67 results on '"Koopmans, Raymond"'
Search Results
2. 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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3. Criteria for Psychosis in Major and Mild Neurocognitive Disorders: International Psychogeriatric Association (IPA) Consensus Clinical and Research Definition.
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Cummings, Jeffrey, Pinto, Luiz Cortez, Cruz, Manuel, Fischer, Corinne E., Gerritsen, Debby L., Grossberg, George T., Hwang, Tzung-Jeng, Ismail, Zahinoor, Jeste, Dilip V., Koopmans, Raymond, Lanctot, Krista L., Mateos, Raimundo, Peschin, Susan, Sampaio, Cristina, Tsuang, Debby, Wang, Huali, Zhong, Kate, Bain, Lisa J., and Sano, Mary
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Psychosis is common among individuals with neurocognitive disorders, is difficult to manage, and causes considerable burden and stress to patients and caregivers. Developing effective treatments is a substantial unmet medical need but research has been slowed by the need for updated consensus diagnostic criteria. To address this need, the International Psychogeriatrics Association initiated a process to develop criteria for clinical use, research, and treatment development efforts. The process included clinical, regulatory, and industry stakeholders as well as input from a global network of experts in geriatric psychiatry responding to two surveys (N = 336). Results from the consensus process confirmed that clinicians wanted elaboration of aspects of the definition proposed by Jeste and Finkel in 2000 to ensure that the criteria are applied appropriately. Based on discussions, the survey, and emerging research, criteria were revised to apply to psychosis occurring with all major and mild neurocognitive disorders. Other important changes include providing examples of hallucinations and delusions and clarifying time course, impact, and exclusionary criteria. This definition of psychosis in major and mild neurocognitive disorders can be used to advance many types of research including development of much needed pharmacologic and nonpharmacologic interventions for psychosis in patients with neurocognitive disorders. [ABSTRACT FROM AUTHOR]
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- 2020
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4. Dutch Long-Term Care in Transition: A Guide for Other Countries.
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Koopmans, Raymond T.C.M., Leerink, Bas, and Festen, Dederieke A.M.
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MEDICAL care , *LONG-term health care - Published
- 2022
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5. Effects of a Multidisciplinary Intervention on the Presence of Neuropsychiatric Symptoms and Psychotropic Drug Use in Nursing Home Residents WithYoung-Onset Dementia: Behavior and Evolution of Young-Onset Dementia Part 2 (BEYOND-II) Study.
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Appelhof, Britt, Bakker, Christian, de Vugt, Marjolein E., van Duinen-van den IJssel, Jeannette C.L., Zwijsen, Sandra A., Smalbrugge, Martin, Teerenstra, Steven, Verhey, Frans R.J., Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
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Objective: The effect of an intervention on neuropsychiatric symptoms (NPS), particularly agitation and aggression, and psychotropic drug use (PDU) in institutionalized people with young-onset dementia (YOD) was evaluated.Methods: A randomized controlled trial was conducted using a stepped wedge design. Thirteen YOD special care units were randomly assigned to three groups, which received the intervention at different time points. Four assessments took place every 6 months during a period of 18 months. Two hundred seventy-four people with YOD who resided in YOD special care units participated, of whom 131 took part in all assessments. The intervention consisted of an educational program combined with a care program, which structured the multidisciplinary process of managing NPS. The care program included the following five steps: evaluation of psychotropic drug prescription, detection, analysis, treatment, and evaluation of treatment of NPS. The Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version were used to assess NPS. Data on PDU were retrieved from residents' medical files. Multilevel models were used to evaluate the effect of the intervention, which accounted for clustering of measurements in clients within units.Results: No significant differences were found in agitation, aggression, other NPS, or PDU after crossing over to the intervention condition.Conclusion: We found no evidence that the intervention for management of NPS in nursing home residents with YOD was more effective in reducing agitation, aggression, other NPS, or PDU compared with care as usual. [ABSTRACT FROM AUTHOR]- Published
- 2019
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6. Two-Year Course of Quality of Life in Nursing Home Residents with Dementia.
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van der Zon, Anne, Wetzels, Roland B., Bor, Hans, Zuidema, Sytse U., Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
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Objective: To assess the course of quality of life (QoL) in nursing home residents with dementia and to study its predictors.Methods: This longitudinal, multicenter, observational cohort study with a 2-year follow-up looked at 290 residents with dementia, who lived in 14 dementia special care units in nine nursing homes in the Netherlands. QoL was assessed with the Qualidem, providing a total score and QoL profile with nine subscales. Residents were assessed at five assessments: every 6 months during 2 years. A linear mixed model was used for data analysis.Results: No change was found in the Qualidem total score (range: 0-111) over 2 years. However, a significant increase of QoL over time was seen in the subscales "Care relationship," "Negative affect," "Restless tense behavior," "Positive self-image," "Social isolation," and "Feeling at home." A significant decrease of QoL was seen in the subscales "Positive affect," "Social relations," and "Having something to do." Most predictors of the course of Qol were found for the subscales "Positive self-image" (sex, Global Deterioration Scale, Severe Impairment Battery, Activities of Daily Living, and Neuropsychiatric Inventory) and "Having something to do" (Global Deterioration Scale, Severe Impairment Battery, and Activities of Daily Living). Sex and Neuropsychiatric Inventory at baseline were the predictors found most frequently.Conclusion: The total QoL score was stable over a 2-year period. However, QoL subscales showed multidirectional changes. The largest QoL decline in the subscale "Having something to do" suggests that more attention should be given to useful activities in nursing home care. [ABSTRACT FROM AUTHOR]- Published
- 2018
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7. Nursing Home Residents with Dementia and Very Frequent Agitation: A Particular Group.
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Veldwijk-Rouwenhorst, Annelies E., Smalbrugge, Martin, Wetzels, Roland, Bor, Hans, Zuidema, Sytse U., Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
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Objective: Although many nursing home residents with dementia show agitation, hardly any literature is published about very frequent agitation. The WAALBED-III study focuses on the 2-week prevalence and correlates of very frequent agitation in these residents.Design: Cross-sectional study using combined data of four studies.Setting: One hundred nineteen dementia special care units in twenty-six nursing homes in The Netherlands.Participants: Two thousand seventy-four residents with dementia.Measurements: We operationally defined very frequent agitation as having a score of 6 (several times a day) or 7 (several times an hour) on at least five items of the Cohen Mansfield Agitation Inventory (CMAI) combined with a CMAI total score above the 90th percentile. To assess the association of demographic and behavioral characteristics with very frequent agitation, we performed a multivariate multilevel logistic regression analysis.Results: The 2-week prevalence of very frequent agitation was 7.4% (95% CI: 6.374-8.634). Correlates for very frequent agitation were age (OR: 0.967, 95% CI: 0.942-0.992), dementia severity (GDS 6 = OR: 3.636, 95% CI: 1.929-6.875; GDS 7 = OR: 2.951, 95% CI: 1.321-6.588), delusions (OR: 2.480, 95% CI: 1.555-3.956), anxiety (OR: 1.904, 95% CI: 1.259-2.881), euphoria (OR: 3.712, 95% CI: 2.171-6.337) and irritability (OR: 4.411, 95% CI: 2.854-6.816).Conclusions: To our knowledge, this study is the first to report prevalence data and correlates about nursing home residents with very frequent agitation. We found several correlated factors for very frequent agitation. Still, further research is needed for a better understanding of the behavior of this group, and to identify good treatment options. [ABSTRACT FROM AUTHOR]- Published
- 2017
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8. The Dutch Move Beyond the Concept of Nursing Home Physician Specialists.
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Koopmans, Raymond T.C.M., Pellegrom, Mariëtte, and van der Geer, Eric R.
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MEDICAL specialties & specialists , *NURSING care facilities , *PHYSICIANS - Published
- 2017
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9. The Impact of Young Onset Dementia on Informal Caregivers Compared with Late Onset Dementia: Results from the NeedYD Study.
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Millenaar, Joany K., de Vugt, Marjolein E., Bakker, Christian, van Vliet, Deliane, Pijnenburg, Yolande A. L., Koopmans, Raymond T. C. M., and Verhey, Frans R. J.
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Objectives: The impact of the dementia might be more severe for caregivers of people with young onset dementia (YOD) compared with those who care for someone with late onset dementia (LOD), as a young age among caregivers has been identified as a predictor of increased burden. The present study compares well-being between LOD and YOD caregivers longitudinally because this knowledge is essential in order to develop adequate support programs.Design, Setting, and Participants: 220 YOD and 108 LOD patient-caregiver dyads were included from two prospective cohorts with a 2-year follow up. To assess well-being we used the Short Sense of Competence Questionnaire, the RAND-36, the Symptom Checklist 90, and the Montgomery Asberg Depression Rating Scale. The severity and the course of the different measures used to describe caregiver burden were analyzed with linear mixed models.Results: Caregivers in both groups experienced high levels of physical and psychological complaints, mild depressive symptoms, lower health-related quality of life (HRQoL), and decreased feelings of competence. The severity and the course of most measures were similar in both groups, although HRQoL on both the physical and the mental domain was lower for the YOD caregivers.Conclusions: The number of actual psychological and physical complaints does not differ between YOD and LOD caregivers. YOD caregivers have greater perceived difficulties in daily life because of these complaints, however. [ABSTRACT FROM AUTHOR]- Published
- 2016
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10. Unmet Needs and Health-Related Quality of Life in Young-Onset Dementia.
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Bakker, Christian, de Vugt, Marjolein E., van Vliet, Deliane, Verhey, Frans, Pijnenburg, Yolande A., Vernooij-Dassen, Myrra J. F. J., and Koopmans, Raymond T. C. M.
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The article presents a study aimed at proving that the number of unmet needs in young-onset dementia (YOD) is related to both patient and caregiver health-related quality of life (HRQOL). Topics discussed include HRQOL in YOD patients and likely differences with caregiver views on patient HRQOL, HRQOL in YOD caregivers compared with the general population, and the link between unmet needs and both patient and caregiver HRQOL in YOD.
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- 2014
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11. The Use of Formal and Informal Care in Early Onset Dementia: Results From the NeedYD Study.
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Bakker, Christian, de Vugt, Marjolein E., van Vliet, Deliane, Verhey, Frans R. J., Pijnenburg, Yolande A., Vemooij-Dassen, Myrra J. F. J., and Koopmans, Raymond T. C. M.
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Objective: Early onset dementia (EOD) poses specific challenges and issues for both the patient and (in)formal care. This study explores the use of (in)formal care prior to institutionalization, and its association with patient and caregiver characteristics. Design/Setting: Participants were part of a community-based prospective longitudinal study of 215 patients and their informal caregivers. Participants: Baseline data of a subsample of 215 patient--caregiver dyads were analyzed. Measurements: Analyses of covariance were performed to determine correlates of(in)formal care use assessed with the Resource Utilization in Dementia (RUD)-Lite questionnaire. Results: Informal care had a 3:1 ratio with formal care. Supervision/surveillance constituted the largest part of informal care. In more than half of cases, patients had only one informal caregiver. The amount of informal care was associated with disease severity, showing more informal care hours in advanced disease stages. Fewer informal care hours were related to more caregiver working hours, especially in younger patients. The amount of formal care was related to disease severity, behavioral problems, and initiative for activities of daily living. Conclusion: In EOD, it appears that family members provide most of the care. However, other social roles still have to be fulfilled. Especially in spousal caregivers of younger patients in advanced disease stages, there is a double burden of work and care responsibilities. This finding also indicates that even within the EOD group there might be important age-related differences. The relatively higher amount of formal care use during advanced disease stages suggests a postponement in the use of formal care. [ABSTRACT FROM AUTHOR]
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- 2013
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12. Comparative Validation of Proxy-Based Montgomery-Asberg Depression Rating Scale and Cornell Scale for Depression in Dementia in Nursing Home Residents With Dementia.
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Leontjevas, Ruslan, Gerritsen, Debby L., Vernooij-Dassen, Myrra J. F. J., Smalbrugge, Martin, and Koopmans, Raymond T. C. M.
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Objective: To 1) compare the accuracy of the Montgomery-Asberg Depression Rating Scale (MADRS) and the Cornell Scale for Depression in Dementia (CSDD) in nursing home residents with dementia when professional caregivers are the only available source of information and 2) explore different methods to account for missing items. Design: Cross-sectional design. Setting: Nursing home (NH). Participants: One hundred one residents with dementia. Measurements: NH residents with dementia were assessed on the presence of clinical depression using Provisional Diagnostic Criteria for Depression of Alzheimer's Disease. The MADRS and CSDD were administered in a structured interview with professional primary caregivers. Results: Receiver operating characteristic" analyses revealed no significant differences between areas under the empirical curve for MADRS and CSDD. Imputation of a lowest possible item score for missing items revealed larger areas than three other methods (significant result only for CSDD). A MADRS cutoff score of "> 13" yielded the highest sum of sensitivity (78%) and specificity (66%). A CSDD cutoff score of ">6" yielded the highest sum of sensitivity (94%) and specificity (49%). Both scales showed high negative predictive values up to 100% and low positive predictive values not exceeding 50%. Conclusion: The proxy-based MADRS and CSDD did not differ in distinguishing depressed from nondepressed NH residents and may be used for screening purposes. For missing items, imputation of a lowest possib le item score may be applied. The MADRS and CSDD may be better used for ruling out rather than for ruling in depression. [ABSTRACT FROM AUTHOR]
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- 2012
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13. To What Extent Can Multimorbidity Be Viewed as a Determinant of Postural Control in Stroke Patients?
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Spruit-van Eijk, Monica, Zuidema, Sytse U., Buijck, Bianca I., Koopmans, Raymond T., and Geurts, Alexander C.
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Abstract: Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RT, Geurts AC. To what extent can multimorbidity be viewed as a determinant of postural control in stroke patients? Objective: To investigate the determinants of postural imbalance after stroke in geriatric patients admitted for low-intensity rehabilitation in skilled nursing facilities (SNFs), particularly the role of multimorbidity. Design: Cross-sectional study design. Setting: Fifteen SNFs. Participants: All patients who were admitted for rehabilitation after stroke in one of the participating SNFs (N=378) were eligible. Interventions: Not applicable. Main Outcome Measures: The Berg Balance Scale (BBS) was selected as a measure of standing balance and the Functional Ambulation Categories (FAC) as a measure of walking balance. Results: Multimorbidity was present in 34% of the patients. The patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on both outcome measures. In linear regression analyses, both the BBS and FAC were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively), while proprioception added only to the variance of the FAC. Conclusions: Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs. Muscle strength and the interaction of muscle strength with static sitting balance were important determinants of both standing and walking balance, indicating these factors as essential targets for rehabilitation. [Copyright &y& Elsevier]
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- 2012
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14. Course of Neuropsychiatric Symptoms in Residents with Dementia in Nursing Homes Over 2-Year Period.
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Wetzels, Roland B., Zuidema, Sytse U., de Jonghe, Jos F. M., Verhey, Frans R. J., and Koopmans, Raymond T. C. M.
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Objective: To determine the course of neuropsychiatric symptoms (NPSs) in nursing home residents with dementia and to determine their variability across diagnosis. Design: Prospective cohort study over 2 years. Setting: Fourteen dementia special care units in nine nursing homes in The Netherlands. Participants: One hundred seventeen residents with dementia. Measurements: NPSs were measured using the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Results: The majority of residents had moderately severe to severe dementia. All but a few residents (97%) showed any NPS, and co-occurrence of NPSs was high. Agitation, irritability, and aberrant motor behavior were the most prevalent over the 2 years. Depression and anxiety as well as NPI total score decreased over time, whereas apathy tended to increase. Agitation and aberrant motor behavior were the most persistent symptoms. In asymptomatic residents, highest incidence rates were found for apathy, aggression/agitation, irritability, and aberrant motor behavior. Anxiety and apathy were more prevalent in Alzheimer disease (AD) compared with vascular disease (VaD); vice versa, aggression and depression were more prevalent in VaD. Differences in change over time between AD and VaD were found for irritability and disinhibition. Conclusion: This is the first study examining the 2-year course of NPSs in a large group of nursing home residents with dementia. Virtually all residents demonstrated and/or developed NPSs. Although affective symptoms decreased, apathy tended to increase. Agitated behaviors were particularly persistent. Our data may contribute to improve mental healthcare for demented nursing home residents. [ABSTRACT FROM AUTHOR]
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- 2010
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15. Concrete Steps Toward Academic Medicine in Long Term Care.
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Koopmans, Raymond T.C.M., Lavrijsen, Jan C.M., and Hoek, Frank
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- 2013
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16. Advancing Long Term Care: Central European Perspectives
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Holmerová, Iva, Koopmans, Raymond, Skela Savič, Brigita, Egervári, Agnes, Hermann, Brigitte, Ruseckiene, Rasa, and Tolson, Debbie
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ELDER care , *AGING , *HOSPITAL utilization , *LONG-term health care , *NURSING home patients , *NURSING care facilities - Published
- 2012
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17. Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial.
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Tilburgs, Bram, Koopmans, Raymond, Vernooij-Dassen, Myrra, Adang, Eddy, Schers, Henk, Teerenstra, Steven, van de Pol, Marjolein, Smits, Carolien, Engels, Yvonne, and Perry, Marieke
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CONFIDENCE intervals , *CONVERSATION , *DECISION making , *DEMENTIA , *DEMENTIA patients , *PHYSICIAN-patient relations , *ROLE playing , *STATISTICAL sampling , *ADVANCE directives (Medical care) , *RANDOMIZED controlled trials , *EDUCATIONAL outcomes , *BLIND experiment , *PATIENTS' attitudes , *DESCRIPTIVE statistics , *ODDS ratio - Abstract
Advance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care. A single-blinded cluster randomized controlled trial. In 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice. Intervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering. 38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P =.002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P =.003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P <.001) preferences per person with dementia than control group GPs. Our educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown. [ABSTRACT FROM AUTHOR]
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- 2020
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18. Reimagining Postdiagnostic Care and Support in Young-Onset Dementia.
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Bakker, Christian, Verboom, Marjon, and Koopmans, Raymond
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AGE , *MEDICAL care , *DEMENTIA , *AGE factors in disease , *PSYCHIATRIC treatment , *MIDDLE age , *ADULTS - Abstract
Although dementia has a profound impact in general, young-onset dementia causes additional problems and challenges as people are affected in their prime years. Awareness has increased that people with young-onset dementia and their families have specific care needs and dedicated services are necessary to accommodate those needs. However, in many countries, age-appropriate care and support for people with young-onset dementia is still largely unavailable. In this special article, barriers as well as facilitators for the development of postdiagnostic care and support in young-onset dementia are addressed. Drawing from the experiences in the Netherlands, the establishment of an appropriate infrastructure has proven a corner stone in service development in young-onset dementia. The establishment of a center at the national level for the development and dissemination of knowledge and affiliated regional centers that coordinate and offer care and support at the regional level has helped to reimagine, redefine, but more importantly also rearrange, postdiagnostic care and support in young-onset dementia in the Netherlands. This has resulted in care standards for service provision in young-onset dementia that have been incorporated in the dementia standard at the national level. Also, a quality hallmark has been developed to guide the arrangement of age-appropriate services at the local level. Moreover, specific training programs are in place for health care professionals involved in young-onset dementia. To be able to prioritize topics in research for the upcoming years, a scientific agenda has been established. The strong collaboration between organizations that provide a voice for people with dementia, care providers and research centers, that all strive to support people to live well with young-onset dementia has boosted these developments and may inspire other countries searching for ways to improve postdiagnostic care and support in young-onset dementia. [ABSTRACT FROM AUTHOR]
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- 2022
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19. Palliative Care in People With Young-Onset Dementia (YOD): An Undiscovered Area!
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Koopmans, Raymond T.C.M., van der Steen, Jenny T., and Bakker, Christian
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AGE factors in disease , *ALZHEIMER'S disease , *PALLIATIVE treatment , *PRESENILE dementia , *FRONTOTEMPORAL dementia - Published
- 2015
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20. Short- and Long-Term Mortality and Mortality Risk Factors among Nursing Home Patients after COVID-19 Infection.
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Booij, Johannes A., van de Haterd, Julie C.H.Q., Huttjes, Sanne N., van Deijck, Rogier H.P.D., and Koopmans, Raymond T.C.M.
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RESEARCH , *COVID-19 , *CONFIDENCE intervals , *TIME , *RETROSPECTIVE studies , *ACQUISITION of data , *DYSPNEA , *MEDICAL records , *KAPLAN-Meier estimator , *DESCRIPTIVE statistics , *LOGISTIC regression analysis , *FATIGUE (Physiology) , *REACTIVE oxygen species , *LONGITUDINAL method , *COMORBIDITY , *OXYGEN in the body ,MORTALITY risk factors - Abstract
To assess short- and long-term mortality and risk factors in nursing home patients with COVID-19 infection. Retrospective 2-center cohort study. Dutch nursing home patients with clinically suspected COVID-19 infection confirmed by reverse transcription-polymerase chain reaction testing. Data were gathered between March 2020 and November 2020 using electronic medical records, including demographic characteristics, comorbidities, medical management, and symptoms on the first day of suspected COVID-19 infection. Mortality at 30 days and 6 months was assessed using multivariate logistic regression models and Kaplan-Meier analysis. At 6 months, a subgroup analysis was performed to estimate the mortality risk between COVID-negative patients and patients who survived COVID-19. Risk factors for mortality were assessed through multivariate logistic regression models. A total of 321 patients with suspected COVID-19 infection were included, of whom 134 tested positive. Sixty-two patients in the positive group died at 30 days, with a short-term mortality rate of 2.9 (95% CI 1.7–5.3). Risk factors were fatigue (OR 2.6, 95% CI 1.3–6.2) and deoxygenation (OR 2.9, 95% CI 1.3–7.6). At 6 months, the mortality risk was 2.1 (95% CI 1.3–3.7). Risk factors for 6-month mortality were shortness of breath (OR 2.7, 95% CI 1.3–7.0), deoxygenation (OR 2.5, 95% CI 1.1–6.5) and medical management (OR 4.5, 95% CI 1.7–25.8). However, among patients who survived COVID-19 infection, the long-term mortality risk was not sustained (OR 1.0, 95% CI 0.4–2.7). Overall, COVID-19 infection increases short- and long-term mortality risk among nursing home patients. However, this study shows that surviving COVID-19 infection does not lead to increased mortality in the long term within this population. Therefore, advanced care planning should focus on quality of life among nursing home patients after COVID-19 infection. [ABSTRACT FROM AUTHOR]
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- 2022
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21. Generalist-Specialist Collaboration in Primary Care for Frail Older Persons: A Promising Model for the Future.
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Vrijmoeth, Talitha, Wassenaar, Annelies, Koopmans, Raymond T.C.M., Nieuwboer, Minke S., and Perry, Marieke
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RESEARCH methodology , *INTERVIEWING , *PRIMARY health care , *QUALITATIVE research , *INTERPROFESSIONAL relations , *QUALITY assurance , *CASE studies , *THEMATIC analysis , *MEDICAL needs assessment - Abstract
The complex care needs of frail older persons living at home is a major challenge for health care systems worldwide. One possible solution is to employ a primary care physician (PCP) with additional geriatric expertise. In the Netherlands, elderly care physicians (ECPs), who traditionally work in nursing homes, are increasingly encouraged to utilize their expertise within primary care. However, little is known about how PCPs and ECPs collaborate. Therefore, we aimed to unravel the nature of the current PCP-ECP collaboration in primary care for frail older persons, and to identify key concepts for success. A qualitative multiple case study with semistructured interviews. A selection of 22 participants from 7 "established collaboration practices" within the primary care setting in the Netherlands, including at least 1 ECP, 1 PCP, and 1 other health care professional for every included established collaboration practice. Transcripts of individual interviews were analyzed using largely double and independent open and axial coding, and formulation of themes and subthemes. Data analysis revealed 4 key concepts for success: (1) clarification of roles and expectations (ie, patient-centered care and embedding in existing care networks), (2) trust, respect, and familiarity as drivers for collaboration (ie, mutual trust through knowing each other and having shared goals); (3) framework for regular communication (ie, structural meetings and a shared vision); and (4) government, payer, and organization support (ie, financial support and emphasis on the collaboration's urgency by organizations and national policy makers). For a successful generalist-specialist collaboration, health care professionals need to invest in building relationships and mutual trust, and incorporating their efforts in the existing care networks to guarantee patient-centeredness. When provided with reimbursement and appreciation, this collaboration is a promising change in general practice to improve the care and outcomes of frail older persons. [ABSTRACT FROM AUTHOR]
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- 2022
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22. Medications in Post-Acute and Long-Term Care: Challenges and Controversies.
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Sloane, Philip D., Brandt, Nicole J., Cherubini, Antonio, Dharmarajan, T.S., Dosa, David, Hanlon, Joseph T., Katz, Paul, Koopmans, Raymond T.C.M., Laird, Rosemary D., Petrovic, Mirko, Semla, Todd P., Tan, Edwin C.K., and Zimmerman, Sheryl
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ANTIBIOTICS , *CONFLICT (Psychology) , *DRUG prescribing , *LONG-term health care , *MEDICAL prescriptions , *MEDICAL practice , *NURSING care facilities , *PARASYMPATHOMIMETIC agents , *PSYCHIATRIC drugs , *QUALITY assurance , *SERIAL publications , *SUBACUTE care , *PROTON pump inhibitors , *PHYSICIAN practice patterns , *INDIVIDUALIZED medicine , *INAPPROPRIATE prescribing (Medicine) - Published
- 2021
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23. The Prevalence and Determinants of Neuropsychiatric Symptoms in People With Acquired Brain Injury in Nursing Homes.
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Kohnen, Roy F., Lavrijsen, Jan C.M., Akkermans, Reinier P., Gerritsen, Debby L., and Koopmans, Raymond T.C.M.
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AGGRESSION (Psychology) , *BRAIN injuries , *LONG-term health care , *NURSING care facilities , *SCIENTIFIC observation , *PSYCHOLOGICAL tests , *PSYCHIATRIC drugs , *QUESTIONNAIRES , *AGITATION (Psychology) , *MULTIPLE regression analysis , *BEHAVIOR disorders , *DISEASE prevalence , *CROSS-sectional method , *STATISTICAL models , *DESCRIPTIVE statistics - Abstract
Establishing the prevalence and determinants of neuropsychiatric symptoms (NPS) in patients with acquired brain injury (ABI) in nursing homes. Cross-sectional, observational study. Patients 18-65 years old with ABI in special care units in Dutch nursing homes. Nursing homes were recruited through the national expertise network for patients with severe ABI, regional brain injury teams, and by searching the Internet. Patient characteristics were collected through digital questionnaires. NPS were assessed with the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI), cognition with the Mini-Mental State Examination, and activities of daily living with the Disability Rating Scale. Psychotropic drug use (PDU) was retrieved from the electronic prescription system. Individual NPS were clustered. Associations between determinants and NPS were examined using multilevel multivariate linear regression models. In a population of 118 patients from 12 nursing homes, 73.7% had 1 or more clinically relevant NPS and 81.3% 1 or more agitated behaviors. The most common NPS were agitation, in particular aberrant motor behavior (24.6%), repetitious sentences/questions (35.5%), and constant requests for attention (34.6%), verbal (33.6%) and physical (50.5%) aggression, and irritability (28.0%). Male patients were more likely to display hyperactivity. Being married was associated with less verbally agitated behavior and pain was associated with a higher CMAI total score. PDU increased the likelihood of a higher NPI-NH total score. NPS are common in patients with ABI ≤65 years of age residing in nursing homes. This is a first step to fill in the knowledge gap concerning NPS in this population. An increasing number of patients with severe ABI may survive the acute phase and will reside many years in nursing homes. It is important to shed more light on these NPS, with regard to course, magnitude, and severity, to ultimately develop appropriate care for this vulnerable group of patients. [ABSTRACT FROM AUTHOR]
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- 2020
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24. Allowing Visitors Back in the Nursing Home During the COVID-19 Crisis: A Dutch National Study Into First Experiences and Impact on Well-Being.
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Verbeek, Hilde, Gerritsen, Debby L., Backhaus, Ramona, de Boer, Bram S., Koopmans, Raymond T.C.M., and Hamers, Jan P.H.
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EPIDEMICS , *HEALTH , *INTERVIEWING , *RESEARCH methodology , *MEDICAL protocols , *NURSING care facilities , *PERSONAL protective equipment , *QUESTIONNAIRES , *VISITING the sick , *CROSS-sectional method , *COVID-19 - Abstract
To prevent and control COVID-19 infections, nursing homes across the world have taken very restrictive measures, including a ban for visitors. These restrictive measures have an enormous impact on residents' well-being and pose dilemmas for staff, although primary data are lacking. A Dutch guideline was developed to cautiously open nursing homes for visitors during the COVID-19 pandemic. This study reports the first findings on how the guideline was applied in the local context; the compliance to local protocols; and the impact on well-being of residents, their family caregivers, and staff. A mixed-methods cross-sectional study was conducted. In total, 26 nursing homes were permitted to enlarge their possibilities for allowing visitors in their facility. These nursing homes were proportionally representative of the Netherlands as they were selected by their local Area Health Authority for participation. At each nursing home, a contact person was selected for participation in the current study. A mixed-methods cross-sectional study was conducted, consisting of questionnaire, telephone interviews, analyses of documentation (ie, local visiting protocols), and a WhatsApp group. Variation in local protocols was observed, for example, related to the use of personal protective equipment, location, and supervision of visits. In general, experiences were very positive. All nursing homes recognized the added value of real and personal contact between residents and their loved ones and indicated a positive impact on well-being. Compliance with local guidelines was sufficient to good. No new COVID-19 infections were reported during this time. These results indicate the value of family visitation in nursing homes and positive impact of visits. Based on these results, the Dutch government has decided to allow all nursing homes in the Netherlands to cautiously open their homes using the guidelines. More research is needed on impact and long-term compliance. [ABSTRACT FROM AUTHOR]
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- 2020
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25. Comparing Advance Care Planning in Young-Onset Dementia in the USA vs Belgium: Challenges Partly Related to Societal Context.
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Van Rickstal, Romy, De Vleminck, Aline, Morrison, Sean R., Koopmans, Raymond T., van der Steen, Jenny T., Engelborghs, Sebastiaan, Neugroschl, Judith, Aldridge, Melissa D., Sano, Mary, and Van den Block, Lieve
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CAREGIVERS , *DEMENTIA , *INTERVIEWING , *RESEARCH methodology , *RESEARCH , *ADVANCE directives (Medical care) , *QUALITATIVE research , *JUDGMENT sampling - Abstract
Advance care planning in young-onset dementia largely remains a blind spot within current literature. This study aimed to explore the engagement in and the conceptualization of advance care planning from the perspective of family caregivers of persons with young-onset dementia and to identify potential similarities and differences in this area between American and Belgian persons with young-onset dementia and their family caregivers. An exploratory qualitative study. We purposively sampled adult family caregivers of persons with young-onset dementia; our respondents were 13 American and 15 Belgian caregivers with varying familial relationships to the patient. We conducted 28 semi-structured interviews, using the same interview guide for American and Belgian respondents. Verbatim transcripts were analysed through the method of constant comparative analysis. Important similarities between American and Belgian respondents were restricted knowledge of advance care planning, limited communication about advance directives, and their recommendation for professionals to timely initiate advance care planning. Major differences were attention paid to those end-of-life decisions depicted in the legislature of their respective countries, American caregivers placed higher emphasis on financial planning than their Belgian peers, and, in the case of consulting professionals for advance directives, American caregivers turned to lawyers, whereas Belgian caregivers relied on physicians. Specific nuances and challenges in terms of advance care planning in young-onset dementia arise from a particular societal and legal context on the one hand, and from patients' and caregivers' younger age on the other. Professionals' awareness of and responsiveness to these specificities could facilitate the advance care planning process. Based on our interpretation of results, several recommendations for practice and policy are made. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Effects on staff outcomes from an intervention for management of neuropsychiatric symptoms in residents of young-onset dementia care units: A cluster randomised controlled trial.
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van Duinen-van den IJssel, Jeannette C.L., Bakker, Christian, Smalbrugge, Martin, Zwijsen, Sandra A., Appelhof, Britt, Teerenstra, Steven, Zuidema, Sytse U., de Vugt, Marjolein E., Verhey, Frans R.J., and Koopmans, Raymond T.C.M.
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PSYCHOLOGICAL burnout prevention , *PSYCHIATRIC nursing , *AGE factors in disease , *PSYCHOLOGICAL burnout , *CONFIDENCE intervals , *DEMENTIA , *DEPERSONALIZATION , *EMOTIONS , *HEALTH care teams , *JOB satisfaction , *JOB stress , *NURSES , *NURSES' attitudes , *QUESTIONNAIRES , *RESEARCH funding , *STATISTICAL sampling , *RANDOMIZED controlled trials , *EVALUATION of human services programs , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Neuropsychiatric symptoms are common in nursing home residents with young-onset dementia and burdensome for nursing staff. It is known that neuropsychiatric symptoms are associated with burn-out complaints and low job satisfaction. An intervention aimed at decreasing neuropsychiatric symptoms in nursing home residents with young-onset dementia might also result in less burnout complaints and job demands and improve job satisfaction in nursing staff. The aim was to evaluate the effect of the intervention on nursing staff burnout, job satisfaction and job demands. Cluster randomised controlled trial using a stepped wedge design with a total duration of 18 months, with four assessments. Thirteen young-onset dementia special care units across the Netherlands were, by means of random allocation software, assigned to three groups crossing over at different time points. All nursing staff, in total 391, were invited to participate. 305 nursing staff participated during the course of the study of whom 71 participated in all assessments. An educational program followed by a structured multidisciplinary care program aimed at the management of neuropsychiatric symptoms. The care program consists of evaluation of psychotropic drug prescription followed by detection, analysis, treatment and evaluation of treatment of neuropsychiatric symptoms. Emotional exhaustion, depersonalisation and personal accomplishment were assessed with the Utrecht Burnout Scale. Job satisfaction and job demands were assessed with subscales of the Leiden Quality of Work Questionnaire. The baseline burnout risk on emotional exhaustion and personal accomplishment was average, and low on depersonalisation. The mean scores for job satisfaction were above average and for job demands average. Linear mixed models showed that the intervention had no effect on emotional exhaustion (estimated effect −0.04, 95% confidence interval −1.25 to 1.16), depersonalisation (estimated effect 0.24, 95% confidence interval −0.26 to 0.74), personal accomplishment (estimated effect −0.82, 95% confidence interval −1.86 to 0.22) job satisfaction (estimated effect −0.40, 95% confidence interval −0.98 to 0.17) and job demands (estimated effect −0.04, 95% confidence interval −0.57 to 0.49). A significant difference was found between registered nurses and other nursing staff on emotional exhaustion and job satisfaction. Compared to other staff members, registered nurses' emotional exhaustion scores slightly increased while job satisfaction slightly decreased when using the intervention. The intervention was not effective on three dimensions of burnout, job satisfaction and job demands. Staff scored positive on the outcomes of interest before implementation of the intervention, leaving little opportunity for improvement. [ABSTRACT FROM AUTHOR]
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- 2019
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27. Bayesian Analyses Showed More Evidence for Apathy than for Depression Being Associated With Cognitive Functioning in Nursing Home Residents.
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Leontjevas, Ruslan, Fredrix, Lily, Smalbrugge, Martin, Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
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APATHY , *COGNITION disorders , *MENTAL depression , *NURSING home patients , *PROBABILITY theory , *PSYCHOLOGICAL tests , *REGRESSION analysis , *CROSS-sectional method - Abstract
Abstract Objectives Depression, apathy, and cognitive impairments are widespread in nursing home (NH) residents. Scarce research that explicitly compares apathy to depression suggests that the association between apathy and cognitive functioning is stronger than the association between depression and cognitive functioning. This study in Dutch NH residents aimed to use Bayesian methods for comparing the evidence for the relationship of cognitive performance with apathy to that with depression. Design Cross-sectional. Setting and Participants Sixteen NH somatic care units (N = 190 residents; mean age 77.2 years, standard deviation 12.9), and 17 dementia special care units (N = 243 residents; mean age 82.8 years standard deviation, 6.8]). Measures The Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were administered in residents for cognitive performance. Professional carers were interviewed for the Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Results Regression models built with the BayesFactor package in R showed Bayesian factors (BFs) that implied extremely strong evidence in terms of the Jeffrey classification for the relationship of apathy with MMSE [standardized effect size, −0.57 (−0.66 to −0.48), BF = 3.4E+28], and with FAB [−0.50 (−0.59 to −0.42), BF = 3.0E+24]. Regarding depression, evidence was a minor fraction of that for apathy [MMSE, −0.17 (−0.27 to −0.06), BF = 15.45; FAB, −0.12 (−0.22 to −0.02), BF = 2.11]. The most evidence existed for the associations of apathy with MMSE orientation problems, especially orientation in time. Conclusions/Implications The study implies that cognitive assessments are important to differentiate apathy from depression in NH residents both with dementia and without dementia. More research is needed to clarify whether disorientation in time is a specific cognitive marker of apathy that may be used to reduce false positive depression diagnoses. [ABSTRACT FROM AUTHOR]
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- 2018
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28. Do Not Harm Older Persons in Primary Care by Case Finding of Cognitive Decline, Instead Assess Cognition Only Following Loss of Well-being.
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Olde Rikkert, Marcel G.M., Claassen, Jurgen A.H.R., and Koopmans, Raymond T.C.M.
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COGNITION disorders , *GERIATRIC assessment , *COGNITIVE testing , *PRIMARY health care , *OLD age , *PREVENTION - Published
- 2016
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29. Process Evaluation of an Intervention for the Management of Neuropsychiatric Symptoms in Young-Onset Dementia.
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Appelhof, Britt, Bakker, Christian, van Duinen-van den IJssel, Jeannette C.L., Zwijsen, Sandra A., Smalbrugge, Martin, Verhey, Frans R.J., de Vugt, Marjolein E., Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
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TREATMENT of dementia , *AGE distribution , *AGE factors in disease , *DEMENTIA , *INTERNET , *NEUROPSYCHOLOGY , *QUESTIONNAIRES , *SYMPTOMS - Abstract
Objectives A process evaluation was performed for an intervention aimed at improvement of the management of neuropsychiatric symptoms in young-onset dementia. Data about sample quality and intervention quality was evaluated to better understand internal and external validity. In addition, data about the implementation strategy and factors affecting implementation were evaluated to improve further implementation of the intervention. Design A model proposed by Leontjevas and colleagues consisting of first-order (validity) and second-order (implementation) data was used. Setting and Participants Care units delivering specialized treatment and support for residents with young-onset dementia. Measures A description of the recruitment, randomization procedure, and intervention reach was carried out to determine sample quality. To determine intervention quality, data on satisfaction, relevance, feasibility, and fidelity were collected through a questionnaire and reports logged on the server of the web-based intervention. A description of the implementation strategy was provided. Barriers and facilitators for implementation were collected by a questionnaire and analyzed by deductive content analysis. Results Care units varied in size and were recruited from different geographical regions in the Netherlands. The informed consent rate of the residents was 87.7%. The majority of the nursing home staff were satisfied with the intervention. However, parts of the intervention were perceived as less relevant for their own organization. The feasibility of the intervention was considered low. The fidelity differed between care units. The implementation strategy did not overcome all barriers. Factors affecting implementation covered 3 themes: organizational aspects, culture of the organization, and aspects of the intervention. Conclusions In general, our results showed sufficient internal and external validity, warranting further effect analyses. Adaptations to specific steps of the care program should be considered to increase feasibility and sustainability. In addition, integration of the care program into the electronic health records is expected to further improve implementation. [ABSTRACT FROM AUTHOR]
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- 2018
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30. Nursing Staff Distress Associated With Neuropsychiatric Symptoms in Young-Onset Dementia and Late-Onset Dementia.
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van Duinen-van den IJssel, Jeannette C.L., Mulders, Ans J.M.J., Smalbrugge, Martin, Zwijsen, Sandra A., Appelhof, Britt, Zuidema, Sytse U., de Vugt, Marjolein E., Verhey, Frans R.J., Bakker, Christian, and Koopmans, Raymond T.C.M.
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TREATMENT of dementia , *NEUROLOGICAL disorders , *THERAPEUTICS , *PSYCHOSES , *AGE factors in disease , *AGGRESSION (Psychology) , *APATHY , *CAREGIVERS , *DELUSIONS , *EMOTIONS , *HOSPITAL medical staff , *MULTIVARIATE analysis , *NURSES' attitudes , *NURSING care facilities , *SEX distribution , *SLEEP , *AGITATION (Psychology) , *MULTIPLE regression analysis , *SOCIAL support , *BURDEN of care , *RETROSPECTIVE studies , *SEVERITY of illness index , *HOSPITAL nursing staff , *ODDS ratio , *DELAYED onset of disease - Abstract
Objective The aims of this study were (1) to investigate the relationship between different neuropsychiatric symptoms (NPS) and the level of distress experienced by nurses caring for residents with young-onset dementia (YOD) and (2) to compare these findings with those for nurses caring for residents with late-onset dementia (LOD). Design/Setting This is a retrospective study conducted in Dutch long-term care facilities. Data were used from the Behavior and Evolution of Young-ONset Dementia studies (BEYOND) Parts I and II and the WAAL Behavior in Dementia-II (Waalbed-II) study. Participants A total of 382 nursing home residents with YOD and 261 nursing home residents with LOD were included. Measurements The Neuropsychiatric Inventory, nursing home version, was used to assess nursing staff distress and the frequency (F) and severity (S) of NPS. Multilevel logistic regression analysis was used to investigate the relationships between nursing staff distress related to NPS and YOD and LOD care units, the F × S score per symptom, gender, dementia subtype, and dementia severity. Results Nurses working in YOD care units rated sleep and nighttime behavior disorders, delusions, and agitation/aggression most often as highly distressing and euphoria most often as not distressing. Multivariate analyses indicated that the frequency and severity of NPS were significantly associated with staff distress in all symptoms, except for apathy. Comparison of the 2 groups of nurses demonstrated that the odds for distress related to sleep and nighttime behavior disorders were higher for nurses in YOD care units than for nurses in LOD units. For both the YOD and LOD nurses, irritability in male residents had higher impact than similar behavior in female residents. Conclusion This study provides important insight into distress related to individual NPS and the interaction with residents' characteristics. All NPS result in distress. The frequency and severity of the behavior is an important predictor. Sleep and nighttime behavior disorders are more likely to result in distress in YOD nurses than in LOD nurses. The amount of distress related to NPS emphasizes the urgent need for adequate management of NPS and the support of professional caregivers. [ABSTRACT FROM AUTHOR]
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- 2018
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31. What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study.
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van den Brink, Anne M.A., Gerritsen, Debby L., de Valk, Miranda M.H., Mulder, Astrid T., Oude Voshaar, Richard C., and Koopmans, Raymond T.C.M.
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BASIC needs , *GERIATRIC nursing , *INTERVIEWING , *LONGITUDINAL method , *RESEARCH methodology , *MULTIVARIATE analysis , *NEED (Psychology) , *NURSES , *NURSING home patients , *QUESTIONNAIRES , *REGRESSION analysis , *COMORBIDITY , *CROSS-sectional method - Abstract
Objective Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs. Methods Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents’ and nursing staff’s perceptions. Descriptive and multivariate regression analyses were conducted. Results Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated ‘no need’ regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs. Conclusions Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable. [ABSTRACT FROM AUTHOR]
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- 2018
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32. IAGG/IAGG GARN International Survey of End-of-Life Care in Nursing Homes.
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Wallace, Cara L., Swagerty, Daniel, Barbagallo, Mario, Vellas, Bruno, Cha, Heung Bong, Holmerova, Iva, Dong, Birong, Koopmans, Raymond, Cruz-Jentoft, Alfonso J., Gutierrez Robledo, Luis Miguel, Moreno, Juan Cuadros, Hajjar, Ramzi, Woo, Jean, Arai, Hidenori, Okochi, Jiro, Visvanathan, Renuka, Abdul-Rahman, Samia A., Goel, Ashish, Moser, Andrea, and Rolland, Yves
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HOSPICE care , *INTERNATIONAL agencies , *NURSING care facilities , *PALLIATIVE treatment , *SURVEYS , *TERMINAL care - Abstract
This article reports the findings of a survey on end-of-life (EOL) care in nursing homes of 18 long-term care experts across 15 countries. The experts were chosen as a convenience-based sample of known experts in each country. The survey was administered in 2016 and included both open-ended responses for defining hospice care, palliative care, and “end of life,” and a series of questions related to the following areas—attitudes toward EOL care, current practice and EOL interventions, structure of care, and routine barriers. Overall experts strongly agreed that hospice and palliative care should be available in long-term care facilities and that both are defined by holistic, interdisciplinary approaches using measures of comfort across domains. However, it appears the experts felt that in most countries the reality fell short of what they believed would be ideal care. As a result, experts call for increased training, communication, and access to specialized EOL services within the nursing home. [ABSTRACT FROM AUTHOR]
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- 2017
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33. 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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TERMINAL sedation , *HOSPICE care , *TREATMENT of dementia , *PALLIATIVE treatment , *PSYCHOMETRICS , *COMPARATIVE studies , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *NURSING care facilities , *PAIN , *RESEARCH , *TIME , *EVALUATION research , *TREATMENT effectiveness - Abstract
Context: A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS.Objectives: To identify the course of discomfort in patients receiving CPS.Methods: A prospective observational multicenter study in nine hospices and palliative care units was performed. The Discomfort Scale-Dementia of Alzheimer Type (DS-DAT) was independently assessed for monitoring of patient discomfort during CPS. The DS-DAT scores range from 0 (no observed discomfort) to a maximum of 27 (high level of observed discomfort). Using a mixed model, the mean group score of discomfort between four predefined time frames of CPS was compared, correcting for confounding patient characteristics.Results: A total of 130 patients were sedated, and the DS-DAT was completed in 106 patients at least once. The median duration of the sedation in these 106 patients was 25.5 hours (range 2-161). The mean score of the DS-DAT in the phase before sedation was 12.16 (95% CI 9.83-14.50) and decreased significantly to 8.06 (95% CI 5.53-10.58) in the titration phase of sedation. The mean score of the DS-DAT in the final phase of sedation was 7.42 (95% CI 4.90-9.94).Conclusion: This study shows that CPS is associated with a decrease in the level of discomfort within an acceptable time frame, although in some sedated patients higher levels of discomfort in the last hours of life occurred. Although the DS-DAT seems to be of value for monitoring the level of discomfort during CPS, the results of this study should be interpreted within the constraints of the limitations, and further research on the psychometric properties of this tool is needed before the DS-DAT can be used in clinical practice. [ABSTRACT FROM AUTHOR]- Published
- 2016
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34. The Difficulty With Studying Challenging Behavior.
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Gerritsen, Debby L., Smalbrugge, Martin, Veldwijk-Rouwenhorst, Annelies E., Wetzels, Roland, Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
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COMMUNICATION , *DEMENTIA , *DEMENTIA patients , *INTELLECT , *INVECTIVE , *LANGUAGE & languages , *BEHAVIOR disorders , *SYMPTOMS - Published
- 2019
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35. Changes in Prescribed Drugs Between Admission and the End of Life in Patients Admitted to Palliative Care Facilities.
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van Nordennen, Ronald T.C.M., Lavrijsen, Jan C.M., Heesterbeek, Malou J.A.B., Bor, Hans, Vissers, Kris C.P., and Koopmans, Raymond T.C.M.
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ANALGESICS , *DRUG therapy , *PSYCHIATRIC drugs , *GASTROINTESTINAL agents , *DEATH , *DRUG utilization , *HEALTH facilities , *LIFE expectancy , *MEDICAL cooperation , *MEDICAL prescriptions , *SCIENTIFIC observation , *PALLIATIVE treatment , *RESEARCH , *TERMINALLY ill , *COMORBIDITY , *POLYPHARMACY , *THERAPEUTICS - Abstract
Background The aim of prescribing medication in palliative end-of-life care should be symptom control. Data are lacking regarding the prescription of medication at the end of life. Aim To investigate the prescription of medication in patients at the end of life in palliative care facilities. Design, setting, and participants An observational multicenter study in 7 inpatient palliative care facilities. Participants were adults with an estimated life expectancy of less than 3 months. The study was conducted from February 1, 2012, to January 1, 2013. Results A total of 155 patients were enrolled. On average, patients were prescribed 6.1 drugs at the moment of admission and 4.6 drugs on the day of death. The prescription of analgesics, psycholeptics, and drugs for functional gastrointestinal disorders increased from admission until death. In general, these are drug classes prescribed for symptom control. All other drug classes decreased between admission and the day of death, including different drug classes for the treatment of comorbid disease, such as anticoagulants, beta-blocking agents, drugs used in diabetes, and lipid-modifying agents. Conclusions and relevance A reduction in the total amount of medication is seen between admission and death in the palliative care facilities. Although there is an increase in prescribed symptom-specific medication and a reduction in medication prescribed for comorbid disease, there are still patients dying with medication not used for symptom control. This increases pill burden and indicates that physicians need to develop guidelines and educational programs for decreasing medication for comorbidities at the end of life. [ABSTRACT FROM AUTHOR]
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- 2016
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36. Prevalence and Correlates of Neuropsychiatric Symptoms in Nursing Home Patients With Young-Onset Dementia: The BEYOnD Study.
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Mulders, Ans J.M.J., Fick, Ilma W.F., Bor, Hans, Verhey, Frans R.J., Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
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PSYCHIATRIC drugs , *AGE factors in disease , *AGGRESSION (Psychology) , *APATHY , *COGNITION , *DEMENTIA , *LENGTH of stay in hospitals , *LONG-term health care , *LONGITUDINAL method , *MOTOR ability , *NURSING home patients , *NURSING care facilities , *PSYCHOLOGICAL tests , *RESEARCH funding , *AGITATION (Psychology) , *MULTIPLE regression analysis , *PSYCHOSOCIAL factors , *CROSS-sectional method , *SEVERITY of illness index , *DESCRIPTIVE statistics , *SYMPTOMS , *PSYCHOLOGY - Abstract
Objective Young-onset dementia (YOD) is defined as dementia that develops before the age of 65. Neuropsychiatric symptoms (NPS) have important clinical consequences for patients and their family members. To date, knowledge about the prevalence and correlates of NPS in YOD is limited, but essential to establish specific tailored care for patients with YOD. The aim of this study was to explore the prevalence and correlates of NPS in nursing home residents with YOD. Design/Setting Cross-sectional cohort study in Dutch long-term care facilities providing specialized care for YOD. Participants Participants included 230 institutionalized patients with YOD. Measurements NPS were assessed using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). The influence of gender, dementia severity, type of dementia, and disease awareness on clusters of relevant NPS was investigated using multivariate logistic regression analysis and subsequently corrected for the possible confounders of age, duration of institutionalization, and psychoactive medication use. Results Ninety percent of the nursing home residents with YOD showed 1 or more neuropsychiatric symptoms, 88% showed significant agitation, and 56% showed relevant apathy. No gender differences were found. Although physically aggressive behavior, non–physically aggressive behavior, and apathy were more common in patients with (very) severe cognitive decline (Global Deterioration Scale [GDS] stage 6–7), verbally agitated behavior was common in patients in all except the most severe stages of dementia (GDS 2–6). Apathy was more prevalent in alcohol-related dementia. Low levels of awareness were associated with more physically aggressive behavior and aberrant motor behavior. Conclusion The prevalence of NPS was high and was associated with the severity and type of dementia and disease awareness. Agitation and apathy are the most important symptoms to focus on in YOD. The high prevalence of NPS supports the idea of care delivery in special care units. Further research is needed on potentially influencing environmental correlates of NPS in YOD. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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37. 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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OPIOIDS , *TERMINAL care , *HEALTH surveys , *TERMINAL sedation , *MULTIVARIATE analysis , *KARNOFSKY Performance Status , *THERAPEUTIC use of narcotics , *ANALGESICS , *AGE distribution , *COMPARATIVE studies , *HOSPICE care , *HOSPITAL admission & discharge , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *NURSING care facilities , *PALLIATIVE treatment , *PATIENTS , *RESEARCH , *LOGISTIC regression analysis , *EVALUATION research , *GLASGOW Coma Scale - Abstract
Context: Knowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning.Objectives: This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life.Methods: A prospective multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed.Results: A total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P < 0.001), the use of psycholeptics (P = 0.003), and higher Edmonton Symptom Assessment System distress score (P = 0.05). Multivariate logistic regression analysis showed that only the use of opioids at admission (odds ratio 1.90; 95% confidence interval 1.18-3.05) was significantly associated with the administration of CPS.Conclusion: Physicians should be aware that patients who use opioids at admission have an increased risk for the administration of CPS at the end of life. In this group of patients, a comprehensive personalized care plan starting at admission is mandatory to try to prevent the development of refractory symptoms. Further research is recommended, to identify other determinants of the administration of CPS and to investigate which early interventions will be effective to prevent the need for CPS in patients at high risk. [ABSTRACT FROM AUTHOR]- Published
- 2016
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38. Prevalence of Comorbidity in Patients With Young-Onset Alzheimer Disease Compared With Late-Onset: A Comparative Cohort Study.
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Gerritsen, Adrie A.J., Bakker, Christian, Verhey, Frans R.J., de Vugt, Marjolein E., Melis, René J.F., and Koopmans, Raymond T.C.M.
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AGE factors in disease , *ALZHEIMER'S disease , *CLUSTER analysis (Statistics) , *COGNITION , *COMPARATIVE studies , *OUTPATIENT services in hospitals , *LONGITUDINAL method , *MEMORY , *MENTAL health services , *NOSOLOGY , *RESEARCH , *RESEARCH funding , *COMORBIDITY , *INDEPENDENT living , *DESCRIPTIVE statistics - Abstract
Objectives With the lack of a cure for Alzheimer disease (AD), the identification of comorbidity is important to reduce the possibility of excess disability. Although comorbidity in patients with late-onset AD (LO-AD) is common, for people with young-onset AD (YO-AD), it is unclear how often comorbidity occurs. Furthermore, it is uncertain whether comorbidity in patients with YO-AD differs from that in patients with LO-AD. The aim of this study was to explore the prevalence, types of morbidity, and morbidity profiles in patients with YO-AD compared with those of patients with LO-AD. Design Explorative cohort study from 2 separate Dutch cohorts (Needs in Young-onset Dementia [NeedYD] and the Clinical Course of Cognition and Comorbidity–Dementia Study [4C-Dementia study]). Setting Participants were recruited in 2007 and 2008 from (1) the memory clinics of 3 Dutch Alzheimer centers, (2) the memory clinics of general hospitals, (3) mental health services in the southern part of the Netherlands, and (4) young-onset dementia specialized day care facilities. A comparison group of community-dwelling, elderly patients with AD was selected from the 4C-Dementia study. Patients in this study were recruited in 2010 and 2011 from the aforementioned Alzheimer centers. Measurements The prevalence rates of comorbidity were compared between 177 patients with YO-AD and 155 patients with LO-AD. Comorbidity was classified using the International Classification of Diseases, 10th Revision (ICD-10). The total amount of comorbidity was established by counting the number of existing diseases (ICD categories or chapters) and comorbidity was also dichotomized as present or absent. Furthermore, a hierarchical cluster analysis was performed to study clusters of comorbidity. Results Compared with LO-AD, patients with YO-AD showed less ( P < .001) overall comorbidity (58.2% vs 86.5%) and had lower prevalence rates of diabetes, obesity, and circulatory diseases; however, the prevalence rates of diseases of the nervous system in YO-AD (6.2%) were higher compared with those of patients with LO-AD (4.5%). The cluster analysis revealed a distinctive group of patients with YO-AD with either no comorbidity or with a disease of the nervous system. Endocrine, nutritional, and metabolic diseases and diseases of the circulatory system were present in 34% of the patients with YO-AD. Conclusion Comorbidity is less common in YO-AD than in LO-AD. However, general practitioners should be aware that approximately one-third of the patients with YO-AD suffer from or have endocrine, nutritional, and metabolic diseases and/or diseases of the circulatory system. Treatment should therefore not only focus on dementia but also on comorbidity. This attention may slow the functional decline in AD. These exploratory analyses suggested a higher prevalence of nervous system diseases in YO-AD compared with LO-AD. However, the finding did not reach statistical significance and in combination with the exploratory nature of the analyses justifies further investigation. If verified, this finding may help to decrease the time to diagnosis of AD and, subsequently, support in young patients with a neurological disease. Further investigation is needed to gain more insight into the association between comorbidity and AD in younger people. [ABSTRACT FROM AUTHOR]
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- 2016
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39. Prospective Observations of Discomfort, Pain, and Dyspnea in Nursing Home Residents With Dementia and Pneumonia.
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van der Maaden, Tessa, van der Steen, Jenny T., de Vet, Henrica C.W., Hertogh, Cees M.P.M., and Koopmans, Raymond T.C.M.
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PNEUMONIA treatment , *ELDER care , *GERIATRIC assessment , *DEMENTIA , *PSYCHOLOGICAL distress , *DYSPNEA , *LONG-term health care , *LONGITUDINAL method , *NURSING home patients , *NURSING care facilities , *PAIN in old age , *PNEUMONIA , *RESEARCH funding , *SCALE analysis (Psychology) , *SUFFERING , *COMORBIDITY , *PAIN measurement , *SYMPTOMS , *OLD age - Abstract
Objectives To describe observations of suffering in patients with dementia from the diagnosis of pneumonia until cure or death. Design Prospective observational study between January 2012 and May 2014. Setting Dutch nursing homes (32). Participants Nursing home patients with dementia and pneumonia (n = 193). Measurements Independent observers performed observations of patients with dementia scheduled 13 times within the 15 days following diagnosis of pneumonia; twice daily in the first 2 days– to observe discomfort (Discomfort Scale–Dementia of Alzheimer Type; range 0–27), comfort (End Of Life in Dementia-Comfort Assessment in Dying; range 14–42), pain (Pain Assessment in Advanced Dementia; range 0–10), and dyspnea (Respiratory Distress Observation Scale; range 0–16). Results Observational data were obtained for 208 cases of pneumonia in 193 patients. In 71.2% of cases, patients received 1 or more treatments to relieve symptoms such as antipyretics, opioids, or oxygen; 89.4% received antibiotics. Discomfort was highest 1 day after diagnosis [mean Discomfort Scale-Dementia of Alzheimer Type score 8.1 (standard deviation, SD 5.8)], then declined, and stabilized around day 10 [mean 4.5 (SD 4.1)], or increased in the days preceding death. Observed pain and dyspnea followed a comparable pattern. Discomfort patterns did not differ much between cases treated with and without antibiotics. Conclusions Pneumonia in patients with dementia involved elevated levels of suffering during 10 days following diagnosis and in the days preceding death. Overall observed discomfort was low compared with prior Dutch studies, and the number of treatments to relieve symptoms was higher. Future studies should examine whether symptoms of pneumonia can be relieved even more, and what treatments are the most effective. [ABSTRACT FROM AUTHOR]
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- 2016
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40. A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia.
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van der Spek, Klaas, Gerritsen, Debby L., Smalbrugge, Martin, Nelissen-Vrancken, Marjorie H. J. M. G., Wetzels, Roland B., Smeets, Claudia H.W., Zuidema, Sytse U., and Koopmans, Raymond T. C. M.
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PSYCHIATRIC drugs , *NEUROBEHAVIORAL disorders , *TREATMENT of dementia , *NURSING care facilities , *MEDICAL records , *THERAPEUTICS - Abstract
Objectives The aim of this study was to develop an index derived from the Medication Appropriateness Index (MAI) items that is suited for clinical studies evaluating appropriateness of psychotropic drug use (PDU) for neuropsychiatric symptoms (NPS) in patients with dementia in nursing homes and to test its reliability and validity. Study Design and Setting An expert panel reviewed the MAI items to develop items for appropriateness of PDU; a second, independent, expert panel determined content validity of the items. An interrater reliability study was conducted (N = 54), and a summated index score, based on weighted item scores, was developed to enhance the use in clinical studies. Construct validity was explored using a representative sample of 560 medical records. Results Five existing MAI items were used, the MAI item "indication" was adjusted, a new item "evaluation" was added, and scoring rules were based on guideline recommendations, to create the Appropriate Psychotropic drugs use In Dementia (APID) index. The second expert panel concluded that all items contributed to the construct "appropriateness." All items and the summated index score had moderate to almost perfect interrater reliability (intraclass correlation coefficient for agreement, 0.577-1). The summated index score showed promising construct validity, for example, no multicollinearity issues were found. Conclusion The results of this study show that the APID index is reliable and valid for measuring appropriateness of PDU for NPS in dementia in nursing homes in clinical studies. [ABSTRACT FROM AUTHOR]
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- 2015
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41. An International Definition for “Nursing Home”.
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Sanford, Angela M., Orrell, Martin, Tolson, Debbie, Abbatecola, Angela Marie, Arai, Hidenori, Bauer, Juergen M., Cruz-Jentoft, Alfonso J., Dong, Birong, Ga, Hyuk, Goel, Ashish, Hajjar, Ramzi, Holmerova, Iva, Katz, Paul R., Koopmans, Raymond T.C.M., Rolland, Yves, Visvanathan, Renuka, Woo, Jean, Morley, John E., and Vellas, Bruno
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LONG-term health care , *NOSOLOGY , *NURSING care facilities , *SURVEYS , *TERMS & phrases - Abstract
There is much ambiguity regarding the term “nursing home” in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of “nursing home.” [ABSTRACT FROM AUTHOR]
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- 2015
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42. Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia.
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Smeets, Claudia H.W., Smalbrugge, Martin, Zuidema, Sytse U., Derksen, Els, de Vries, Erica, van der Spek, Klaas, Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
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PSYCHIATRIC drugs , *ELDER care , *COMMUNICATION , *CONCEPTUAL structures , *DEMENTIA , *DRUG utilization , *GERIATRIC nursing , *GROUNDED theory , *INTERPROFESSIONAL relations , *INTERVIEWING , *LONG-term health care , *RESEARCH methodology , *MEDICAL personnel , *MEDICAL prescriptions , *NURSING home patients , *NURSING care facilities , *PHYSICIANS , *PROFESSIONS , *THEMATIC analysis , *PATIENTS' families , *DATA analysis software , *SYMPTOMS - Abstract
Objectives The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia. Design A qualitative study using a grounded theory approach. Setting Twelve NHs in The Netherlands. Participants Fifteen physicians and 14 nurses. Measurements Individual, face-to-face, in-depth semistructured interviews. Interviews were audio recorded, transcribed, and qualitatively analyzed using Atlas.ti. Results The qualitative analysis revealed 4 emerging themes with factors either or both enhancing or limiting PD prescription, which we used to develop a conceptual framework. First, the mindset of physicians and nurses toward NPS and PDs appeared to contribute. Second, inadequate knowledge of and experience with NPS and limited people skills of nurses may induce PD prescription. Also, knowledge of effectiveness and side effects of PDs from education, literature, and guidelines, and previous personal experiences was considered relevant. Third, effective communication and cooperation between professionals and with family may improve the appropriateness of PD prescription. Fourth, external factors including staffing issues, nursing home setting, access to consultants, national and local policies, and zeitgeist were considered to affect PD prescription. Conclusion We have developed a conceptual framework explaining how different factors influence PD prescription. This provides opportunities for improving PD prescription in NH residents with dementia. [ABSTRACT FROM AUTHOR]
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- 2014
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43. Perspectives on Parkinson Disease Care in Dutch Nursing Homes.
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van Rumund, Anouke, Weerkamp, Nico, Tissingh, Gerrit, Zuidema, Sytse U., Koopmans, Raymond T., Munneke, Marten, Poels, Petra J.E., and Bloem, Bastiaan R.
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PARKINSON'S disease treatment , *DOPA , *ELDER care , *CAREGIVERS , *FOCUS groups , *INTERVIEWING , *LONG-term health care , *RESEARCH methodology , *MEDICAL quality control , *PATIENT-professional relations , *NURSING home patients , *NURSING care facilities , *NURSING home employees , *PATIENT satisfaction , *PERSONNEL management , *QUALITY assurance , *RESEARCH funding , *QUALITATIVE research - Abstract
Introduction Parkinson's disease (PD) is a complex and disabling disorder. Ultimately, 20% to 40% of patients are admitted to a nursing home, and neurologists often lose track of these patients. Care and treatment of these institutionalized patients have not been addressed comprehensively, but anecdotal reports suggest it is suboptimal. We conducted a qualitative study to analyze the quality of PD care in Dutch nursing homes from the perspective of residents, caregivers, and health care workers. Methods Experiences and (unmet) needs of 15 nursing home residents with PD and parkinsonism (90% Hoehn and Yahr stage 4 and 5) and 15 informal caregivers were assessed using semistructured interviews. Furthermore, 5 focus group discussions were organized with 13 nurses and 22 other health care professionals to explore the experiences and barriers of PD care. Results Three core unmet needs were identified: (1) unsatisfactory empathy and emotional support, according to residents and informal caregivers; (2) insufficient staff knowledge on PD-related issues, such as motor fluctuations, leading to poorly timed administration of levodopa; (3) suboptimal organization of care with limited access to neurologists and specialized PD nurses. Conclusions PD care in Dutch nursing homes is suboptimal according to residents, informal caregivers, and health care workers. Three core areas for improvement were identified, including greater attention for psychosocial problems, improved PD-specific knowledge among nursing home staff, and better collaboration with hospital staff trained in movement disorders. [ABSTRACT FROM AUTHOR]
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- 2014
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44. International Survey of Nursing Home Research Priorities.
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Morley, John E., Caplan, Gideon, Cesari, Matteo, Dong, Birong, Flaherty, Joseph H., Grossberg, George T., Holmerova, Iva, Katz, Paul R., Koopmans, Raymond, Little, Milta O., Martin, Finbarr, Orrell, Martin, Ouslander, Joseph, Rantz, Marilyn, Resnick, Barbara, Rolland, Yves, Tolson, Debbie, Woo, Jean, and Vellas, Bruno
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TREATMENT of dementia , *ELDER care , *GERIATRIC nutrition , *DEMENTIA , *LONG-term health care , *MEDICAL care research , *HEALTH policy , *NURSING care facilities , *POLICY science research , *PRIORITY (Philosophy) , *QUALITY assurance , *SURVEYS , *TERMINAL care , *EVIDENCE-based medicine , *PROFESSIONAL practice , *POLYPHARMACY , *SYMPTOMS ,RESEARCH evaluation - Abstract
Abstract: This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open questions and ranking exercises to move toward consensus on the research priorities. A key finding was the prioritization of research to underpin the care of people with cognitive impairment/dementia and of the management of the behavioral and psychological symptoms of dementia within the nursing home. Other important areas were end-of-life care, nutrition, polypharmacy, and developing new approaches to putting evidence-based practices into routine practice in nursing homes. It explores possible innovative educational approaches, reasons why best practices are difficult to implement, and challenges faced in developing high-quality nursing home research. [Copyright &y& Elsevier]
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- 2014
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45. Parkinson Disease in Long Term Care Facilities: A Review of the Literature.
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Weerkamp, Nico J., Tissingh, Gerrit, Poels, Petra J.E., Zuidema, Syste U., Munneke, Marten, Koopmans, Raymond T.C.M., and Bloem, Bastiaan R.
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PARKINSON'S disease diagnosis , *PARKINSON'S disease treatment , *LONG-term health care , *NURSING home patients , *NURSING care facilities , *PARKINSON'S disease , *SEVERITY of illness index - Abstract
Abstract: Parkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities. Even fewer studies have addressed the treatment strategies used to support these institutionalized patients, who are mostly in advanced stages of the disease. The available evidence suggests that current management of patients with PD in LTC facilities is less than optimal. In the Netherlands, and we suspect in many other countries, there are no formal guidelines for treating patients with PD who have been admitted to a LTC facility. In this review, we describe the epidemiology, clinical characteristics, and clinical management of patients with PD in LTC settings. We also address potentially modifiable elements of care and provide several recommendations to improve the management of PD in these facilities. We conclude by suggesting a possible guide for future research in this area. [Copyright &y& Elsevier]
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- 2014
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46. Predictors of the Time to Institutionalization in Young- Versus Late-Onset Dementia: Results From the Needs in Young Onset Dementia (NeedYD) Study
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Bakker, Christian, de Vugt, Marjolein E., van Vliet, Deliane, Verhey, Frans R.J., Pijnenburg, Yolande A., Vernooij-Dassen, Myrra J.F.J., and Koopmans, Raymond T.C.M.
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AGE factors in disease , *ELDER care , *CAREGIVERS , *COMPARATIVE studies , *DEMENTIA , *HOME nursing , *HOSPITAL admission & discharge , *LONG-term health care , *LONGITUDINAL method , *PATIENTS , *SOCIAL support , *INDEPENDENT living , *PROPORTIONAL hazards models , *SYMPTOMS - Abstract
Abstract: Objective: To investigate the time from symptom onset to institutionalization in persons with young-onset dementia (YOD) and compare these findings with late-onset dementia (LOD), and to determine which factors predict institutionalization in persons with YOD compared with LOD. Design/Setting: Longitudinal study of community-dwelling patients with YOD and LOD and their caregivers. Participants: A total of 226 patients with YOD and 102 with LOD and their informal caregivers were recruited through memory clinics and health care facilities. Measurements: Cox proportional hazard models were used to relate covariates with time to institutionalization. The main outcome was time from symptom onset to institutionalization. Key predictors were cohort (YOD or LOD), neuropsychiatric symptoms, caregiver distress caused by neuropsychiatric symptoms, and caregivers’ sense of competence (Short Sense of Competence Questionnaire total score). Results: The time from symptom onset to institutionalization was nearly 9 years for patients with YOD compared with approximately 4 years for patients with LOD. In the YOD group, apathy significantly predicted time of institutionalization. Furthermore, the caregiver’s competence in caring for the person with dementia significantly predicted institutionalization in both groups. Conclusions: Patients with YOD are cared for at home for a longer period than patients with LOD. The results of this study underline the importance of a timely diagnosis for these patients and their families to facilitate the initiation of appropriate care and support. Support programs aimed at enhancing the caregivers’ sense of competence and ability to deal with neuropsychiatric symptoms, especially apathy, may postpone the institutionalization of the patient. [Copyright &y& Elsevier]
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- 2013
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47. Process Evaluation to Explore Internal and External Validity of the “Act in Case of Depression” Care Program in Nursing Homes.
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Leontjevas, Ruslan, Gerritsen, Debby L., Koopmans, Raymond T.C.M., Smalbrugge, Martin, and Vernooij-Dassen, Myrra J.F.J.
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Abstract: Background: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): “Act in case of Depression” (AiD). Objective: Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Methods: Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Setting: Nursing home. Results: The pattern of residents’ informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Conclusion: Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of evaluating the first-order process data before executing statistical effect analyses is thus underlined. [ABSTRACT FROM AUTHOR]
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- 2012
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48. The SAFE or SORRY? programme. Part II: Effect on preventive care
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van Gaal, Betsie G.I., Schoonhoven, Lisette, Mintjes, Joke A.J., Borm, George F., Koopmans, Raymond T.C.M., and van Achterberg, Theo
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BEDSORES prevention , *ACCIDENTAL fall prevention , *PREVENTION of medical errors , *URINARY tract infection prevention , *URINARY tract infections , *RISK factors of falling down , *ANALYSIS of variance , *CLINICAL trials , *CONFIDENCE intervals , *HOSPITAL wards , *MEDICAL protocols , *MEDICAL records , *NURSING care facilities , *PATIENT safety , *PREVENTIVE health services , *RESEARCH , *RESEARCH funding , *CHANGE management , *DISEASE risk factors ,BEDSORE risk factors - Abstract
Abstract: Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given. Design: Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008. Settings: Ten hospital wards and ten nursing home wards. Participants: We monitored nursing care given to adult patients with an expected length of stay of at least five days. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed. Results: The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate=6%, CI: −7–19) and nursing homes (estimate=4%, CI: −5–13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate=19%, CI: 17–21). For falls in hospitals and nursing homes, no more patients at risk received preventive care. Conclusion: Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators. [Copyright &y& Elsevier]
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- 2011
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49. Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. Part I: Primary outcome of a cluster randomised trial
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van Gaal, Betsie G.I., Schoonhoven, Lisette, Mintjes, Joke A.J., Borm, George F., Hulscher, Marlies E.J.L., Defloor, Tom, Habets, Herbert, Voss, Andreas, Vloet, Lilian C.M., Koopmans, Raymond T.C.M., and van Achterberg, Theo
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BEDSORES prevention , *ACCIDENTAL fall prevention , *PREVENTION of medical errors , *URINARY tract infection prevention , *ANALYSIS of variance , *PRESSURE ulcers , *CLINICAL medicine , *CLINICAL trials , *CONFIDENCE intervals , *ACCIDENTAL falls , *HOSPITALS , *LONG-term health care , *LONGITUDINAL method , *MEDICAL errors , *MEDICAL protocols , *MEDICAL records , *NURSING care facilities , *PATIENT education , *PATIENT safety , *PERSONNEL management , *POISSON distribution , *RESEARCH funding , *STATISTICAL sampling , *URINARY tract infections , *EFFECT sizes (Statistics) , *KEY performance indicators (Management) - Abstract
Abstract: Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events. Design: A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period. Settings: Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group. Participants: During baseline and follow-up, patients (≥18 years) with an expected length of stay of at least five days, were asked to participate. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up. Results: At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses showed a rate ratio for the development of an adverse event in favour of the intervention group of 0.57 (95% CI: 0.34–0.95) and 0.67 (95% CI: 0.48–0.99) for hospital patients and nursing home patients respectively. Conclusion: This study showed that implementing multiple guidelines simultaneously is possible, which is promising. Patients in the intervention groups developed 43% and 33% fewer adverse events compared to the usual care groups in hospitals and nursing homes respectively. Even so, more research is necessary to underline these results. Trial registration: clinicaltrials.gov, number NCT00365430. [Copyright &y& Elsevier]
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- 2011
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50. The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial
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van Gaal, Betsie G.I., Schoonhoven, Lisette, Vloet, Lilian C.M., Mintjes, Joke A.J., Borm, George F., Koopmans, Raymond T.C.M., and van Achterberg, Theo
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HOSPITAL care , *QUALITY control , *PATIENT safety , *NURSING home care , *NURSE-patient relationships , *HEALTH services administration , *MEDICAL quality control , *THERAPEUTIC complications , *MEDICAL protocols , *PREVENTION , *MANAGEMENT , *BEDSORES prevention , *ACCIDENTAL fall prevention , *HOSPITAL personnel , *NURSING education , *NURSING audit , *URINARY tract infection prevention , *ANALYSIS of variance , *CLINICAL trials , *CONFIDENCE intervals , *HOSPITALS , *LONG-term health care , *NURSING , *NURSING care facilities , *PRACTICAL nurses , *QUESTIONNAIRES , *RESEARCH funding , *STATISTICAL sampling , *TEACHING methods , *CONTROL groups , *EDUCATION - Abstract
Abstract: Background: Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy. Objectives: The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses. Design: A cluster randomised trial was conducted between September 2006 and July 2008. Settings: Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward. Participants: All nurses from participating wards. Methods: A knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately. Results: After correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: −0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10–0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: −0.35 to 0.35) overall, nor for the separate subjects. Conclusion: The educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed. Trial registration: ClinicalTrials.gov ID [NCT00365430]. [Copyright &y& Elsevier]
- Published
- 2010
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