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AIMS AND OBJECTIVES: To gain insight into the request, use and associated factors of involuntary treatment in people with dementia (PwD) receiving professional home care in the Netherlands and Belgium. BACKGROUND: Most of the PwD remain living at home as long as possible. Due to complex care needs, this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. DESIGN: Secondary data analyses of two cross-sectional surveys. METHODS: Dementia case managers and district nurses filled in a questionnaire for each PwD in their caseload. This study included data of 627 PwD receiving professional home care in the Netherlands and 217 in Belgium. The same methodology (questionnaire and variables) was used in both samples. Descriptive statistics and multi-level logistic regression analyses were used to analyse the data. The study adhered to the STROBE checklist. RESULTS: More than half of the PwD (50.7%) living at home received involuntary treatment (Belgium 68.2% and the Netherlands 44.7%). Nonconsensual care (82.7%) was the most common, followed by psychotropic medication (40.7%) and physical restraints (18.5%). Involuntary treatment use was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. Involuntary treatment was most often requested by family caregivers. CONCLUSIONS: Involuntary treatment is often used in PwD, which is in line with previous findings indicating dementia as a risk factor for involuntary treatment use. More research is needed to gain insight into variations in prevalence across other countries, which factors influence these differences and what countries can learn from each other regarding prevention of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE: To provide person-centred care, it is important to study ways to prevent involuntary treatment in PwD and to stimulate dialogue between professional and family caregivers for alternative interventions. ispartof: JOURNAL OF CLINICAL NURSING vol:31 issue:13-14 pages:1998-2007 ispartof: location:England status: published

Quality indicators are used in nursing homes to assess physical restraint use. Switzerland introduced two publicly reported indicators measuring the use of 1) bedrails and 2) trunk fixation or seating that prevent standing up. Whether these indicators show good between-provider variability is unknown. The study aimed to measure the prevalence of physical restraint use and assess their between-provider variability using a cross-sectional, multicentre study of a convenience sample of nursing homes. The between-provider variability of the indicators was assessed with intraclass correlation 1 and with caterpillar plots based on Empirical Bayes estimates. We included 11,412 residents from 152 nursing homes. Prevalence rates were 13.5% (n=1’433) for bedrails and 3.6% (n=411) for trunk fixation / seating that prevent standing up. For the first indicator, intraclass correlation 1 was 0.245 (95%-CI 0.197-0.286), for the second 0.343 (95%-CI 0.235-0.405). The two indicators showed good between-provider variability and can be recommended for public reporting. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

People with cognitive impairment may experience the care provided by their caregiver(s) as unnecessary or undesirable, which is expressed by behaviors such as resisting the efforts of a caregiver or preventing the caregiver to perform or assist with ADL such as bathing, dressing and toileting. This can lead to stress, agitation and aggression for both the care recipient and the caregiver, and places the caregiver in a complex dilemma. Should the caregiver force hygiene or respect the person’s autonomy to refuse care? It is difficult for caregivers to find a balance between quality of care and safety, while accepting the person’s autonomy. Caregivers in long-term care often feel the necessity to provide care against the will of people with a cognitive impairment, including physical restraints, psychotropic medication, and non-consensual care. This symposium provides an international perspective with presenters from Belgium, Switzerland, Germany, and the Netherlands. The first presenter explores the use and factors associated with physical restraint, psychotropic medication, and non-consensual care in people with dementia receiving home care in the Netherlands and Belgium. Second, a presenter from Switzerland focuses on the prevalence of restraint use in nursing homes. The third presenter introduces an Advance Care Planning intervention from Germany that aims to ensure that personal wishes in home care are followed. The last presenter assesses the feasibility of an approach to prevent and reduce care against a person’s will in the Netherlands. To conclude, our discussant will integrate these insights and draw conclusion for policy, practice and further research. Systems Research in Long-Term Care Interest Group Sponsored Symposium

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group. ispartof: Innovation in Aging vol:4 issue:Issue Supplement_1 pages:665-665 status: published