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OBJECTIVES: To investigate the determinants of survival to late dementia in Dutch nursing home patients. DESIGN: Observational analysis of a cohort of patients with a prospective follow-up. SETTING: Psychogeriatric nursing home “Joachim en Anna” in Nijmegen, the Netherlands. PARTICIPANTS: Dementia patients from a psychogeriatric nursing home admitted between 1980 and 1989. MEASUREMENTS: All patients were followed until death. Age, sex, severity of dementia on admission, and type of dementia were analyzed as determinants of survival to late dementia. Late dementia was operationally defined as total impairment on 20 items of the functional status questionnaire. RESULTS: The mean disease duration of the study population was 7.0 years, with a wide range. Some died soon after dementia was diagnosed, whereas others lived for more than 25 years after onset of the disease. One hundred twenty-six patients (14.2%) reached the phase of late dementia, most of whom were women (90%) with Alzheimer's disease (60%). For most of the patients, this phase lasted 1 year or less. Age, sex, type of dementia, and severity of dementia on admission all contributed significantly to predicting survival to late dementia. CONCLUSION: One of seven nursing home patients with dementia survived to late dementia. Nursing home physicians can use these findings to inform relatives about the prognosis. J Am Geriatr Soc 51:184–187, 2003. [ABSTRACT FROM AUTHOR]

Objectives To determine the prognostic value of apathy for mortality in patients of somatic ( SC) and dementia special care ( DSC) nursing home ( NH) units. Design Longitudinal design, secondary analyses of a 2-year, cluster-randomized trial with six measurements, approximately 4 months in between. Setting SC and DSC-units of Dutch NHs. Participants NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371). Measurements Data were available for 713 NH-patients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale ( AES-10) and applied as categorical variable using known cut-off scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Results Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio ( HR) = 1.77; 95% confidence interval ( CI] = 1.35-2.31, P < .001). Results remained significant ( HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ ( P > .05) in the effect of apathy on mortality. Male gender ( HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years ( HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk ( HR = 1.62, 95% CI = 1.40-1.88, P < .001). Conclusions Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population. [ABSTRACT FROM AUTHOR]

Objectives To determine the prevalence of nonmotor symptoms ( NMS) in nursing home ( NH) residents with Parkinson's disease ( PD) and to establish the association with quality of life. Design Cross-sectional. Setting Nursing homes in the southeast of the Netherlands. Participants Nursing home residents with PD and a Mini- Mental State Examination score of 18 or greater (N = 73; mean age 78.7, disease duration 10 years, mainly Hoehn and Yahr Stages 4 (38%) and 5 (49%)) underwent detailed examination to determine the prevalence of NMS. Measurements Validated instruments for PD-related NMS were used to examine the NH residents with PD. The overall burden of NMS, and autonomic problems in particular, were measured using the Non- Motor Symptoms Scale ( NMSS). Depression, neuropsychiatric symptoms, sleep problems, cognitive dysfunction, and motor impairments were focused on in further detail using established clinimetric tests. Linear regression analysis was used to examine the relationship between these symptoms and quality of life, which was measured using the Parkinson's Disease Questionnaire ( PDQ-8). Results The NMSS revealed a mean of nearly 13 different NMS per resident. Autonomic problems (constipation, urinary urgency) were particularly prevalent (48-75% of residents). Depressive symptoms were present in 45%. The most prevalent neuropsychiatric symptoms other than depression were irritability and apathy. The most common sleep problems were overall poor nighttime sleep quality, daytime sleepiness, and nocturia. Cognitive problems were highly prevalent, and 77% of the residents met the criteria for PD-related dementia. High scores were also obtained for motor impairments. Mean PDQ-8 score was high, indicating poor quality of life. Poor quality of life was most strongly associated with the prevalence and severity of overall NMS burden (coefficient of determination = 0.45). Conclusion Nonmotor symptoms were highly prevalent in NH residents with PD. Quality of life was poor, largely because of NMS. Because many NMS are potentially treatable, diagnosis and treatment of these severely affected individuals deserve more attention. [ABSTRACT FROM AUTHOR]

Objectives To examine the clinical characteristics, motor impairments, and drug treatments of nursing home residents with Parkinson's disease ( PD). Design Cross-sectional study. Setting Nursing homes in the southeast of the Netherlands. Participants Nursing home residents with PD and a Mini- Mental State Examination score of 18 or greater seen by a physician with experience in movement disorders. Measurements Participant characteristics, motor function, and dopaminergic medications were assessed. The Short Parkinson's Evaluation Scale/ SCales for Outcomes in Parkinson's disease ( SPES- SCOPA) was used to assess motor impairments and disabilities. Results Seventy-three nursing home residents with PD (mean age 78.7; 45% male; mean disease duration 10.1 years; Hoehn and Yahr 4 (38%) and 5 (49%)) were included. Most residents were severely disabled, 49% being wheelchair bound. According to the SPES- SCOPA, 44% of residents were 'off' (in a motor state in which they are slow and stiff) most of the time. Dyskinesias were encountered infrequently. Most residents were mainly treated with levodopa monotherapy, and daily doses varied widely (20-1,600 mg, mean 673 mg); 25% of residents were treated with less than 400 mg levodopa daily, and 8% received no levodopa at all. The movement disorders specialist considered 32 residents to be possibly undertreated. Conclusion These findings show that PD in nursing home residents is characterized by severe motor impairment and a high proportion of daily 'off' time, which underscores the need for better management of PD in nursing homes, for example within specialized institutions or with periodic consultations by a movement disorders expert. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To study the practice of continuous palliative sedation (CPS) by Dutch nursing home physicians in 2007. DESIGN: A structured retrospective questionnaire. SETTING: Nationwide nursing home physician study in the Netherlands. PARTICIPANTS: One thousand two hundred fifty-four nursing home physicians received a questionnaire concerning their last case of CPS in 2007; 54% (n=675) responded. MEASUREMENTS: Characteristics of CPS and requests for euthanasia were measured. RESULTS: Three hundred sixteen patients were described. The majority had cancer or dementia. The most-reported refractory symptoms were pain (52%), anxiety (44%), exhaustion (44%), dyspnea (40%), delirium (24%), loss of dignity (18%), and existential distress (16%). In 98% of cases, CPS was aimed at symptom relief. Of patients with cancer, 17% had previously requested euthanasia. The mean starting dose of midazolam was 31 mg every 24 hours (range 0–240 mg/24 h), and the mean end dose was 48 mg every 24 hours (range 0–480 mg/24 h). CONCLUSION: In addition to physical symptoms, anxiety, exhaustion, loss of dignity, and existential distress are often mentioned as refractory symptoms in the decision to start CPS by nursing home physicians. Furthermore, close to one in five patients with cancer had made a previous request for euthanasia. The dosage range of midazolam in this study fits the recommendations of the Dutch national guideline on palliative sedation, although international studies show smaller dosage ranges. Finally, prospective research about the acceptability and assessment of nonphysical symptoms as indications for CPS is recommended. [ABSTRACT FROM AUTHOR]