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Prominent physical inactivity in acute dementia care: psychopathology seems to be more important than the dose of sedative medication
- Authors:
- FLEINER Tim, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(2), 2019, pp.308-314.
- Publisher:
- Wiley
Introduction: To objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care. Materials and Methods: In this cross‐sectional study, the authors assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine‐equivalents and daily benzodiazepine medication is reported as diazepam‐equivalents. The authors assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen‐Mansfield Agitation Inventory. Results: The authors analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms. Discussion: The results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients. (Edited publisher abstract)
Care regimes on the move: comparing home care for dependent older people in Belgium, England, Germany and Italy
- Authors:
- DEGAVRE Florence, et al
- Publisher:
- Universite Catholique de Louvan. Centre Interdisciplinaire de Recherche Travail, Etat et Societe
- Publication year:
- 2012
- Pagination:
- 290p.
- Place of publication:
- Charleroi
Taking the reforms of the 1990s as its starting point, this report examines the dynamics of change experienced by Belgium, England, Germany and Italy in their home care sectors. Central to our analysis is the process of “marketisation”. This constitutes one of the major trends in all these four countries, yet its nature and impact show important national variations. The data referred to in this report relate to developments in and around various home care sectors, and cover both societal and organisational dynamics. Country-based research teams gathered the information, each team following identical methodological guidelines. This report uses official documents and grey literature from the care sector to analyse the discourses underpinning reforms in the field. The conclusions of this research will be of relevance for any country or region struggling to design a home care system for an ageing population. The coordinators of this research project have submitted a proposal for a special issue of Ageing and Society based on the main chapters of this report.
Long-term care quality assurance policies in European countries
- Authors:
- DANDI Roberto, et al
- Publisher:
- European Network of Economic Policy Research Institutes
- Publication year:
- 2012
- Pagination:
- 89p.
- Place of publication:
- Brussels
This report present the findings and conclusions of research undertaken in the context of research projects carried out by a consortium of ENEPRI member institutes. This report is a contribution to Work Package 5 of the ANCIEN project, which focuses on the future of long-term care for the elderly in Europe. This report analyses the quality assurance policies for long-term care (LTC) in the following countries: Austria, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Poland, Slovakia, Slovenia, Spain, Sweden, the Netherlands, and the United Kingdom. First, it discusses quality assurance in LTC by analysing: the dimensions of quality, the policy frameworks for quality in LTC, the different levels of development of LTC quality policies at the international, national, organisational, and individual levels. Second, it describes the methodology for collecting and analysing data on quality policies in the selected countries. Finally, it discusses the results, identifying four clusters of countries based on quality policies and indicators for LTC. These clusters are compared to the clusters identified in Work Package 1 of the ANCIEN project. Policy recommendations are proposed.
Quality assurance indicators of long-term care in European countries
- Authors:
- DANDI Roberto, CASANOVA Georgia
- Publisher:
- European Network of Economic Policy Research Institutes
- Publication year:
- 2012
- Pagination:
- 128p.
- Place of publication:
- Brussels
This report present the findings and conclusions of research undertaken in the context of research projects carried out by a consortium of ENEPRI member institutes. This report is a contribution to Work Package 5 of the ANCIEN project, which focuses on the future of long-term care for the elderly in Europe. The report presents the quality indicators that were collected by the ANCIEN project partners in each country. The main contribution of this report is a classification of the quality assurance indicators in different European countries according to three dimensions: organisation type; quality dimensions; and system dimensions. The countries that provided quality indicators, which are used at a national level or are recommended to be used at a local level by a national authority, are: Estonia, Finland, France, Germany, Hungary, Italy, Latvia, the Netherlands, Spain, Sweden and the United Kingdom. In total, 390 quality indicators were collected. Each quality indicator has been assigned to one or more options in each dimension.
Improving oral health of institutionalized older people with diagnosed dementia
- Authors:
- ZENTHOFERA Andreas, et al
- Journal article citation:
- Aging and Mental Health, 20(3), 2016, pp.303-308.
- Publisher:
- Taylor and Francis
Objective: Previous research has revealed poor oral hygiene and health among older people suffering from dementia. To evaluate the oral health and denture hygiene of older people with and without dementia, six months after carer have followed a dental education programme. Method: Ninety-three older people living in four long-term care homes in south-western Germany were included in this longitudinal cohort study. All participants were allocated into two groups on basis of the medical dementia diagnosis extracted from the medical records in the care documentation: suffering from dementia (n = 33) or not (n = 60). For each participant plaque control record, gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI) were assessed at baseline and six months after carer have followed a dental education programme, and after use of ultrasonic devices for denture cleaning. Differences between all target variables from baseline to follow-up, and between participants with and without dementia, were evaluated by bivariate and multivariate testing. Results: In bivariate testing, participants with dementia had a significantly lower DHI (p < 0.001), a lower GBI (p < 0.05), and a lower CPITN (p < 0.01) at follow-up. In participants without dementia, only for DHI (p < 0.001) a significant improvement was observed. In multivariate analyses, the significant association could not be reproduced (p > 0.05). Conclusions: Use of ultrasonic baths can be a successful means for improving denture hygiene among older people in long-term care with and without dementia. Education for carer in order to improve oral hygiene, however, seems to be of minor significance and to be more effective for people with dementia. (Publisher abstract)
Are patients with dementia treated as well as patients without dementia for hypertension, diabetes, and hyperlipidaemia?
- Authors:
- MÜTHER Johannes, et al
- Journal article citation:
- British Journal of General Practice, 60(578), September 2010, pp.671-674.
- Publisher:
- Royal College of General Practitioners
This study investigated whether GPs treated patients with dementia differently than patients without it. The authors hypothesised that explanations for this could include stigmatisation, treatment with a palliative approach, and the result of the disease process. The index diseases of hypertension, diabetes, and hyperlipidaemia were used to measure care. Sixteen GP’s recruited all their patients with dementia and at least one of the index diseases. Patients without dementia but only the index diseases were matched for age, sex, index disease, and practice, resulting in 216 pairs of patients with and without dementia. Findings indicated no differences in treatment outcomes between the two patients groups, except one significant difference: one of the two documented systolic blood pressure values is lower in the dementia group. Furthermore, patients with dementia more often do not receive any medication or are treated with low-priced medications for hypertension. The authors concluded that GPs did not seem to treat patients with dementia differently, and the use of lower-priced antihypertensive medication could be the only indication for some kind of difference in approach.
Concepts of quality in residential care and nursing homes: UK and German perspectives
- Authors:
- KLEIN Barbara, COOK Albert
- Journal article citation:
- Health Care in Later Life, 3(1), 1998, pp.47-59.
Care reforms in the UK and Germany continue to emphasise the need for providers to improve the quality of their services. There is, however, some debate about how quality is defined, and what are the benefits of quality assurance systems. Describes the scope of a research project into concepts of quality in the UK and Germany. Explores the interest of the different stake-holders in residential care and the difficulties in achieving an operational definition of quality, and describes the experiences of two quality assurance systems that have been implemented in residential care establishments in the UK and evidence of the benefits to be gained.
The graying of the world: who will care for the frail elderly?
- Editor:
- OLSON Laura Katz
- Publisher:
- Haworth Press
- Publication year:
- 1994
- Pagination:
- 345p.,tables,bibliogs.
- Place of publication:
- Binghamton, NY
Comparative study of policies for older people in 11 countries. Countries covered include Canada, China, Finland, Germany, Israel, Japan, Sweden, United Kingdom, United States and Yugoslavia.
Home care for the elderly
- Author:
- INTERNATIONAL SOCIAL SECURITY ASSOCIATION
- Publisher:
- International Social Security Association
- Publication year:
- 1992
- Pagination:
- 140p.
- Place of publication:
- Geneva
Report describing the experience in 8 European countries with regard to assistance, health care and home care for older and disabled people, focusing in particular on the debate over the introduction of a dependency benefit.
Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older
- Authors:
- LANG Caroline, et al
- Journal article citation:
- Journal of Telemedicine and Telecare, 28(1), 2022, pp.37-51.
- Publisher:
- Sage
- Place of publication:
- London
Introduction: Currently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMoSPHAERE study aimed to develop an information and communication platform for an intersectoral networking of, for example, general practitioners, therapists, social services and the multi-morbid older patient. Methods: The study presented was designed as a longitudinal bicentric intervention study which focused on multi-morbid patients aged ≥65 years using home-based telemedical measurement and input devices. The development and testing of this TMA aimed to optimise patients’ health care through intersectoral networking of all treating actors. Quantitative methods of data collection and analysis were used. Results: Patients who completed the study were significantly younger than drop-outs and non-participants. The mental health of study patients significantly improved between the beginning and end of TMA use. The main reason for non-participation in the study was the high time expenditure when participating in the study. No perceived (information) benefits for health and insufficient content variety were the main reasons for drop-out. Appropriateness and handling of TMAs must be aligned with the needs of the heterogeneous user group of multi-morbid patients in order to increase acceptance and the added value of TMAs. Telemonitoring hardware should be oriented on functional capabilities of the older target group. Telemonitoring software content requires an individual, disease-specific approach for patients. The TMA should be unobtrusively integrated into usual daily life and be used to an appropriate extent according to the underlying disease in order to avoid stressing patients. With regard to adherence concerning TMAs, it is crucial to provide a contact person who is always available for patients having problems handling TMAs. Health concerns and questions can thus be addressed early, providing a feeling of safety in the care process. Discussion: User acceptance of TMAs is an essential indicator and driver for use and for future implementation efforts in health care. In order to achieve maximum user centricity in development processes, patients must be involved as experts, co-designers and future users, considering their needs and perceptions. (Edited publisher abstract)