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Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43–0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07–2.81, P=.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43–0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=–0.35– 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis. [ABSTRACT FROM AUTHOR]

Objective To develop and validate a set of relevant, feasible, and reliable quality indicators (QIs) for the Memory Clinics (MCs). Background MCs are important care providers for people with dementia and their caregivers. A set of valid QIs is needed to incorporate evidence-based guidelines into MC clinical practice, and measure adherence to guidelines. Methods A total of 17 MC specialists, 12 primary care physicians; and seven informal caregivers participated in several Delphi rounds to select and validate QIs. Ten MCs participated in the indicator compliance study involving the analysis of data extracted from 100 medical records. Results The initial set of 56 single QIs was reduced to a final set of 14 indicators measuring the quality of processes, structures, and outcomes of care. The panels of representatives of MCs, primary care physicians, and informal caregivers judged overall face validity to be high. The differences in compliance rates between the three indicator types were significant (p < 0.001) as were the differences between the MCs (p < 0.005). The compliance measures were highest for the process indicators and lowest for the outcome indicators. Conclusion The final set of 14 QIs that met the psychometric requirements can be used to facilitate the implementation of guidelines and the assessment of the quality of care offered by MCs. The QIs are acceptable for a broad range of users (specialists, referring physicians, and informal caregivers), and are capable of discriminating between MCs in terms of quality. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective . To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design . A prospective longitudinal study with a follow-up period of 10 months. Setting . Dementia patients living in the community selected by Dutch general practitioners. Subjects . Pairs of demented patients and their primary caregivers (N =138). Main outcome measures . Sense of competence: a 27-item scale (α=0.79) based on issues derived from the family crisis model and the Burden Interview. Continuity in home care is determined by the number of patient's admissions to a nursing or retirement home. Results . Regression analysis revealed that a change in the caregiver's sense of competence was independently predicted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was associated with a longer duration of dementia and the patient's more agitated behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient. A positive influence on the change in the sense of competence was found when these females received a professional intervention consisting of support for the caregiver. Reporting to be a Catholic or a Protestant compared with not being religiously involved positively influenced the change in sense of competence. Logistic regression analysis identified that continuity in home care was predicted by characteristics of the demented patient and the professional social network of the patient. Predictors of continuation of home care were: lower severity of dementia, patient's higher ADL impairment, the intervention and involvement of regular home help. Institutionalization was more likely when the patient's behaviour was more apathetic and a district nurse was involved in the care. Conclusions . Caregiver characteristics influenced the change in sense of competence but did not influence the risk for institutionalization. Findings suggest that health professionals should pay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demented patient. [ABSTRACT FROM AUTHOR]

Objective This study reviews the evidence for effects of combined intervention programmes for both the informal caregiver and the person with dementia. Method Systematic review. Electronic databases and key articles were searched for effect studies of combined programmes, published between January 1992 and February 2005. The resulting 52 reports were scored according to set inclusion criteria. Results Twenty five reports relating to 22 programmes met the inclusion criteria. Various aspects of caregivers' mental health and burden were studied. Best results were obtained regarding general mental health. Other aspects often showed modest and varying results. Caregivers' competence was less often addressed. The effects on the cognitive and physical functioning, behavioural problems and survival of the persons with dementia were modest and inconsistent, whereas their mental health is positively affected and admittance to long stay care is often delayed. Conclusion Combined programmes may improve some, not all, aspects of functioning for caregiver and person with dementia. Care professionals must define their programme goals and target groups before advising their clients on a combined programme. Research may focus on the effects of programmes that were introduced fairly recently and on subgroups of caregivers (female caregivers, depressed caregivers and people with dementia, and minorities). Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]