JF - The American journal of geriatric psychiatry : official journal of the
American Association for Geriatric Psychiatry
A1 - Spijker A
A1 - Wollersheim H
A1 - Teerenstra S
A1 - Graff M
A1 - Adang E
A1 - Verhey F
A1 - Vernooij-Dassen M
KW - eppi-reviewer4
Aged
Aged, 80 and over
Caregivers/*psychology
Community Mental Health Services/methods
*Cost of Illness
Counseling/*methods
Dementia/*nursing/psychology
Depression/therapy
Female
Humans
Institutionalization/*statistics & numerical data
Male
Middle Aged
PY - 2011
DA - 2011/06//
Y1 - 2011/06//
N2 - OBJECTIVE: To evaluate the effectiveness of the Systematic Care Program for
Dementia (SCPD) on patient institutionalization and to determine the predictors of
institutionalization. DESIGN: Single-blind, multicenter, cluster-randomized,
controlled trial. SETTING: Six community mental health services (CMHSs) across the
Netherlands. PARTICIPANTS: A total of 295 patient-caregiver dyads referred to a
CMHS with suspected patient dementia. INTERVENTION: Training of health
professionals in the SCPD and its subsequent use. The SCPD consists of a systematic
assessment of caregiver problems and alerts health professionals in flexible,
connecting, proactive interventions to them. The intensity of the SCPD depends on
the judgment of the health professional, based on individual caregiver needs.
PRIMARY OUTCOME: Institutionalization in long-term care facilities at 12 months of
follow-up. RESULTS: No main intervention effect on institutionalization was found.
However, a better sense of competence in the control group reduced the chance of
institutionalization but not in the intervention group. The caregiver's sense of
competence and depressive symptoms and the patient's behavioral problems and
severity of dementia were the strongest predictors of institutionalization. The
intensity of the program was low, even for dyads exposed to the SCPD. CONCLUSIONS:
Although no main effect was found, the results suggest that the SCPD might prevent
a deterioration of the sense of competence in the intervention group. The intensity
of a program is crucial and should be prescribed on the basis of evidence rather
than left to the discretion of health professionals. Future controlled trials in
daily clinical practice should use a process analysis to control for compliance.
AB - OBJECTIVE: To evaluate the effectiveness of the Systematic Care Program for
Dementia (SCPD) on patient institutionalization and to determine the predictors of
institutionalization. DESIGN: Single-blind, multicenter, cluster-randomized,
controlled trial. SETTING: Six community mental health services (CMHSs) across the
Netherlands. PARTICIPANTS: A total of 295 patient-caregiver dyads referred to a
CMHS with suspected patient dementia. INTERVENTION: Training of health
professionals in the SCPD and its subsequent use. The SCPD consists of a systematic
assessment of caregiver problems and alerts health professionals in flexible,
connecting, proactive interventions to them. The intensity of the SCPD depends on
the judgment of the health professional, based on individual caregiver needs.
PRIMARY OUTCOME: Institutionalization in long-term care facilities at 12 months of
follow-up. RESULTS: No main intervention effect on institutionalization was found.
However, a better sense of competence in the control group reduced the chance of
institutionalization but not in the intervention group. The caregiver's sense of
competence and depressive symptoms and the patient's behavioral problems and
severity of dementia were the strongest predictors of institutionalization. The
intensity of the program was low, even for dyads exposed to the SCPD. CONCLUSIONS:
Although no main effect was found, the results suggest that the SCPD might prevent
a deterioration of the sense of competence in the intervention group. The intensity
of a program is crucial and should be prescribed on the basis of evidence rather
than left to the discretion of health professionals. Future controlled trials in
daily clinical practice should use a process analysis to control for compliance.
DO - 10.1097/JGP.0b013e3182110599
VL - 19
IS - 6
SP - 521
EP - 31
CY - England
SN - 1064-7481 (Linking)
U1 - 34698862
U2 - 21358385
N1 -
ER -

TY - JOUR
T1 - A randomized cross-over controlled study on cognitive rehabilitation of
instrumental activities of daily living in Alzheimer disease.
JF - The American journal of geriatric psychiatry : official journal of the
American Association for Geriatric Psychiatry
A1 - Thivierge S
A1 - Jean L
A1 - Simard M
KW - eppi-reviewer4
Activities of Daily Living/*psychology
Aged, 80 and over
Alzheimer Disease/psychology/*rehabilitation
Cognition
Cross-Over Studies
Female
Humans
Male
Memory
Neuropsychological Tests
Quality of Life/psychology
Treatment Outcome
Alzheimer disease
cognitive rehabilitation
errorless learning
instrumental activities of daily living
spaced retrieval
PY - 2014
DA - 2014/11//
Y1 - 2014/11//
N2 - OBJECTIVE: The goal of the study was to investigate the effectiveness of a
memory rehabilitation program to re-learn instrumental activities of daily living
(IADLs) in patients with Alzheimer disease (AD). DESIGN: This was a 6-month block-
randomized cross-over controlled study. SETTING: All evaluation and training
sessions were performed at each patient's home. PARTICIPANTS: Twenty participants
with mild to moderate AD. INTERVENTION: The trained IADL was chosen by the patient
and his/her caregiver in order to target the patient's needs and interests.
Participants were trained twice a week for 4 weeks with the errorless learning
(ELL) and spaced retrieval (SR) cognitive techniques. After training, there were
several follow-ups over a period of at least 3 months. MEASUREMENTS: Performance on
the trained IADL was assessed by a Direct Measure of Training (DMT), an
observational instrument adapted from a well-validated scale. General cognitive
function, everyday memory functioning, quality of life, neuropsychiatric symptoms
and ADL/IADL of patients, as well as the caregiver's burden were assessed as
secondary outcomes. RESULTS: A statistical significant difference was found between
the trained and untrained groups on the DMT immediately following the intervention.
Improvements were maintained for a 3-month period. The training did not have
effects on any other measures. CONCLUSIONS: The present study showed that it is
possible for AD patients to relearn significant IADLs with the ELL and SR
techniques and to maintain these gains during at least 3 months. The findings of
this study emphasize the importance to design robust but individualized
intervention tailored on patients' particular needs.
AB - OBJECTIVE: The goal of the study was to investigate the effectiveness of a
memory rehabilitation program to re-learn instrumental activities of daily living
(IADLs) in patients with Alzheimer disease (AD). DESIGN: This was a 6-month block-
randomized cross-over controlled study. SETTING: All evaluation and training
sessions were performed at each patient's home. PARTICIPANTS: Twenty participants
with mild to moderate AD. INTERVENTION: The trained IADL was chosen by the patient
and his/her caregiver in order to target the patient's needs and interests.
Participants were trained twice a week for 4 weeks with the errorless learning
(ELL) and spaced retrieval (SR) cognitive techniques. After training, there were
several follow-ups over a period of at least 3 months. MEASUREMENTS: Performance on
the trained IADL was assessed by a Direct Measure of Training (DMT), an
observational instrument adapted from a well-validated scale. General cognitive
function, everyday memory functioning, quality of life, neuropsychiatric symptoms
and ADL/IADL of patients, as well as the caregiver's burden were assessed as
secondary outcomes. RESULTS: A statistical significant difference was found between
the trained and untrained groups on the DMT immediately following the intervention.
Improvements were maintained for a 3-month period. The training did not have
effects on any other measures. CONCLUSIONS: The present study showed that it is
possible for AD patients to relearn significant IADLs with the ELL and SR
techniques and to maintain these gains during at least 3 months. The findings of
this study emphasize the importance to design robust but individualized
intervention tailored on patients' particular needs.
DO - 10.1016/j.jagp.2013.03.008
VL - 22
IS - 11
SP - 1188
EP - 99
CY - England
SN - 1064-7481 (Linking)
U1 - 34698774
U2 - 23871120
N1 -
ER -

TY - JOUR
T1 - Life- and person-centred help in Mecklenburg-Western Pomerania, Germany
(DelpHi): study protocol for a randomised controlled trial.
JF - Trials
A1 - Thyrian JR
A1 - Fiss T
A1 - Dreier A
A1 - Bowing G
A1 - Angelow A
A1 - Lueke S
A1 - Teipel S
A1 - Flessa S
A1 - Grabe HJ
A1 - Freyberger HJ
A1 - Hoffmann W
KW - eppi-reviewer4
Aged
Caregivers/psychology
*Clinical Protocols
Cooperative Behavior
Data Interpretation, Statistical
Dementia/psychology/*therapy
Germany
Humans
Outcome Assessment (Health Care)
Quality of Life
Research Design
Sample Size
PY - 2012
DA - 2012/05//
Y1 - 2012/05//
N2 - BACKGROUND: The provision of appropriate medical and nursing care for people
with dementia is a major challenge for the healthcare system in Germany. New models
of healthcare provision need to be developed, tested and implemented on the
population level. Trials in which collaborative care for dementia in the primary
care setting were studied have demonstrated its effectiveness. These studies have
been conducted in different healthcare systems, however, so it is unclear whether
these results extend to the specific context of the German healthcare system.The
objective of this population-based intervention trial in the primary care setting
is to test the efficacy and efficiency of implementing a subsidiary support system
on a population level for persons with dementia who live at home. METHODS AND STUDY
DESIGN: The study was designed to assemble a general physician-based
epidemiological cohort of people above the age of 70 who live at home (DelpHi
cohort). These people are screened for eligibility to participate in a trial of
dementia care management (DelpHi trial). The trial is a cluster-randomised,
controlled intervention trial with two arms (intervention and control) designed to
test the efficacy and efficiency of implementing a subsidiary support system for
persons with dementia who live at home. This subsidiary support system is initiated
and coordinated by a dementia care manager: a nurse with dementia-specific
qualifications who delivers the intervention according to a systematic, detailed
protocol. The primary outcome is quality of life and healthcare for patients with
dementia and their caregivers. This is a multidimensional outcome with a focus on
four dimensions: (1) quality of life, (2) caregiver burden, (3) behavioural and
psychological symptoms of dementia and (4) pharmacotherapy with an antidementia
drug and prevention or suspension of potentially inappropriate medication.
Secondary outcomes include the assessment of dementia syndromes, activities of
daily living, social support health status, utilisation of health care resources
and medication. DISCUSSION: The results will provide evidence for specific needs in
ambulatory care for persons with dementia and will show effective ways to meet
those needs. Qualification requirements will be evaluated, and the results will
help to modify existing guidelines and treatment paths. TRIAL REGISTRATION:
NCT01401582.
AB - BACKGROUND: The provision of appropriate medical and nursing care for people
with dementia is a major challenge for the healthcare system in Germany. New models
of healthcare provision need to be developed, tested and implemented on the
population level. Trials in which collaborative care for dementia in the primary
care setting were studied have demonstrated its effectiveness. These studies have
been conducted in different healthcare systems, however, so it is unclear whether
these results extend to the specific context of the German healthcare system.The
objective of this population-based intervention trial in the primary care setting
is to test the efficacy and efficiency of implementing a subsidiary support system
on a population level for persons with dementia who live at home. METHODS AND STUDY
DESIGN: The study was designed to assemble a general physician-based
epidemiological cohort of people above the age of 70 who live at home (DelpHi
cohort). These people are screened for eligibility to participate in a trial of
dementia care management (DelpHi trial). The trial is a cluster-randomised,
controlled intervention trial with two arms (intervention and control) designed to
test the efficacy and efficiency of implementing a subsidiary support system for
persons with dementia who live at home. This subsidiary support system is initiated
and coordinated by a dementia care manager: a nurse with dementia-specific
qualifications who delivers the intervention according to a systematic, detailed
protocol. The primary outcome is quality of life and healthcare for patients with
dementia and their caregivers. This is a multidimensional outcome with a focus on
four dimensions: (1) quality of life, (2) caregiver burden, (3) behavioural and
psychological symptoms of dementia and (4) pharmacotherapy with an antidementia
drug and prevention or suspension of potentially inappropriate medication.
Secondary outcomes include the assessment of dementia syndromes, activities of
daily living, social support health status, utilisation of health care resources
and medication. DISCUSSION: The results will provide evidence for specific needs in
ambulatory care for persons with dementia and will show effective ways to meet
those needs. Qualification requirements will be evaluated, and the results will
help to modify existing guidelines and treatment paths. TRIAL REGISTRATION:
NCT01401582.
DO - 10.1186/1745-6215-13-56
VL - 13
IS -
SP - 56
CY - England
SN - 1745-6215 (Linking)
U1 - 34698825
U2 - 22575023
N1 -
ER -

TY - JOUR
T1 - Research protocol of the NeedYD-study (Needs in Young onset Dementia): a
prospective cohort study on the needs and course of early onset dementia.
JF - BMC geriatrics
A1 - van Vliet D
A1 - Bakker C
A1 - Koopmans RT
A1 - Vernooij-Dassen MJ
A1 - Verhey FR
A1 - de Vugt ME
KW - eppi-reviewer4
Age of Onset
*Clinical Protocols
Cohort Studies
Dementia/*diagnosis/epidemiology/*therapy
Disease Progression
Follow-Up Studies
*Health Services Needs and Demand/trends
Humans
Longitudinal Studies
Prospective Studies
PY - 2010
DA - 2010/03//
Y1 - 2010/03//
N2 - BACKGROUND: Early onset dementia has serious consequences for patients and
their family members. Although there has been growing attention for this patient
group, health care services are still mainly targeted at the elderly. Specific
knowledge of the needs of early onset dementia patients and their families is
limited but necessary for the development of adequate health care services and
specific guidelines. This research project is mainly targeted at delineating the
course of early onset dementia, the functional characteristics and needs of early
onset dementia patients and their caregivers, the risk factors for
institutionalization and the interaction with the caring environment.
METHODS/DESIGN: The NeedYD-study (Needs in Young Onset Dementia) is a longitudinal
observational study investigating early onset dementia patients and their
caregivers (n = 217). Assessments are performed every six months over two years and
consist of interviews and questionnaires with patients and caregivers. The main
outcomes are (1) the needs of patients and caregivers, as measured by the
Camberwell Assessment of Needs for the Elderly (CANE) and (2) neuropsychiatric
symptoms, as measured by the NeuroPsychiatric Inventory (NPI). Qualitative analyses
will be performed in order to obtain more in-depth information on the experiences
of EOD patients and their family members. The results of this study will be
compared with comparable data on late onset dementia from a historical cohort.
DISCUSSION: The study protocol of the NeedYD-study is presented here. To our
knowledge, this study is the first prospective cohort study in this research area.
Although some limitations exist, these do not outweigh the strong points of this
study design.
AB - BACKGROUND: Early onset dementia has serious consequences for patients and
their family members. Although there has been growing attention for this patient
group, health care services are still mainly targeted at the elderly. Specific
knowledge of the needs of early onset dementia patients and their families is
limited but necessary for the development of adequate health care services and
specific guidelines. This research project is mainly targeted at delineating the
course of early onset dementia, the functional characteristics and needs of early
onset dementia patients and their caregivers, the risk factors for
institutionalization and the interaction with the caring environment.
METHODS/DESIGN: The NeedYD-study (Needs in Young Onset Dementia) is a longitudinal
observational study investigating early onset dementia patients and their
caregivers (n = 217). Assessments are performed every six months over two years and
consist of interviews and questionnaires with patients and caregivers. The main
outcomes are (1) the needs of patients and caregivers, as measured by the
Camberwell Assessment of Needs for the Elderly (CANE) and (2) neuropsychiatric
symptoms, as measured by the NeuroPsychiatric Inventory (NPI). Qualitative analyses
will be performed in order to obtain more in-depth information on the experiences
of EOD patients and their family members. The results of this study will be
compared with comparable data on late onset dementia from a historical cohort.
DISCUSSION: The study protocol of the NeedYD-study is presented here. To our
knowledge, this study is the first prospective cohort study in this research area.
Although some limitations exist, these do not outweigh the strong points of this
study design.
DO - 10.1186/1471-2318-10-13
VL - 10
IS -
SP - 13
CY - England
SN - 1471-2318 (Linking)
U1 - 34698896
U2 - 20226041
N1 -
ER -

TY - JOUR
T1 - Procedural memory and emotional attachment in Alzheimer disease: implications
for meaningful and engaging activities.
JF - The Journal of neuroscience nursing : journal of the American Association of
Neuroscience Nurses
A1 - Vance DE
A1 - Moore BS
A1 - Farr KF
A1 - Struzick T
KW - eppi-reviewer4
Activities of Daily Living
Adaptation, Psychological
*Alzheimer Disease/complications/prevention & control/psychology
Ceremonial Behavior
Disease Progression
Geriatric Nursing
Health Services Needs and Demand
Humans
Leisure Activities
*Memory Disorders/etiology/prevention & control
Neuropsychology
Nursing Assessment
*Object Attachment
Psychomotor Agitation/etiology/prevention & control
Quality of Life/psychology
*Religion and Psychology
Severity of Illness Index
Spirituality
PY - 2008
DA - 2008/04//
Y1 - 2008/04//
N2 - With an increasing number of older adults being diagnosed with Alzheimer
disease, the need to find meaningful and enjoyable activities in which they can
successfully engage is important for providing good quality of life while
preventing behavioral difficulties that often accompany this diagnosis. Dementia-
related neuropsychological impairments hinder engagement in a variety of enjoyable
activities. For many older adults with Alzheimer disease who have been involved in
a religious tradition, well-rehearsed rituals and emotionally salient behaviors can
be employed well into the later stages of this disease. An approach called
procedural and emotional religious activity therapy, or PERAT, can provide
enjoyable and meaningful activities that may reduce agitation and increase quality
of life for patients as well as for caregivers. Knowledge about the neuropsychology
of procedural and emotional memory is needed to understand how PERAT works.
AB - With an increasing number of older adults being diagnosed with Alzheimer
disease, the need to find meaningful and enjoyable activities in which they can
successfully engage is important for providing good quality of life while
preventing behavioral difficulties that often accompany this diagnosis. Dementia-
related neuropsychological impairments hinder engagement in a variety of enjoyable
activities. For many older adults with Alzheimer disease who have been involved in
a religious tradition, well-rehearsed rituals and emotionally salient behaviors can
be employed well into the later stages of this disease. An approach called
procedural and emotional religious activity therapy, or PERAT, can provide
enjoyable and meaningful activities that may reduce agitation and increase quality
of life for patients as well as for caregivers. Knowledge about the neuropsychology
of procedural and emotional memory is needed to understand how PERAT works.
VL - 40
IS - 2
SP - 96
EP - 102
CY - United States
SN - 0888-0395 (Linking)
U1 - 34698940
U2 - 18481739
N1 -
ER -

TY - JOUR
T1 - A European study investigating patterns of transition from home care towards
institutional dementia care: the protocol of a RightTimePlaceCare study.
JF - BMC public health
A1 - Verbeek H
A1 - Meyer G
A1 - Leino-Kilpi H
A1 - Zabalegui A
A1 - Hallberg IR
A1 - Saks K
A1 - Soto ME
A1 - Challis D
A1 - Sauerland D
A1 - Hamers JP
KW - eppi-reviewer4
Aged
Caregivers
Cohort Studies
Cost of Illness
*Dementia
Europe
Female
*Home Care Services
Humans
*Institutionalization
Male
*Nursing Homes
*Patient Transfer
Prospective Studies
Quality of Health Care
PY - 2012
DA - 2012/01//
Y1 - 2012/01//
N2 - BACKGROUND: Health care policies in many countries aim to enable people with
dementia to live in their own homes as long as possible. However, at some point
during the disease the needs of a significant number of people with dementia cannot
be appropriately met at home and institutional care is required. Evidence as to
best practice strategies enabling people with dementia to live at home as long as
possible and also identifying the right time to trigger admission to a long-term
nursing care facility is therefore urgently required. The current paper presents
the rationale and methods of a study generating primary data for best-practice
development in the transition from home towards institutional nursing care for
people with dementia and their informal caregivers. The study has two main
objectives: 1) investigate country-specific factors influencing
institutionalization and 2) investigate the circumstances of people with dementia
and their informal caregivers in eight European countries. Additionally, data for
economic evaluation purposes are being collected. METHODS/DESIGN: This paper
describes a prospective study, conducted in eight European countries (Estonia,
Finland, France, Germany, Netherlands, Sweden, Spain, United Kingdom). A baseline
assessment and follow-up measurement after 3 months will be performed. Two groups
of people with dementia and their informal caregivers will be included: 1) newly
admitted to institutional long-term nursing care facilities; and 2) receiving
professional long-term home care, and being at risk for institutionalization. Data
will be collected on outcomes for people with dementia (e.g. quality of life,
quality of care), informal caregivers (e.g. caregiver burden, quality of life) and
costs (e.g. resource utilization). Statistical analyses consist of descriptive and
multivariate regression techniques and cross-country comparisons. DISCUSSION: The
current study, which is part of a large European project 'RightTimePlaceCare',
generates primary data on outcomes and costs of long-term nursing care for people
with dementia and their informal caregivers, specifically focusing on the
transition from home towards institutional care. Together with data collected in
three other work packages, knowledge gathered in this study will be used to inform
and empower patients, professionals, policy and related decision makers to manage
and improve health and social dementia care services.
AB - BACKGROUND: Health care policies in many countries aim to enable people with
dementia to live in their own homes as long as possible. However, at some point
during the disease the needs of a significant number of people with dementia cannot
be appropriately met at home and institutional care is required. Evidence as to
best practice strategies enabling people with dementia to live at home as long as
possible and also identifying the right time to trigger admission to a long-term
nursing care facility is therefore urgently required. The current paper presents
the rationale and methods of a study generating primary data for best-practice
development in the transition from home towards institutional nursing care for
people with dementia and their informal caregivers. The study has two main
objectives: 1) investigate country-specific factors influencing
institutionalization and 2) investigate the circumstances of people with dementia
and their informal caregivers in eight European countries. Additionally, data for
economic evaluation purposes are being collected. METHODS/DESIGN: This paper
describes a prospective study, conducted in eight European countries (Estonia,
Finland, France, Germany, Netherlands, Sweden, Spain, United Kingdom). A baseline
assessment and follow-up measurement after 3 months will be performed. Two groups
of people with dementia and their informal caregivers will be included: 1) newly
admitted to institutional long-term nursing care facilities; and 2) receiving
professional long-term home care, and being at risk for institutionalization. Data
will be collected on outcomes for people with dementia (e.g. quality of life,
quality of care), informal caregivers (e.g. caregiver burden, quality of life) and
costs (e.g. resource utilization). Statistical analyses consist of descriptive and
multivariate regression techniques and cross-country comparisons. DISCUSSION: The
current study, which is part of a large European project 'RightTimePlaceCare',
generates primary data on outcomes and costs of long-term nursing care for people
with dementia and their informal caregivers, specifically focusing on the
transition from home towards institutional care. Together with data collected in
three other work packages, knowledge gathered in this study will be used to inform
and empower patients, professionals, policy and related decision makers to manage
and improve health and social dementia care services.
DO - 10.1186/1471-2458-12-68
VL - 12
IS -
SP - 68
CY - England
SN - 1471-2458 (Linking)
U1 - 34698837
U2 - 22269343
N1 -
ER -

TY - JOUR
T1 - Inter-country exploration of factors associated with admission to long-term
institutional dementia care: evidence from the RightTimePlaceCare study.
JF - Journal of advanced nursing
A1 - Verbeek H
A1 - Meyer G
A1 - Challis D
A1 - Zabalegui A
A1 - Soto ME
A1 - Saks K
A1 - Leino-Kilpi H
A1 - Karlsson S
A1 - Hamers JP
KW - eppi-reviewer4
Dementia/*nursing
Humans
Long-Term Care
Netherlands
*Nursing Homes
*Patient Admission
dementia
long-term care
nursing
nursing homes
PY - 2015
DA - 2015/06//
Y1 - 2015/06//
N2 - AIM: To explore inter-country variation of factors associated with
institutionalization of people with dementia. BACKGROUND: There is an urgent need
for evidence on whether factors associated with admission to institutional dementia
care are applicable across healthcare systems, as increasing evidence suggests that
these factors could be country-specific. DESIGN: A prospective cohort study.
METHOD: Primary data were collected in eight European countries, at baseline and
after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads
of people with dementia and their informal caregivers; 791 patients were recently
institutionalized, 1223 patients lived at home and were at risk of
institutionalization. Associations between care setting (institution vs. home) and
factors shown to influence institutionalization (e.g. cognition, independence in
activities of daily life, behaviour) were studied. RESULTS: Considerable
differences were found between the eight countries in characteristics of people
with dementia who had been recently admitted to ILTC. However, caregiver burden
appeared the most consistent factor associated with institutionalization in all
analyses. Indications for the importance of independence in activities of daily
life were found as well, although country differences may be more prominent for
this factor. CONCLUSION: Evidence was found for two common factors, crucial in the
process of institutionalization across countries: caregiver burden and independency
in activities of daily life. However, this study also suggests that admission to
institutional dementia care is context-specific, as wide variation exists in
factors associated with institutionalization across countries. Tailored best-
practice strategies are needed to reflect variations in response to these needs.
AB - AIM: To explore inter-country variation of factors associated with
institutionalization of people with dementia. BACKGROUND: There is an urgent need
for evidence on whether factors associated with admission to institutional dementia
care are applicable across healthcare systems, as increasing evidence suggests that
these factors could be country-specific. DESIGN: A prospective cohort study.
METHOD: Primary data were collected in eight European countries, at baseline and
after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads
of people with dementia and their informal caregivers; 791 patients were recently
institutionalized, 1223 patients lived at home and were at risk of
institutionalization. Associations between care setting (institution vs. home) and
factors shown to influence institutionalization (e.g. cognition, independence in
activities of daily life, behaviour) were studied. RESULTS: Considerable
differences were found between the eight countries in characteristics of people
with dementia who had been recently admitted to ILTC. However, caregiver burden
appeared the most consistent factor associated with institutionalization in all
analyses. Indications for the importance of independence in activities of daily
life were found as well, although country differences may be more prominent for
this factor. CONCLUSION: Evidence was found for two common factors, crucial in the
process of institutionalization across countries: caregiver burden and independency
in activities of daily life. However, this study also suggests that admission to
institutional dementia care is context-specific, as wide variation exists in
factors associated with institutionalization across countries. Tailored best-
practice strategies are needed to reflect variations in response to these needs.
DO - 10.1111/jan.12663
VL - 71
IS - 6
SP - 1338
EP - 50
CY - England
SN - 0309-2402 (Linking)
U1 - 34698703
U2 - 25869186
N1 -
ER -

TY - JOUR
T1 - The effect of a disease management intervention on quality and outcomes of
dementia care: a randomized, controlled trial.
JF - Annals of internal medicine
A1 - Vickrey BG
A1 - Mittman BS
A1 - Connor KI
A1 - Pearson ML
A1 - Della Penna RD
A1 - Ganiats TG
A1 - Demonte RW Jr
A1 - Chodosh J
A1 - Cui X
A1 - Vassar S
A1 - Duan N
A1 - Lee M
KW - eppi-reviewer4
Aged
Aged, 80 and over
California
Caregivers/*standards
Community Health Services/*standards
Dementia/*therapy
*Disease Management
Female
Guideline Adherence
Humans
Male
Middle Aged
*Outcome Assessment (Health Care)
Practice Guidelines as Topic
Primary Health Care/*standards
PY - 2006
DA - 2006/11//
Y1 - 2006/11//
N2 - BACKGROUND: Adherence to dementia guidelines is poor despite evidence that
some guideline recommendations can improve symptoms and delay institutionalization
of patients. OBJECTIVE: To test the effectiveness of a dementia guideline-based
disease management program on quality of care and outcomes for patients with
dementia. DESIGN: Clinic-level, cluster randomized, controlled trial. SETTING: 3
health care organizations collaborating with 3 community agencies in southern
California. PARTICIPANTS: 18 primary care clinics and 408 patients with dementia
age 65 years or older paired with 408 informal caregivers. INTERVENTION: Disease
management program led by care managers and provided to 238 patient-caregiver pairs
at 9 intervention clinics for more than 12 months. MEASUREMENTS: Adherence to 23
guideline recommendations (primary outcome) and receipt of community resources and
patient and caregiver health and quality-of-care measures (secondary outcomes).
RESULTS: The mean percentage of per-patient guideline recommendations to which care
was adherent was significantly higher in the intervention group than in the usual
care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI,
25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher
care quality on 21 of 23 guidelines (P < or = 0.013 for all), and higher
proportions received community agency assistance (P < or = 0.03) than those who
received usual care. Patient health-related quality of life, overall quality of
patient care, caregiving quality, social support, and level of unmet caregiving
assistance needs were better for participants in the intervention group than for
those in the usual care group (P < 0.05 for all). Caregiver health-related quality
of life did not differ between the 2 groups. LIMITATIONS: Participants were well-
educated, were predominantly white, had a usual source of care, and were not
institutionalized. Generalizability to other patients and geographic regions is
unknown. Also, costs of a care management program under fee-for-service
reimbursement may impede adoption. CONCLUSIONS: A dementia guideline-based disease
management program led to substantial improvements in quality of care for patients
with dementia. Current Controlled Trials identifier: ISRCTN72577751.
AB - BACKGROUND: Adherence to dementia guidelines is poor despite evidence that
some guideline recommendations can improve symptoms and delay institutionalization
of patients. OBJECTIVE: To test the effectiveness of a dementia guideline-based
disease management program on quality of care and outcomes for patients with
dementia. DESIGN: Clinic-level, cluster randomized, controlled trial. SETTING: 3
health care organizations collaborating with 3 community agencies in southern
California. PARTICIPANTS: 18 primary care clinics and 408 patients with dementia
age 65 years or older paired with 408 informal caregivers. INTERVENTION: Disease
management program led by care managers and provided to 238 patient-caregiver pairs
at 9 intervention clinics for more than 12 months. MEASUREMENTS: Adherence to 23
guideline recommendations (primary outcome) and receipt of community resources and
patient and caregiver health and quality-of-care measures (secondary outcomes).
RESULTS: The mean percentage of per-patient guideline recommendations to which care
was adherent was significantly higher in the intervention group than in the usual
care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI,
25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher
care quality on 21 of 23 guidelines (P < or = 0.013 for all), and higher
proportions received community agency assistance (P < or = 0.03) than those who
received usual care. Patient health-related quality of life, overall quality of
patient care, caregiving quality, social support, and level of unmet caregiving
assistance needs were better for participants in the intervention group than for
those in the usual care group (P < 0.05 for all). Caregiver health-related quality
of life did not differ between the 2 groups. LIMITATIONS: Participants were well-
educated, were predominantly white, had a usual source of care, and were not
institutionalized. Generalizability to other patients and geographic regions is
unknown. Also, costs of a care management program under fee-for-service
reimbursement may impede adoption. CONCLUSIONS: A dementia guideline-based disease
management program led to substantial improvements in quality of care for patients
with dementia. Current Controlled Trials identifier: ISRCTN72577751.
VL - 145
IS - 10
SP - 713
EP - 26
CY - United States
SN - 0003-4819 (Linking)
U1 - 34698969
U2 - 17116916
N1 -
ER -

TY - JOUR
T1 - Developing and evaluating community based intervention programs for
Alzheimer's patients and their caregivers.
JF - Aging & mental health
A1 - Zarit SH
A1 - Leitsch SA
KW - eppi-reviewer4
Aged
Alzheimer Disease/*psychology/*therapy
*Caregivers
*Community Mental Health Services
Geriatric Assessment
Humans
Needs Assessment
Organizational Objectives
*Outcome and Process Assessment (Health Care)
Program Evaluation
PY - 2001
DA - 2001/05//
Y1 - 2001/05//
N2 - Innovative community based social and behavioral interventions for
individuals suffering from Alzheimer's disease and their family caregivers have
increased substantially in creativity and recognition over the years. However, the
commitment to the scientific design and evaluations of these programs has not
followed suit. The goal of this paper is to explicate the benefits of a systematic
approach to the design and evaluation of intervention programs with the challenges
of the Alzheimer's dyad in mind. Because of the unique nature of the disease,
Alzheimer's programs must flexibly apply existing intervention and evaluation
techniques to program designs which accommodate the degenerative course of the
disease and the unique strain experienced by family caregivers. Using existing
literature as a vehicle to illustrate how successful and unsuccessful programs have
addressed these goals, the paper stresses the need for design and evaluations which
apply creative and robust treatments, but do not compromise scientific rigor.
AB - Innovative community based social and behavioral interventions for
individuals suffering from Alzheimer's disease and their family caregivers have
increased substantially in creativity and recognition over the years. However, the
commitment to the scientific design and evaluations of these programs has not
followed suit. The goal of this paper is to explicate the benefits of a systematic
approach to the design and evaluation of intervention programs with the challenges
of the Alzheimer's dyad in mind. Because of the unique nature of the disease,
Alzheimer's programs must flexibly apply existing intervention and evaluation
techniques to program designs which accommodate the degenerative course of the
disease and the unique strain experienced by family caregivers. Using existing
literature as a vehicle to illustrate how successful and unsuccessful programs have
addressed these goals, the paper stresses the need for design and evaluations which
apply creative and robust treatments, but do not compromise scientific rigor.
VL - 5 Suppl 1
IS -
SP - S84
EP - 98
CY - England
SN - 1360-7863 (Linking)
U1 - 34699051
U2 - 11513504
N1 -
ER -