163 results on '"Koopmans, Raymond"'
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2. After COVID-19 vaccinations: what does living and working in nursing homes look like?
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Urlings, Judith H. J., Backhaus, Ramona, Verbeek, Hilde, de Boer, Bram, Koopmans, Raymond T.C.M., Gerritsen, Debby L., and Hamers, Jan P.H.
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- 2023
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3. Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior
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van Voorden, Gerrie, Koopmans, Raymond T. C. M., Strik-Lips, Mijke M., Smalbrugge, Martin, Zuidema, Sytse U., van den Brink, Anne M. A., Persoon, Anke, Oude Voshaar, Richard C., and Gerritsen, Debby L.
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- 2024
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4. Usability of an app-based clinical decision support system to monitor psychotropic drug prescribing appropriateness in dementia
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Rasing, Naomi, Janus, Sarah, Smalbrugge, Martin, Koopmans, Raymond, and Zuidema, Sytse
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- 2023
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5. Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia
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Veldwijk-Rouwenhorst, Annelies E., Zuidema, Sytse U., Smalbrugge, Martin, Persoon, Anke, Koopmans, Raymond T. C. M., and Gerritsen, Debby L.
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- 2022
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6. Stimuli changes and challenging behavior in nursing homes during the COVID-19 pandemic
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Knippenberg, Inge A. H., Leontjevas, Ruslan, Nijsten, Johanna M. H., Bakker, Christian, Koopmans, Raymond T. C. M., and Gerritsen, Debby L.
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- 2022
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7. A cross-sectional evaluation of the Dutch RHAPSODY program: online information and support for caregivers of persons with young-onset dementia
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Daemen, Maud, Bruinsma, Jeroen, Bakker, Christian, Zwaaftink, Rob Groot, Koopmans, Raymond, Oostijen, Andrea, Loose, Bernard, Verhey, Frans, de Vugt, Marjolein, and Peetoom, Kirsten
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- 2022
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8. Intensive neurorehabilitation for patients with prolonged disorders of consciousness: protocol of a mixed-methods study focusing on outcomes, ethics and impact
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Sharma-Virk, Manju, van Erp, Willemijn S., Lavrijsen, Jan C. M., and Koopmans, Raymond T. C. M.
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- 2021
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9. An exploration of relocation initiatives deployed within and between nursing homes: a qualitative study.
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Broekharst, Damien S. E., Stoop, Annerieke, Achterberg, Wilco P., Caljouw, Monique A. A., on behalf of the RELOCARE Consortium, Luijkx, Katrien G., Verbeek, Hilde, Hamers, Jan P. H., Schols, Jos M. G. A., de Boer, Bram, Urlings, Judith H. J., Brouwers, Mara, Landeweer, Elleke G. M., Luijendijk, Dika H. J., Schreuder, Miranda C., Zuidema, Sytse U., Perry, Marieke, Koopmans, Raymond T. C. M., and Groen, Wim G.
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NURSING care facilities ,HOME nursing ,MEDICAL personnel ,QUALITATIVE research ,INFORMATION sharing - Abstract
Background: Relocations within and between nursing homes often induce stress, anxiety, and depression in residents and cause additional workload for and burnout in staff. To prevent this, many nursing homes deploy pre-transition initiatives, bridging initiatives, and post-transition initiatives to support residents and staff during the relocation process. As little is known about these initiatives, this study aims to explore the pre-relocation, bridging and post-relocation initiatives used for relocations within and between nursing homes. Methods: In seven Dutch nursing homes, eight focus groups were conducted with two to six participants (N = 37) who were actively involved in relocation processes in different roles (i.e., managers, healthcare professionals, support staff, client council members, residents and family). The focus groups were conducted based on a predefined topic list and lasted approximately 60 min. The transcripts were recorded, transcribed verbatim and analysed using thematic coding. Results: Nursing homes had to be inventive in developing relocation initiatives as neither shared guidelines nor knowledge exchange on this topic were available. A total of thirty-seven relocation initiatives were identified in these seven nursing homes. Nineteen pre-relocation initiatives were identified, of which eight emphasized information and engagement, three highlighted training and practice and eight stressed orientation and visualization. Seven bridging initiatives were identified, of which four emphasized coordination and continuity and three highlighted entertainment and celebration. Eleven post-relocation initiatives were identified, of which seven emphasized evaluation and troubleshooting and four highlighted change and adjustment. Conclusion: The identified relocation initiatives were developed unassisted by nursing homes, due to a lack of shared guidelines, knowledge exchange and mutual learning on this topic. Therefore, it may be expedient and more effective to develop general guidelines for relocations within and between nursing homes in collaboration with nursing homes. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Advance care planning with people with dementia: a process evaluation of an educational intervention for general practitioners
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Tilburgs, Bram, Koopmans, Raymond, Schers, Henk, Smits, Carolien, Vernooij-Dassen, Myrra, Perry, Marieke, and Engels, Yvonne
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- 2020
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11. Level of Discomfort Decreases After the Administration of Continuous Palliative Sedation: A Prospective Multicenter Study in Hospices and Palliative Care Units
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van Deijck, Rogier H.P.D., Hasselaar, Jeroen G.J., Verhagen, Stans C.A.H.H.V.M., Vissers, Kris C.P., and Koopmans, Raymond T.C.M.
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- 2016
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12. Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study
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van Deijck, Rogier H.P.D., Hasselaar, Jeroen G.J., Verhagen, Stans C.A.H.H.V.M., Vissers, Kris C.P., and Koopmans, Raymond T.C.M.
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- 2016
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13. The development and feasibility evaluation of a program to identify and manage apathy in people with dementia:the SABA program
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Nijsten, Johanna M. H., Plouvier, Annette O. A., Smalbrugge, Martin, Koopmans, Raymond T. C. M., Leontjevas, Ruslan, and Gerritsen, Debby L.
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Objectives: To develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA). Methods: A theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6). Results: SABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program’s materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating. Conclusions: SABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.
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- 2023
14. The importance of trust-based relations and a holistic approach in advance care planning with people with dementia in primary care: a qualitative study
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Tilburgs, Bram, Vernooij-Dassen, Myrra, Koopmans, Raymond, Weidema, Marije, Perry, Marieke, and Engels, Yvonne
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- 2018
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15. Cost-effectiveness of a multicomponent primary care program targeting frail elderly people
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Ruikes, Franca G. H., Adang, Eddy M., Assendelft, Willem J. J., Schers, Henk J., Koopmans, Raymond T. C. M., and Zuidema, Sytse U.
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- 2018
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16. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study
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Lovink, Marleen H., van Vught, Anneke J. A. H., Persoon, Anke, Schoonhoven, Lisette, Koopmans, Raymond T. C. M., and Laurant, Miranda G. H.
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- 2018
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17. Moral dilemmas and conflicts concerning patients in a vegetative state/unresponsive wakefulness syndrome: shared or non-shared decision making? A qualitative study of the professional perspective in two moral case deliberations
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Span-Sluyter, Conny A. M. F. H., Lavrijsen, Jan C. M., van Leeuwen, Evert, and Koopmans, Raymond T. C. M.
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- 2018
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18. Provisional consensus on the nomenclature and operational definition of dementia at a young age, a Delphi study
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van de Veen, Dennis, Bakker, Christian, Peetoom, Kirsten, Pijnenburg, Yolande, Papma, Janne, de Vugt, Marjolein, Koopmans, Raymond, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Neurology, and Amsterdam Neuroscience - Neurodegeneration
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Psychiatry and Mental health ,SDG 3 - Good Health and Well-being ,PEOPLE ,terminology ,ONSET DEMENTIA ,operational definition ,young-onset dementia ,Geriatrics and Gerontology ,CARE ,DIAGNOSIS ,Delphi - Abstract
OBJECTIVES: Dementia at a young age differs from late onset dementia in pathology and care needs. This requires further research to improve the understanding of this group, support and service provision. Aim of current study is to reach consensus on the terminology and operational definition (i.e., age-related criteria and possible causes) of dementia at a young age, to aid further research.METHODS: A classical Delphi technique was used to transform opinions into group consensus by using an online survey. In three rounds statements regarding (1) terminology, (2) age-related criteria, and (3) aetiologies that can be considered as causes of dementia at a young age were sent to international experts in the field to give their opinions and additional comments on the statements.RESULTS: Forty-four experts responded and full consensus was reached on 22 out of 35 statements. Young-onset dementia emerged as the term of preference. Provisional consensus was found for the use of age 65 at symptom onset as preferred cut-off age. Consensus was reached on the inclusion of 15 out of 22 aetiologies and categories of aetiologies as potential cause for dementia at a young age.CONCLUSIONS: A clear term and operational definition have been reached. Although beneficial for conducting future research to gain more insight in pathology and care needs of young people living with dementia, still consensus about some details is lacking. To reach consensus about these details and implications for use in research and clinical practice, the organisation of an in person consensus meeting is advised.
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- 2022
19. Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial
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Ruikes, Franca G.H., Zuidema, Sytse U., Akkermans, Reinier P., Assendelft, Willem J.J., Schers, Henk J., and Koopmans, Raymond T.C.M.
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- 2016
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20. 'Het was zo lekker rustig': Impact van de lockdown op probleemgedrag
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Koopmans, Raymond, Bakker, Christian, Gerritsen, Debby L., Knippenberg, I.A.H., Leontjevas, R., Plouvier, Annette, Section Methodology & Statistics, and RS-Research Line Methodology & statistics (part of IIESB program)
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- 2020
21. 'Het was zo lekker rustig':Impact van de lockdown op probleemgedrag
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Koopmans, Raymond, Bakker, Christian, Gerritsen, Debby L., Knippenberg, I.A.H., Leontjevas, R., and Plouvier, Annette
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- 2020
22. The Course and Predictors of Quality of Life in Nursing Home Residents with Young-onset Dementia
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Pu, Lihui, Bakker, Christian, Appelhof, Britt, Van Duinen-van den Ijssel, Jeannette C. L., Zwijsen, Sandra A., Teerenstra, Steven, Smalbrugge, Martin, Verhey, Frans R. J., de Vugt, Marjolein E., Zuidema, Sytse U., Koopmans, Raymond T. C. M., and Life Course Epidemiology (LCE)
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- 2020
23. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study
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Spruit-van Eijk, Monica, Zuidema, Sytse U., Buijck, Bianca I., Koopmans, Raymond T.C.M., and Geurts, Alexander C. H.
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- 2012
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24. Reasons for Dermatology Consultations in Nursing Homes and the Estimated Potential of Teledermatology as a Triage Tool.
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KLÖSTERS, Frederik M., VAN WINDEN, Marieke E. C., ANGENENT, Freya R., VAN BERGEN, Lambertus Henrikus, VAN STEVENINCK-WENSING, Marjolein, ZWEERS, Manon C., GALIMONT-COLLEN, Ann F. S., BRONKHORST, Ewald M., KOOPMANS, Raymond T. C. M., and LUBEEK, Satish F. K.
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NURSING care facilities ,DERMATOLOGY ,MEDICAL triage ,ELDER care ,TELERADIOLOGY ,DERMATOLOGISTS - Abstract
Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently. [ABSTRACT FROM AUTHOR]
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- 2022
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25. Bridging the Gap Between Primary Care and Public Health
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Van Weel, Chris, Koopmans, Raymond, Van der Velden, Koos, Bottema, Ben, and de Vries Robbé, Peter
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- 2009
26. From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes.
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Backhaus, Ramona, Verbeek, Hilde, de Boer, Bram, Urlings, Judith H. J., Gerritsen, Debby L., Koopmans, Raymond T. C. M., and Hamers, Jan P. H.
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NURSING care facilities ,FAMILY nursing ,COVID-19 ,NURSING home patients ,CAREGIVERS - Abstract
Background: To protect nursing home residents, many governments around the world implemented blanket visitor bans in March and April 2020. As a consequence, family caregivers, friends, and volunteers were not allowed to enter nursing homes, while residents were not allowed to go out. Up until now, little is known on the long-term consequences and effects of visiting bans and re-opening of nursing homes. The aim of the study was to assess the long-term effects of the pandemic on residents, family members, and staff, and their preparedness for the next coronavirus wave.Methods: A mixed-methods approach was used, consisting of a questionnaire and analyses of documentation (local visiting protocols). Of the 76 nursing home locations that participated in a Dutch national pilot on welcoming visitors back into nursing homes, 64 participated in this follow-up study. Data were collected in September/October 2020. For each nursing home, one contact person completed the questionnaire. Descriptive statistics were calculated for quantitative questionnaire data. Data on open-ended questions, as well as data from the documentation, were analyzed thematically.Results: The study demonstrated that the consequences of strict visiting bans do not disappear at the moment the visiting ban is lifted. Although in October 2020, daily life in nursing homes was more "back to normal," more than one-third of the respondents indicated that they still applied restrictions. Compared to the situation before the pandemic, fewer volunteers were working in the nursing homes, grandchildren visited their relative less often, and visits differed.Conclusions: Five months after the visiting ban in Dutch nursing homes had been lifted, it still had an impact on residents, family members, and staff. It is questionable whether nursing homes feel prepared for welcoming visitors in the case of new COVID-19 infections. Nursing homes indicated that they felt prepared for the next wave, while at the same time, they were particularly concerned about staff well-being and vitality. It seems wise to invest in staff well-being. In addition, it seems desirable to think about how to support nursing homes in seeking a balance between infection prevention and well-being of residents, family members, and staff. [ABSTRACT FROM AUTHOR]- Published
- 2021
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27. Actief behandelen door het ervaren: Psychomotorische therapie bij ouderen met depressie in verpleeghuizen
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Leontjevas, R., Quint - Fens, M.H., Plouvier, Annette, Hendriks, Alwies, Gerritsen, Debby L., Gerritsen, Debby, Leontjevas, Roeslan, Quint-Fens, Manon, Derksen, Els, Koopmans, Raymond, Smalbrugge, Martin, Section Methodology & Statistics, RS-Research Line Methodology & statistics (part of IIESB program), and Academic Affairs
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- 2019
28. The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly
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Ruikes Franca GH, Meys Antoinette RM, van de Wetering Gijs, Akkermans Reinier P, van Gaal Betsie GI, Zuidema Sytse U, Schers Henk J, van Achterberg Theo, and Koopmans Raymond TCM
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Frail elderly ,Complex intervention ,Integrated care ,Functional status ,Cost-effectiveness ,Implementation ,Process evaluation ,Primary care ,Medicine (General) ,R5-920 - Abstract
Abstract Background With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. Methods/design The CareWell-primary care study includes a (cost-) effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver ‘care as usual’. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients’ and professionals’ approval of the program, and the barriers and facilitators to implementation. Discussion The CareWell-primary care study will provide new insights into the (cost-) effectiveness, feasibility, and barriers and facilitators for implementation of this complex intervention in primary care. Trial registration The CareWell-primary care study is registered in the ClinicalTrials.gov Protocol Registration System: NCT01499797
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- 2012
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29. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis
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Buijck Bianca I, Zuidema Sytse U, Eijk Monica, Bor Hans, Gerritsen Debby L, and Koopmans Raymond TCM
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Stroke ,Geriatric ,Rehabilitation ,Skilled-nursing-facility ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. Methods This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Results Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Conclusion Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
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- 2012
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30. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial
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van de Ven Geertje, Draskovic Irena, Adang Eddy MM, Donders Rogier ART, Post Aukje, Zuidema Sytse U, Koopmans Raymond TCM, and Vernooij-Dassen Myrra JFJ
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Geriatrics ,RC952-954.6 - Abstract
Abstract Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. Trial registration The trial is registered in the Netherlands National Trial Register: NTR2314.
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- 2012
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31. Exploring perspectives of young onset dementia caregivers with high versus low unmet needs
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Millenaar, Joany K., Bakker, Christian, van Vliet, Deliane, Koopmans, Raymond T. C. M., Kurz, Alexander, Verhey, Frans R. J., de Vugt, Marjolein E., RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Psychiatrie & Neuropsychologie, and MUMC+: MA Med Staf Spec Psychiatrie (9)
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young onset dementia ,caregivers ,care needs ,ADULT-CHILD ,PEOPLE ,EXPERIENCE ,service use - Abstract
BackgroundThis study is part of the Research to Assess Policies and Strategies for Dementia in the Young project. Information about specific needs in young onset dementia (YOD) will provide the basis for the development of an e-health intervention to assist caregivers in coping with YOD in several European countries. ObjectiveThe aim was to investigate the issues caregivers of people with YOD face. MethodsA qualitative content analysis method was used to analyse interviews with YOD caregivers. Quantitative data of the Needs in Young Onset Dementia study were used to select caregivers based on a ranking of unmet needs, to capture differences and similarities between caregivers that experienced high levels of unmet needs versus those with low levels of unmet needs. Needs were assessed with the Camberwell Assessment of Needs in the Elderly. ResultsFindings revealed the following themes: (i) acceptance; (ii) perception of the relationship; (iii) role adaptation; (iv) Availability of appropriate services; (v) social support; and (vi) awareness in the person with dementia and acceptance of help. Several factors seemed more apparent in the caregivers who experienced few unmet needs opposed to the caregivers who experienced more unmet needs. ConclusionThe current study provides an in-depth perspective on the caregiver's experiences and emphasizes specific themes that could be addressed in future interventions. This might contribute to a caring situation in which the caregiver experiences less unmet needs. Copyright (c) 2017 John Wiley & Sons, Ltd.
- Published
- 2018
32. Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol
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Vernooij-Dassen Myrra JFJ, Adang Eddy M, Leontjevas Ruslan, Teerenstra Steven, Smalbrugge Martin, Gerritsen Debby L, Derksen Els, and Koopmans Raymond TCM
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Psychiatry ,RC435-571 - Abstract
Abstract Background The aim of this study is evaluating the (cost-) effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR): NTR1477
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- 2011
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33. Grip on challenging behaviour: a multidisciplinary care programme for managing behavioural problems in nursing home residents with dementia. Study protocol
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Eefsting Jan A, van Tulder Maurits W, Bosmans Judith E, Koopmans Raymond TCM, Zuidema Sytse U, Smalbrugge Martin, Zwijsen Sandra A, Gerritsen Debby L, and Pot Anne-Margriet
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. Methods/Design The care programme is based on Dutch national guidelines. It will consist of four steps: detection, analysis, treatment and evaluation. A stepped wedge design will be used. A total of 14 dementia special care units will implement the care programme. The primary outcome is behavioural problems. Secondary outcomes will include quality of life, prescription rate of antipsychotics, use of physical restraints and workload and job satisfaction of nursing staff. The effect of the care programme will be estimated using multilevel linear regression analysis. An economic evaluation from a societal perspective will also be carried out. Discussion The care programme is expected to be cost-effective and effective in decreasing behavioural problems, workload of nursing staff and in increasing quality of life of residents. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR 2141
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- 2011
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34. Geriatric rehabilitation of stroke patients in nursing homes: a study protocol
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Geurts Alexander CH, Voncken Frans LM, Zuidema Sytse U, Buijck Bianca I, Spruit-van Eijk Monica, and Koopmans Raymond TCM
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Geriatrics ,RC952-954.6 - Abstract
Abstract Background Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. Methods/Design This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation. Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation. Discussion This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients.
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- 2010
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35. Research protocol of the NeedYD-study (Needs in Young onset Dementia): a prospective cohort study on the needs and course of early onset dementia
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Vernooij-Dassen Myrra JFJ, Koopmans Raymond TCM, Bakker Christian, van Vliet Deliane, Verhey Frans RJ, and de Vugt Marjolein E
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Geriatrics ,RC952-954.6 - Abstract
Abstract 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.
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- 2010
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36. The design of the SAFE or SORRY? study: a cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events
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Koopmans Raymond TCM, Borm George F, Mintjes Joke AJ, Hulscher Marlies EJL, Schoonhoven Lisette, van Gaal Betsie GI, and van Achterberg Theo
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Patients in hospitals and nursing homes are at risk of the development of, often preventable, adverse events (AEs), which threaten patient safety. Guidelines for prevention of many types of AEs are available, however, compliance with these guidelines appears to be lacking. Besides general barriers that inhibit implementation, this non-compliance is associated with the large number of guidelines competing for attention. As implementation of a guideline is time-consuming, it is difficult for organisations to implement all available guidelines. Another problem is lack of feedback about performance using quality indicators of guideline based care and lack of a recognisable, unambiguous system for implementation. A program that allows organisations to implement multiple guidelines simultaneously may facilitate guideline use and thus improve patient safety. The aim of this study is to develop and test such an integral patient safety program that addresses several AEs simultaneously in hospitals and nursing homes. This paper reports the design of this study. Methods and design The patient safety program addresses three AEs: pressure ulcers, falls and urinary tract infections. It consists of bundles and outcome and process indicators based on the existing evidence based guidelines. In addition it includes a multifaceted tailored implementation strategy: education, patient involvement, and a computerized registration and feedback system. The patient safety program was tested in a cluster randomised trial on ten hospital wards and ten nursing home wards. The baseline period was three months followed by the implementation of the patient safety program for fourteen months. Subsequently the follow-up period was nine months. Primary outcome measure was the incidence of AEs on every ward. Secondary outcome measures were the utilization of preventive interventions and the knowledge of nurses regarding the three topics. Randomisation took place on ward level. The results will be analysed separately for hospitals and nursing homes. Discussion Major challenges were the development of the patient safety program including a digital registration and feedback system and the implementation of the patient safety program. Trial registration Trial registration: ClinicalTrials.gov ID [NCT00365430]
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- 2009
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37. Passive movement therapy in patients with moderate to severe paratonia; study protocol of a randomised clinical trial (ISRCTN43069940)
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de Bie Rob A, Bor Jacobus HJ, Verhey Frans RJ, Hobbelen Johannes SM, and Koopmans Raymond TCM
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Geriatrics ,RC952-954.6 - Abstract
Abstract Background Paratonia, a form of hypertonia, is associated with loss of mobility and with the development of contractures especially in the late stages of the dementia. Passive movement therapy (PMT) currently is the main physiotherapeutic intervention. General doubt about the beneficial effects of this widely used therapy necessitates a randomised clinical trial (RCT) to study the efficacy of PMT on the severity of paratonia and on the improvement of daily care. Methods/Design A RCT with a 4-week follow-up period. Patients with dementia (according to the DSM-IV-TR Criteria) and moderate to severe paratonia are included in the study after proxy consent. By means of computerised and concealed block randomisation (block-size of 4) patients are included in one of two groups. The first group receives PMT, the second group receives usual care without PMT. PMT is given according to a protocol by physical therapist three times a week for four weeks in a row. The severity of paratonia (Modified Ashworth scale), the severity of the dementia (Global Deterioration Scale), the clinical improvement (Clinical Global Impressions), the difficulty in daily care (Patient Specific Complaints) and the experienced pain in daily care of the participant (PACSLAC-D) is assessed by assessors blind to treatment allocation at baseline, after 6 and 12 treatments. Success of the intervention is defined as a significant increase of decline on the modified Ashworth scale. The 'proportion of change' in two and four weeks time on this scale will be analysed. Also a multiple logistic regression analysis using declined/not declined criteria as dependent variable with correction for relevant confounders (e.g. stage of dementia, medication, co-morbidity) will be used. Discussion This study is the first RCT of this size to gain further insight on the effect of passive movement therapy on the severity of paratonia. Trial registration Current Controlled Trials ISRCTN43069940
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- 2007
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38. The Prevalence and Determinants of Neuropsychiatric Symptoms in Late‐Stage Parkinsonism.
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Hommel, Adrianus L.A.J., Meinders, Marjan J., Lorenzl, Stefan, Dodel, Richard, Coelho, Miguel, Ferreira, Joaquim J., Laurens, Brice, Spampinato, Umberto, Meissner, Wassilios, Rosqvist, Kristina, Timpka, Jonathan, Odin, Per, Wittenberg, Michael, Bloem PhD, Bas R., Koopmans, Raymond T., and Schrag, Anette
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APATHY ,PARKINSONIAN disorders ,PARKINSON'S disease ,COGNITION disorders ,SYMPTOMS ,DEMOGRAPHIC characteristics - Abstract
Background: Late‐stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late‐stage PD. Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion: Neuropsychiatric symptoms are common in late‐stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late‐stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized. [ABSTRACT FROM AUTHOR]
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- 2020
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39. Bayesian analyses showed more evidence for apathy than for depression being associated with cognitive functioning in nursing homes
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Fredrix, E.W.H.M., Leontjevas, Ruslan, Smalbrugge, Martin, Koopmans, Raymond, Gerritsen, Debby L., Department Science, RS-Research Line Resilience (part of LIRS program), Section Methodology & Statistics, and RS-Research Line Methodology & statistics (part of IIESB program)
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- 2016
40. The course of neuropsychiatric symptoms in patients with dementia in primary care.
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Borsje, Petra, Lucassen, Peter L B J, Bor, Hans, Wetzels, Roland B, Pot, Anne Margriet, and Koopmans, Raymond T C M
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MENTAL health services ,CAREGIVERS ,PRIMARY care ,DEMENTIA patients ,BURDEN of care ,DEMENTIA ,PSYCHOLOGY of caregivers ,COMPARATIVE studies ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PRIMARY health care ,PSYCHOLOGICAL tests ,PSYCHOMOTOR disorders ,QUESTIONNAIRES ,RESEARCH ,EVALUATION research - Abstract
Background: During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services.Objectives: To investigate the course of NPS in people with dementia in primary care.Methods: Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS.Results: The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome.Conclusions: GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care. [ABSTRACT FROM AUTHOR]- Published
- 2019
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41. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study.
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Lovink, Marleen Hermien, Laurant, Miranda G. H., van Vught, Anneke J. A. H., Maassen, Irma, Schoonhoven, Lisette, Persoon, Anke, and Koopmans, Raymond T. C. M.
- Abstract
Objectives This study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs. Design A multiple-case study was conducted that draws on realist evaluation principles. Setting Seven nursing homes in the Netherlands Participants The primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78). Data collection Data collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents. Results An optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional. Conclusions Collaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences. [ABSTRACT FROM AUTHOR]
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- 2019
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42. Using Video Feedback at Home in Dementia Care: A Feasibility Study.
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Gerritsen, Debby L., Koopmans, Raymond T. C. M., Walravens, Veerle, and van Vliet, Deliane
- Abstract
Video feedback at home (VFH) aims to improve the well-being of informal caregivers and persons with dementia by training the caregiver to communicate successfully. This feasibility study had 2 aims: (1) to investigate possible effects regarding VFH, caregiver self-efficacy and the burden experienced, and the frequency of challenging behavior in persons with dementia, and (2) to perform a process evaluation of barriers and facilitators regarding the use of VFH. The respondents were caregivers of home-dwelling persons with dementia participating in VHF (N = 10), a group of caregivers who declined participating in VFH (N = 18), stakeholders (N = 6), and field experts (N = 55). The assessments performed were Positive and Negative Affect Scales, Cohen-Mansfield Agitation Inventory, Sense of Competence Scale, semistructured interviews, and questionnaires. Results demonstrated that caregivers were satisfied with VFH and that various (sub)scores on questionnaires improved. Caregivers mentioned a reluctance toward being filmed and both caregivers and referrers were unfamiliar with VFH. Recommendations have been made for health-care professionals and researchers to overcome these barriers. [ABSTRACT FROM AUTHOR]
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- 2019
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43. Dementia and Parkinson's Disease: Similar and Divergent Challenges in Providing Palliative Care.
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van der Steen, Jenny T., Lennaerts, Herma, Hommel, Danny, Augustijn, Bertie, Groot, Marieke, Hasselaar, Jeroen, Bloem, Bastiaan R., and Koopmans, Raymond T. C. M.
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PARKINSON'S disease treatment ,DEMENTIA ,CAREGIVER attitudes ,ACCIDENTAL falls ,SYMPTOMS - Abstract
Dementia and Parkinson's disease are incurable neurological conditions. Patients often experience specific, complex, and varying needs along their disease trajectory. Current management typically employs a multidisciplinary team approach. Recognition is growing that this team approach should also address palliative care issues to optimize quality of life for patient and family caregivers, but it remains unclear how palliative care is best delivered. To inspire future service development and research, we compare the trajectories and conceptualization of palliative care between dementia and Parkinson's disease. Both Parkinson's disease and dementia are characterized by a protracted course, with progressive but fairly insidious development of disability. However, patients with Parkinson's disease may experience relatively stable periods initially but with time, a wide range of debilitating symptoms develops, many of which do not respond well to treatment. Eventually, dementia develops in most Parkinson patients, while motor disability develops in many dementia patients. In both diseases, symptoms such as pain, apathy, sleeping problems, falls, and a high caregiver burden are prevalent. Advance care planning has benefits in terms of being prepared before the disease progresses into a stage with communication problems or severe cognitive impairment. However, for both conditions, the protracted disease trajectories complicate conceptualization of palliative care through different stages of the disease, with pertinent questions such as when to offer what interventions pro-actively. Given the similarities and differences, we should develop palliative approaches that are partially generic and partially disease-specific. These should be integrated seamlessly with disease-specific care. Substantial research is already being performed on dementia palliative care. This may also inform the further development of palliative care for Parkinson's disease, including an evaluation of palliative interventions and services. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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44. Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review.
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Tilburgs, Bram, Vernooij-Dassen, Myrra, Koopmans, Raymond, Perry, Marieke, van Gennip, Hans, and Engels, Yvonne
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TREATMENT of dementia ,MEDICAL care ,GENERAL practitioners ,TREATMENT effectiveness ,DATA analysis ,MANAGEMENT - Abstract
Background: Due to the disease’s progressive nature, advance care planning (ACP) is recommended for people with early stage dementia. General practitioners (GPs) should initiate ACP because of their longstanding relationships with their patients and their early involvement with the disease, however ACP is seldom applied. Aim: To determine the barriers and facilitators faced by GPs related to ACP with people with dementia. Data sources: We systematically searched the relevant databases for papers published between January 1995 and December 2016, using the terms: primary healthcare, GP, dementia, and ACP. We conducted a systematic integrative review following Whittemore and Knafl’s method. Papers containing empirical data about GP barriers and/or facilitators regarding ACP for people with dementia were included. We evaluated quality using the Mixed-Method-Appraisal-Tool and analyzed data using qualitative content analysis. Results: Ten qualitative, five quantitative, and one mixed-method paper revealed four themes: timely initiation of ACP, stakeholder engagement, important aspects of ACP the conversation, and prerequisites for ACP. Important barriers were: uncertainty about the timing of ACP, how to plan for an uncertain future, lack of knowledge about dementia, difficulties assessing people with dementia’s decisional capacities, and changing preferences. Facilitators for ACP were: an early start when cognitive decline is still mild, inclusion of all stakeholders, and discussing social and medical issues aimed at maintaining normal life. Conclusion: Discussing future care is difficult due to uncertainties about the future and the decisional capacities of people with dementia. Based on the facilitators, we recommend that GPs use a timely and goal-oriented approach and involve all stakeholders. ACP discussions should focus on the ability of people with dementia to maintain normal daily function as well as on their quality of life, instead of end-of-life-discussions only. GPs need training to acquire knowledge and skills to timely initiate collaborative ACP discussions. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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45. The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial.
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VAN DER SPEK, KLAAS, KOOPMANS, RAYMOND T. C. M., SMALBRUGGE, MARTIN, NELISSEN-VRANCKEN, MARJORIE H. J. M. G., WETZELS, ROLAND B., SMEETS, CLAUDIA H. W., DE VRIES, ERICA, TEERENSTRA, STEVEN, ZUIDEMA, SYTSE U., and GERRITSEN, DEBBY L.
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PSYCHIATRIC drugs , *DEMENTIA , *DRUG prescribing , *MEDICAL records , *MEDICAL practice , *NURSES , *NURSING home patients , *PHARMACISTS , *PHYSICIANS , *PHYSICIAN practice patterns , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *MEDICATION reconciliation , *SYMPTOMS - Abstract
Objective: We studied the efficacy of biannual structured medication reviews to improve the appropriateness of psychotropic drug (PD) prescriptions for neuropsychiatric symptoms (NPS) in nursing home patients with dementia. Study Design and Setting: In this randomised controlled trial, the intervention encompassed a structured multidisciplinary medication review by physician, pharmacist and nurse. During this 18-month study, the patient's medical files were assessed every 6 months. The primary outcome was the appropriateness of PD prescriptions defined by the Appropriate Psychotropic drug use In Dementia (APID) index sum score, lower scores indicating more appropriate use. Results: At baseline, 380 patients were included, of which 222 were randomised to the intervention group. Compared to the control group, the APID index sum score in the intervention group improved significantly for all PD prescriptions (-5.28, P = 0.005). Conclusion: We advise the implementation of a structured, repeated medication review with the essential roles of pharmacist, physician and nurse, into daily practice. This work was supported and funded by the Netherlands Organisation for Health Research and Development (ZonMw). Netherlands Trial Register (NTR3569). [ABSTRACT FROM AUTHOR]
- Published
- 2018
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46. The association between implementation and outcome of a complex care program for frail elderly people.
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Ruikes, Franca G. H., van Gaal, Betsie G. I., Oudshoorn, Liset, Zuidema, Sytse U., Akkermans, Reinier P., Assendelft, Willem J. J., Schers, Henk J., and Koopmans, Raymond T. C. M.
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FRAIL elderly ,MEDICAL care for older people ,HEALTH programs ,LINEAR statistical models ,HEALTH planning ,GERIATRIC assessment ,COMPARATIVE studies ,RESEARCH methodology ,EVALUATION of medical care ,MEDICAL cooperation ,PRIMARY health care ,QUALITY of life ,RESEARCH ,STATISTICAL sampling ,ACTIVITIES of daily living ,EVALUATION research ,RANDOMIZED controlled trials ,SOCIAL services case management ,EVALUATION of human services programs - Abstract
Background: Over the last 20 years, the effectiveness of complex care programs aiming to prevent adverse outcomes in frail elderly people has been disappointing. Recently, we found no effectiveness of the CareWell primary care program. It is largely unknown to what extent incomplete implementation of these complex interventions influences their outcomes.Objective: To examine the association between the degree of implementation of the CareWell program and the prevention of functional decline in frail elderly people.Methods: Quantitative process evaluation conducted alongside a cluster-controlled trial. Two hundred and four frail elderly participants from six general practitioner practices in the Netherlands received care according to the CareWell program, consisting of four key components: multidisciplinary team meetings, proactive care planning, case management and medication reviews. We measured time registrations of team meetings, case management and medication reviews and care plan data as stored in a digital information portal. These data were aggregated into a total implementation score (TIS) representing the program's overall implementation. We measured functional decline with the Katz-15 change score (follow-up score at 12 months minus the baseline score). The association between TIS and functional decline was analyzed with linear mixed model analyses.Results: We found no statistically significant differences in functional decline between TIS groups (F = 1.350, P = 0.245). In the groups with the highest TISs, we found more functional decline.Conclusion: A higher degree of implementation of the CareWell program did not lead to the prevention of functional decline in frail elderly people. [ABSTRACT FROM AUTHOR]- Published
- 2018
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47. Neuropsychiatric symptoms and psychotropic drug use in patients with dementia in general practices.
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Borsje, Petra, Lucassen, Peter L. B. J., Wetzels, Roland B., Pot, Anne Margriet, and Koopmans, Raymond T. C. M.
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NEUROBEHAVIORAL disorders ,PSYCHIATRIC drugs ,DEMENTIA patients ,FAMILY medicine ,DISEASE prevalence ,COMPARATIVE studies ,DEMENTIA ,MENTAL depression ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL prescriptions ,PSYCHOLOGICAL tests ,PSYCHOMOTOR disorders ,QUESTIONNAIRES ,RESEARCH ,EVALUATION research ,CROSS-sectional method - Abstract
Background: Neuropsychiatric symptoms (NPS) frequently occur in community-dwelling patients with dementia and they are also frequently prescribed psychotropic drugs. The prescription of psychotropic drugs has been found to be associated with the level of NPS. Data on NPS in patients with dementia in general practices are scarce.Objectives: The aim of this study was to assess the prevalence rates of NPS and psychotropic drug use (PDU) in patients with dementia in general practices.Methods: We analyzed data from the baseline measurement of a prospective cohort study in a sample of (Dutch) patients in general practices. Prevalence rates of NPS and subsyndromes assessed with the Neuropsychiatric Inventory (NPI) and of PDU were calculated. Prevalence rates of individual NPS are presented both as clinically relevant symptoms (NPI symptom score ≥ 4) and as prevalence rates of symptoms with symptom score > 0.Results: Of the 117 patients, more than 90% had at least one symptom and more than 65% had at least one clinically relevant symptom. The most common NPS were agitation/aggression, dysphoria/depression and irritability/lability. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference. Only 28.7% of the patients used at least one, 7.0% used at least two different and 1.7% used at least three different types of psychotropic drugs (excluding anti-dementia medication).Conclusions: NPS are highly prevalent in patients with dementia in general practices, but PDU is rather low. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference. [ABSTRACT FROM AUTHOR]- Published
- 2018
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48. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.
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Lovink, Marleen Hermien, Persoon, Anke, van Vught, Anneke J. A. H., Schoonhoven, Lisette, Koopmans, Raymond T. C. M., and Laurant, Miranda G. H.
- Abstract
Introduction In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. Methods and analysis This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context–mechanism–outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. Ethics and dissemination The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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49. Improving comfort in people with dementia and pneumonia: a cluster randomized trial.
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van der Maaden, Tessa, de Vet, Henrica C. W., Achterberg, Wilco P., Boersma, Froukje, Schols, Jos M. G. A., Mehr, David R., Galindo-Garre, Francisca, Hertogh, Cees M. P. M., Koopmans, Raymond T. C. M., and van der Steen, Jenny T.
- Subjects
NURSING care facilities ,TREATMENT of dementia ,PNEUMONIA treatment ,SYMPTOMS ,HEALTH outcome assessment ,CLUSTER randomized controlled trials ,REGRESSION analysis ,BLIND experiment ,PREVENTION ,TREATMENT of dyspnea ,COMPARATIVE studies ,DEMENTIA ,DYSPNEA ,EMOTIONS ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PNEUMONIA ,RESEARCH ,EVALUATION research ,RANDOMIZED controlled trials ,PSYCHOLOGY - Abstract
Background: Pneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia.Methods: A single-blind, multicenter, cluster randomized controlled trial was conducted in 32 Dutch nursing homes. Outcomes were assessed on the patient level. The main outcome measures were discomfort and symptoms: discomfort (DS-DAT: Discomfort Scale-Dementia of Alzheimer Type), (lack of) comfort (EOLD-CAD: End Of Life in Dementia-Comfort Assessment in Dying), pain (PAINAD: Pain Assessment in Advanced Dementia), and respiratory distress (RDOS: Respiratory Distress Observation Scale). Outcomes were scheduled daily from diagnosis until 10 days later and a final time between 13-15 days from diagnosis by trained observers who were blinded to the intervention and the residents' condition and treatment. In a pre-intervention phase, usual care was provided to all homes. In the intervention phase, matched clusters of homes were randomized to either the control (n = 16) or intervention condition (n = 16).Results: Between 1 January 2012 and 1 May 2015, 464 episodes of pneumonia were included. Outcomes were obtained for 399 episodes in 367 residents. Longitudinal multilevel linear regression analyses were performed on log-transformed outcomes, so coefficients should be interpreted as a ratio, and a coefficient of 1 means no difference. The practice guideline in the intervention phase did not reduce the level of discomfort and symptoms: DS-DAT: 1.11 (95 % CI 0.93-1.31), EOLD-CAD: 1.01 (95 % CI 0.98-1.05), PAINAD: 1.04 (95 % CI 0.93-1.15), RDOS: 1.11 (95 % CI 0.90-1.24). However, in both the intervention and control groups, lack of comfort and respiratory distress gradually decreased during the entire 3.5 years of data collection, and were lower in the intervention phase compared to the pre-intervention phase: DS-DAT: 0.93 (95 % CI 0.85-1.01), EOLD-CAD: 0.98 (95 % CI 0.97-1.00), PAINAD: 0.96 (95 % CI 0.91-1.01), RDOS: 0.92 (95 % CI 0.87-0.98).Conclusions: When compared to usual care, the practice guideline for optimal symptom relief did not relieve discomfort and symptoms in nursing home residents with dementia and pneumonia. However, discomfort and symptoms decreased gradually throughout the data collection in both the intervention homes and the control homes. An intervention that focuses on creating awareness may be more effective than a physician practice guideline.Trial Registration: The Netherlands National Trial Register (ID number NTR5071 . Registered 10 March 2015). [ABSTRACT FROM AUTHOR]- Published
- 2016
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50. Psychological distress in informal caregivers of patients with dementia in primary care: course and determinants.
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Borsje, Petra, Hems, Marleen A. P., Lucassen, Peter L. B. J., Bor, Hans, Koopmans, Raymond T. C. M., and Pot, Anne Margriet
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PSYCHOLOGICAL distress ,CAREGIVERS ,DEMENTIA ,MEDICAL care ,LONGITUDINAL method ,PSYCHOLOGY of caregivers ,COMPARATIVE studies ,MENTAL depression ,NEUROPSYCHOLOGICAL tests ,RESEARCH methodology ,MEDICAL cooperation ,MENTAL health ,PRIMARY health care ,PSYCHOLOGICAL tests ,QUALITY of life ,QUESTIONNAIRES ,RESEARCH ,SEX distribution ,PSYCHOLOGY of Spouses ,PSYCHOLOGICAL stress ,EVALUATION research - Abstract
Background: The course of psychological distress in informal caregivers of patients with dementia has been investigated in longitudinal studies with conflicting outcomes.Objectives: We investigated the course and determinants of psychological distress in informal caregivers of patients with dementia in primary care.Methods: In this prospective observational cohort study, data were collected at baseline, after 9 and 18 months. We assessed cognition and neuropsychiatric symptoms (NPS) of the patient (Mini-Mental State Examination and Neuropsychiatric Inventory) and psychological distress (Sense of Competence Questionnaire, Center for Epidemiological Studies Depression scale and General Health Questionnaire 12-tem version) of the informal caregivers. Determinants for the course of psychological distress were caregivers' age, gender and relationship with the patient, patients' cognition and NPS, participation in a care program and admission to long-term care facilities (LTCF). With linear mixed models, the course over time for psychological distress and its determinants were explored.Results: We included 117 informal caregivers, of whom 23.1% had a high risk for depression and 41.0% were identified to be likely to have mental problems at baseline. We found a stable pattern of psychological distress over time. Higher frequency of NPS, informal caregivers' age between 50 and 70 years and being female or spouse were associated with higher psychological distress. For patients who were admitted to a LTCF during the study psychological distress of the informal caregivers improved.Conclusions: GPs should focus on NPS in patients with dementia and on caregivers' psychological distress and be aware of their risk for depression and mental problems, specifically to those who are spouse, female or between 50 and 70 years of age. [ABSTRACT FROM AUTHOR]- Published
- 2016
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