O1.3 Dementia care
Chair: Janne Røsvik
O1.3.1 Maintaining well-being among dementia family caregivers: Does dyadic relationship matter?
Doris Sau-fung Yu, Fan Zhang
Chinese University of Hong Kong
Background: The experience of dementia challenges family relationships, especially within the persons with dementia (PwD) and their family caregivers. Expressed emotion (EE), characterized by caregivers’ criticism and hostility towards PwD, captures the affective quality of a dyadic relationship. Although it is a strong health determinant among family caregivers of mentally ill persons, least has been done to examine its role pertains to dementia caregiving. This study aimed at exploring how dyadic relationship in this perspective shapes the caregiver’s health.
Methods: This multi-site, prospective, quantitative exploratory study recruited 401 Chinese family caregivers (Mean age=58.2±12.9) in Hong Kong. Family Attitude Scale and 36-item Health Survey (SF-36) were used to measure EE and caregiver’s health respectively.
Results: Overall, 25% family caregivers were found to report high EE. Using the cut-off score of ≤52 on the 5-item Mental Health Inventory (derived from SF-36), 45% of them reported depressive symptom. After controlling for demographic and caregiving profiles, dementia stage and symptom severity, EE was found independently predicted a poorer mental health (Mental component score: Beta = -0.363, p <0.001), even though its impact on physical health was not significant.
Conclusion: Dementia caregiving support service has placed little attention to enhance the quality of interaction and relationship between the caregiving dyads. Our finding prompts the need to fill up this service gap. Expressed emotion may serve as a hallmark characteristic for screening high-risk caregivers. Based on the findings, strategies to promote adaptive emotional regulation and relationship quality for the care dyads of PwD will be discussed.
O1.3.2 Geriatrician in the practice model of integrated dementia care
Jeremy Christley, Tabitha Hartwell
Shoalhaven Hospital, Australia
The Shoalhaven in regional Australia has an aging population with a high prevalence of dementia and insufficient specialists to provide a timely service to these patients. General Practitioners reported that they had limited experience in managing patients living with dementia.
The Geriatrician in the Practice (GIP) project was developed to better meet this population need and was designed to have an education component for primary health staff and improve the health care experience of patients and families receiving dementia assessment. GIP involved moving dementia clinics from the hospital sector into primary care. A geriatrician and Dementia Clinical Nurse Consultant attended the general practice and ran a joint comprehensive geriatric assessment with the general practitioner and practice nurse. On the job training in dementia assessment and management was provided to the practice nurses and general practitioners at the clinics. Patient benefits were proposed to include assessment in a familiar, less stressful environment and better care coordination
Outcomes of the GIP clinics have included high levels of patient and practitioner satisfaction, identification of groups of patients who were not attending hospital clinics, increased recognition of cognitive impairment in primary practice, improved confidence in primary care in the management of patients living with dementia, less need for specialist review and decreased emergency department attendances.
O1.3.3 Ordering care and support for families of older people with dementia living at home
Margrét Guðnadóttir1, Kristin Bjornsdóttir1, Christine Ceci2, Marit Kirkevold3
1 University of Iceland, Iceland, 2 University of Alberta, Canada, 3 University of Oslo, Norway
Background: Studies of families caring for persons with dementia living at home reflect feelings of being forgotten and abandoned by the authorities, with overload of responsibilities in their care giving. This calls for a re-thinking of service provision and knowledge of how families can be assisted to address the difficulties they face and what they find helpful in everyday life.
Methods: We focused on contextual issues and the perspective of official employees in dementia care in Iceland. Data comprised of interviews with key informants from the clinical field (n=18), field observations in day care (n=6) and published documents addressing care-giving for people with dementia. Data was analysed using discourse analysis, emphasizing how dementia as a problem was understood and 'patterned'. Research question: How do key informants and policy makers see the work of dementia care as being or needing to be distributed?
Research results: Entering formal care system through the Outpatient Memory Clinic is described as Reaching shore. When signs of dementia progress, families often become overwhelmed and reach a Crossroad, asking for more formal support such as day care. As the need for care at home is enhanced co-ordination between services becomes weaker, leading to Insecurity. Building a bridge between services is complicated since no dementia strategy has been set at the policy level in Iceland.
Conclusions: Although services designed for people with dementia living at home and their families are considered well developed in the early stages, helpful actions are still lacking in later stages.
O1.3.4 Tablet-based interventions for people with dementia in different health care settings
Johanna Nordheim1, Jan-Niklas Voigt-Antons2, Julie O'Sullivan1, Adelheid Kuhlmey1, Paul Gellert1
1 Charité-Universitätsmedizin, Germany, 2 Technische Universität Berlin, Germany
Information and Communication Technologies (ICTs) could be a valuable tool for delivering of nonpharmacological therapies (NPTs) for People with Dementia (PwD). However, research on ICT-based interventions in PwD is still sparse. The objective of the PflegeTab trial was to investigate the effects of an ICT-based intervention to improve quality of life (QoL) and reduce apathy in PwD living in nursing homes. The subsequent DemTab study will investigate the benefits of ICT for community dwelling PwD.
166 nursing home residents (53–100 yrs; 74% female; MMSE: M=14.1) were recruited from 10 facilities and randomised at nursing home level to ICT or active control. We developed an ICT-intervention, which comprised several adaptive tablet applications and stimulating multimedia features targeting cognitive and functional abilities and emotional self-regulation.
The DemTab study applies ICT to community dwelling PwD and establishes an additional communication platform between patients, family carers, and outpatient care facilities. DemTab will follow a mixed-methods feasibility approach as part of a cRCT.
Findings from the PflegeTab study were inconsistent for participating nursing homes: overall, apathy and QoL did not change significantly, while in specific matched pairs, we found a significant time*group difference (p=.03).
The PflegeTab study showed that an ICT-based intervention was feasible in nursing homes. ICT may constitute a helpful extension in delivering NPTs for PwD. Staff and family members need frequent supervision and support when using the ICTs.
The findings from the PflegeTab study have been considered in the study design of the new DemTab study.