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Exergaming is a meaningful activity in which physical exercises are combined with cognitive stimulation in a gaming environment. It is feasible for people with dementia and can help overcome barriers to stay active. This study aimed to get insight into the effects of exergaming in people with dementia visiting day-care centres and their family caregivers compared to usual activities in day-care centres. Also, issues in implementation of exergaming were assessed. Twenty day-care centres participated with in total 112 couples of people with dementia and informal carers. Positive effects were found on cognition and social functioning in people with dementia and on stress and burden of family caregivers. Exergaming was much appreciated among persons with dementia, family caregivers and staff of the day-care centres. On the basis of this study, it has been recommended to offer exergaming in a person-centred manner for people with dementia and to include our recommendations for the implementation of exergaming in daily practice.

Measuring Quality of Life (QOL) can be difficult due to its individual character. To explore the value of personalized QOL measurement for people with dementia, personalized versions of two dementia-specific QOL scales (Dementia quality of Life (DQoL) and Quaility of Life in Alzheimer's Disease (QoL-AD)) were constructed. This study investigated whether the personalized measures are more valid to detect variations in QOL than their standard versions for people with mild to moderate dementia, with sufficient internal consistency. Moreover, the relationship between the personalized QOL measures and severity of dementia was investigated. Finally, the study explored the differences between countries regarding the personalized overall QOL and differences in the importance of QOL domains. This explorative one-group design study used baseline data from the MEETINGDEM study into the implementation of the Meeting Centres Support Programme in Italy, Poland and the UK. The personalized versions of the DQoL and QoL-AD were reliable, but not more valid than their standard versions. No relationship between severity of dementia and personalized QOL was found. While no differences were found between countries for the overall QOL score, some QOL domains were valued differently: people with dementia from the UK rated self-esteem, mood, physical health, energy level and the ability to do chores around the house significantly less important than people from Italy and Poland. The personalized versions of the DQoL and QoL-AD may offer dementia care practice important insights into what domains contribute most to an individual’s QOL.

BackgroundIt has been demonstrated that people with dementia’s wellbeing can improve by using touchscreen technology. The FindMyApps program is a training and web-based selection-tool to help people with dementia and their caregivers find suitable apps that can improve their self-management and engagement in meaningful activities. As part of an exploratory RCT into FindMyApps a process evaluation was conducted according to the MRC Framework for process evaluation. Contextual, implementation and mechanisms of impact factors which may influence trial outcomes were evaluated.MethodA mixed methods design was used, in which quantitative and qualitative data were collected by semi-structured interviews (SSI) with stakeholders The SSI comprised closed and open questions, designed specifically for this study. Twenty people with mild dementia (MMSE >17; GDS 3-4) or Mild Cognitive Impairment (MCI) and twenty informal caregivers in both experimental and control groups, as well as 3 other stakeholders (researchers, technical helpdesk person) involved in the implementation of the intervention, were interviewed. Participants were recruited in the Netherlands. Exclusion criteria: moderate to severe dementia or severe sight problems. All participant dyads were provided a tablet computer for the three months intervention period. In the experimental group, people with dementia and caregivers were trained to use the tablet and FindMyApps after which the caregivers guided the persons with dementia to learn to use FindMyApps and find, and use, suitable apps for self-management and meaningful activities. In the control group, dyads only received general instruction in tablet use and a list of websites where to find potentially useful apps.ResultRegarding contextual factors, it was found that some technical problems might have influenced the intervention. Regarding implementation, participants noted that the training in the use of FindMyApps was of variable quality. Regarding mechanisms of impact it was found that dyads usually used the apps they found through FindMyApps regularly and enjoyed them, but they did not use FindMyApps itself regularly.ConclusionFindMyApps was experienced as a useful tool by most people with dementia/MCI and informal caregivers. Several adaptations to the trial protocol are recommended, to ensure robust outcomes in a definitive trial into its effectiveness.

Background: Physical exercise benefits functioning, health, and well-being. However, people living with dementia in particular hardly engage in exercise. Exergaming (exercise and gaming) is an innovative, fun, and relatively safe way of exercising in a virtual reality or gaming environment. It may help people living with dementia overcome barriers they can experience regarding regular exercise activities. Objective: This systematic literature review aims to provide an overview of the cost-effectiveness of exergaming and its effects on physical, cognitive, emotional, and social functioning, as well as the quality of life in people living with dementia. Methods: PubMed, Embase, Cinahl, PsycINFO, the Cochrane Library, and the Web of Science Core Collection were searched. Selection of studies was carried out by at least two independent researchers. Results: Three studies were found to be eligible and were included in this review. Two of these showed some statistically significant effects of exergaming on physical, cognitive, and emotional functioning in people living with dementia, although based on a very small sample. No articles were found about the cost-effectiveness of exergaming. Conclusions: Only a few controlled studies have been conducted into the effectiveness of exergaming, and these show very little significant benefits. More well-designed studies are necessary to examine the effects of exergaming.

Background and Aims. The Meeting Centres Support Programme (MCSP) for people with mild to moderately severe dementia and their carers proved effective in the Netherlands, and is now being implemented in other European countries. This study aimed to compare factors that at the preparation of two meeting centres in Italy were expected and experienced as facilitating or impeding implementation. Methods. At the start, stakeholders (n = 19) filled in a checklist on expected facilitators and barriers. After opening the centres, experienced facilitators and barriers were inventoried in semi-structured interviews (n = 13) and analysed by two independent researchers, using a Theoretical model on implementation. Additionally, minutes of the initiative group were investigated. Expected and experienced facilitators and barriers were compared. Results. In contrary to the expectations, the use of existing networks/collaboration between organizations facilitated the preparation phase. As expected, motivated stakeholders were facilitating. Shortening of the original time plan (for pragmatic reasons) was not expected, and made some preparatory tasks difficult to fulfil. Lack of Italian examples and cultural differences in working method made the realization of meeting centres difficult to imagine. Some experienced factors were not foreseen due to unexpected events. Conclusions. Most aspects of MCSP appeared well implementable in the Italian setting. Many factors were in line with the Dutch implementation study, new influencing factors were also found.

Dit boek integreert beschikbare kennis om het optimaal functioneren van mensen met dementie te bevorderen. Over persoonsgerichte dementiezorg vanuit geneeskundig, functioneel en belevingsperspectief.

The increasing number of persons with dementia means growing demands on care and support at home, and so additional solutions are needed. In the European COGKNOW project dementia experts and technological system designers cooperate closely to develop a cognitive prosthetic device that supports persons with mild dementia in their daily functioning and improves their quality of life. The project focuses on the areas of memory, social contact, daily activities, and feelings of safety. The design process is user-participatory and consists of three iterative cycles. In each cycle 12 to 18 persons with dementia of the Alzheimer type and their carers at three test sites across Europe are invited to actively participate in the development process. Each cycle starts with user needs inquiry workshops and interviews, followed by (further) technological development of the device, and ends with user field tests to test the userfriendliness, usefulness and impact of the developed prototype in daily life. This article reports on the first project phase in which a top four list of Information and Communication Technological (ICT) solutions was selected that formed the basis todevelop a first prototype. The list was based on the priorities of needs mentioned by thefirst participants group of people with dementia (n=17) and their carers (n=17), thesolutions they preferred, their disabilities, personal and situational characteristics, and thetechnological designers' opinions on the feasibility of developing the proposed solutionswithin the time frame of the project. Based on the information gathered in the user workshops and interviews, the dementia expert researchers further explained the selected ICT solutions in written scenarios. Next, a functional requirements list was composed and a first prototype was developed that offered support in four areas: reminding - day and time orientation support, find mobile service and reminding service; social contact - telephone support by picture dialling; activities - media control support through a music play back and radio function; and, feelings of safety - a warning service to indicate when the front door is open and an emergency contact service. The results of this first project phase show that, in general, the people with mild dementia as well as their carers were able to express and prioritize their (unmet) needs, and the kind of technological assistance they preferred in the selected areas. This made it possible to compose an overall priority list for the development of a multifunctional ICT device. In next phases it will be tested if the user-participatory development and multidisciplinary approach applied result in a user-friendly and useful device that positively impacts the autonomy and quality of life of people with dementia and their carers.

Objective: To investigate how informal carers of community dwelling persons with dementia value the Meeting Centers Support Programme (MCSP) for people with dementia and their carers, including the carer support activities, such as informative meetings, discussion groups and individual consultation, and to explore if characteristics of the carers are related to their satisfaction with and effectiveness of the support programme. Methods: Participants were 71 informal carers of persons with mild to severe dementia who participated in the MSCP. Beside background characteristics, after 7 months of participation, a questionnaire was administered to the carers to investigate their satisfaction with the entire support programme and the different support activities offered to the carers. To measure the effectiveness of the MCSP in carers, before and after 7 months of participation in the MCSP interviews were held with regard to different outcome measures, i.e.: psychological and psychosomatic complaints, feeling of competence, experienced burden, and institutionalisation of the person with dementia. Results: The large majority of carers were satisfied with the entire support programme (91,6%) as well as with each of the support activities offered to the carers. Several carer characteristics, such as lower age, longer duration of caregiving and higher degree of social support, were related to a more positive evaluation of the support programme. Characteristics that were related to the effect measures were loneliness, duration of caregiving, financial expenditure and formal support before starting the programme. Conclusion: This exploratory study demonstrated that the satisfaction of carers with the MCSP, including the carer support activities, and the effectiveness of the support offered were related to characteristics of the carers. Thus it seems relevant to continue the evaluation of different types of support for carers on a larger scale and in different settings, to get insight into the relation between carer characteristics, the satisfaction with support activities and the effectiveness of the support offered. Insight into these relations may contribute to more effective and efficient support of carers of persons with dementia.

Dementia is a progressive, chronic disease affecting 5% of all persons above 65 and over 40% of people over 90. The aim of the COGKNOW project is to achieve a breakthrough with research that addresses the needs of those with dementia, particularly those with mild dementia living in the community. This entails cognitive reinforcement in four main areas: helping people to remember, helping to maintain social contact, helping with performing daily life and recreational activities and finally enhance feelings of safety. Based on a sound foundation of needs reported in dementia literature, workshops and individual interviews have been carried out with dementia sufferers and their carers in three European countries. A ranked analysis of information from workshops and interviews, and the state of the art of successful ICT solutions will be the basis for formulating the functionalities of the technical solution and for the development of a cognitive prosthetic device with associated services for people with mild dementia. The research and evaluation will be conducted from human factors, technology, and business perspectives in three phases of one year each. In this paper we discuss the design of the COGKNOW project, the first results of the user needs inquiry workshops and the ICT solutions the COGKNOW project will focus on in the first year.

We-centric services may play an important role in the field of care and support for elderly persons with dementia and their carers. They may solve problems, such as fragmentation of care, gaps in the continuum of care and welfare services, and inefficient and uncustomized service delivery to patients and carers. In the FRUX Health Care pilot opportunities for we-centric, context-sensitive service bundles in the field of dementia care will be explored. The service on which we focus in this paper is a dynamic interactive social chart for dementia care (DEM-DISC). The feasibility of DEM-DISC will be investigated from a domain specific content perspective (needs, offerings, information and advice), an ICT perspective (ontology and application), a user perspective (persons with dementia, their carers and professionals/ organizations), and an organisational perspective (necessary collaboration, governance and control, business modelling). A first demonstrator (validator) of the DEM-DISC will be designed, built and evaluated. Future possibilities to connect DEM-DISC to actual service delivery will be explored. In this paper we discuss the most important research questions from the different perspectives and the methods used to answer them.

In this article the waiting list for psychogeriatric nursing home care has been described for a large town in the Randstad (Netherlands). A literature study on psychogeriatric waiting lists was conducted; in a qualitative research project the procedure for admission on the waiting list was studied; and in a files study the characteristics of patients on the waiting lists, the waiting times and factors influencing waiting time have been studied. During the research period (1991) 111 patients were admitted to a waiting list, including 8 patients for whom admission was considered to be very urgent. These highly urgent patients were all mildly demented and had a mean waiting time of nine days. Almost half of the patients who were considered 'normally urgent' were moderately demented. The normally urgent patients had a mean waiting time of fourteen weeks. Hospitalized patients waiting for admission to a nursing home, had a lower waiting time than patients with the same urgency who were waiting at home. In comparison to the norms (8 weeks), the mean waiting time was unacceptably long.

In this article the waiting list for psychogeriatric nursing home care has been described for a large town in the Randstad (Netherlands). A literature study on psychogeriatric waiting lists was conducted; in a qualitative research project the procedure for admission on the waiting list was studied; and in a files study the characteristics of patients on the waiting lists, the waiting times and factors influencing waiting time have been studied. During the research period (1991) 111 patients were admitted to a waiting list, including 8 patients for whom admission was considered to be very urgent. These highly urgent patients were all mildly demented and had a mean waiting time of nine days. Almost half of the patients who were considered 'normally urgent' were moderately demented. The normally urgent patients had a mean waiting time of fourteen weeks. Hospitalized patients waiting for admission to a nursing home, had a lower waiting time than patients with the same urgency who were waiting at home. In comparison to the norms (8 weeks), the mean waiting time was unacceptably long.

Objective. To determine whether the national information system on available beds in neonatal intensive care units (NICUs) leads to fair distribution and good efficiency and quality of care. Setting. Two out of the ten NICUs in the Netherlands. Design. Descriptive. Methods. Data were gathered through observations and 18 interviews with among others neonatologists, gynaecologists and paediatricians. Another 19 doctors were interviewed by phone after a patient they had referred was refused. Interviews were analysed by means of Kwalitan, a computer programme for analysis of qualitative research. Results. When a patient could not be admitted in his own region, the information system was often used to find out which NICUs had a bed available. Sometimes a NICU was called that, according to the information system, did not have a place available. Reasons were: the information was not up to date and not all available beds were reported. This last reason had to do with the wish to keep a bed free for patients from the NICU's own region. Because most doctors were aware of this, they sometimes negotiated about beds, which was time-consuming. Conclusion. The information system was used often, but was working below optimal level, resulting in diminished efficiency. This was primarily caused by the priority given to patients of the own region, which had to do with quality of care considerations. The existing variation in use of the priority policy deserves attention from the viewpoint of procedural justice.

Objective. To investigate what criteria are applied in the actual practice of patient selection for renal transplantation and how practice relates to guidelines developed in medical ethics and health law. Setting. Two centres for renal transplantation and nine dialysis centres. Design. Descriptive. Methods. Data were collected by observation and open interviews with 33 physicians and other health professionals involved, and analysed using a computer programme for qualitative data. Results. Formally, scarcity of donor organs did not affect the referral and indication of patients for renal transplantation. However, according to some respondents, fewer people were entered on the waiting list because of scarcity. This concerned mainly patients less likely to benefit from a transplantation in terms of life expectancy or enhancement of quality of life. Conclusion. There was some 'covert selection', in that scarcity implicitly or unintentionally was a factor in the decision whether or not to place patients on the waiting list for renal transplantation. The absence of consensus on acceptable selection criteria and the emphasis on medical criteria in the social debate on selection criteria may have contributed to this covert selection.

Objective: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. Method: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain (n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group (N = 49) and a control group (N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. Results: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. Conclusions: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.

Objective: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. Method: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain (n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group (N = 49) and a control group (N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. Results: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. Conclusions: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.