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Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of p

This article describes the coaching strategies of the NESTORE e-coach, a virtual coach for promoting healthier lifestyles in older age. The novelty of the NESTORE project is the definition of a multi-domain personalized pathway where the e-coach accompanies the user throughout different structured and non-structured coaching activities and recommendations. The article also presents the design process of the coaching strategies, carried out including older adults from four European countries and experts from the different health domains, and the results of the tests carried out with 60 older adults in Italy, Spain and The Netherlands.

Background A psychosocial dementia care programme for challenging behaviour (DEMBASE (R)) was developed in collaboration with a Swedish BPSD-registry team for in-home care services use in Japan. The programme consisted of a web-based tool for the continued assessment of challenging behaviours and interdisciplinary discussion meetings. Effectiveness of the adapted programme was verified through a cluster-randomised controlled trial. The Tokyo Metropolitan Government provided municipal funding to introduce the programme into daily practice beginning in April 2018. Objectives To investigate both facilitators and barriers associated with programme implementation. Design A secondary analysis of qualitative and quantitative data. Settings Data were collected in naturalistic long-term care settings from April 2018 to March 2019. Participants A total of 138 professionals and 157 people with dementia participated in the programme. Methods Challenging behaviour in persons with dementia was assessed by professionals using a total Neuropsychiatric Inventory score. Data on expected facilitators and barriers were extracted for qualitative analysis from a debriefing meeting between professionals. Results Of the 157 persons with dementia, 81 (51.6%) received follow-up behavioural evaluations by March 2019. The average level of challenging behaviour was significantly reduced for 81 persons from baseline to their most recent follow-up evaluations. Facilitators included programme available for care managers, visualised feedback on professionals work, affordable for providers and professionals and media coverage. Barriers included professionals from different organisations, unpaid work, operation requirement for municipalities and conflict with daily benefit-oriented framework. Conclusions A follow-up evaluation was not fully achieved. Further strategies to address barriers may include the development of a benefit-rewarding scheme for interdisciplinary discussion meetings, an e-learnin, Funding Agencies|Tokyo Metropolitan GovernmentTokyo Metropolitan Government [29-Fukushi-Hoken-Kourei-Zaitaku 1397]; Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science

Virtual Coaches, also known as e-coaches, are a disruptive technology in healthcare. Indeed, among other usages, they might provide cost-effective solutions for increasing human wellbeing in different domains, such as physical, nutritional, cognitive, social, and emotional. This paper presents a systematic review of virtual coaches specifically aimed at improving or maintaining older adults' health in the aforementioned domains. Such digital systems assume various forms, from classic apps, to more advanced conversational agents or robots. Fifty-six articles describing a virtual coach for older adults and aimed at improving their wellbeing were identified and further analyzed. In particular, we presented how previous studies defined their virtual coaches, which behavioral change models and techniques they adopted and the overall system architecture, in terms of monitoring solutions, processing methods and modalities for intervention delivery. Our results show that few thorough evaluations of e-coaching systems have been conducted, especially regarding multi-domain coaching approaches. Through our analysis, we identified the wellbeing domains that should be addressed in future studies as well as the most promising behavior change models and techniques and coaching interfaces. Previous work illustrates that older adults often appreciate conversational agents and robots. However, the lack of a multidomain intervention approach in the current literature motivates us to seek to define future solutions., System Engineering

Background: There are no studies on how the same psychosocial dementia care program is adapted to both in-home andresidential care settings.Objective: To evaluate the time investment required by professionals to implement a psychosocial dementia care programto manage neuropsychiatric symptoms. Methods: A prospective observational study design was used. The program consisted of 1) a one-day training course,2) three interdisciplinary discussion meetings in five months, and 3) a web-based tool for the continued assessment ofneuropsychiatric symptoms. Care professionals implemented the intervention in in-home (19 in-home care managementagencies and 14 multiple in-home service providers) and residential care settings (19 group homes and eight nursing homes)in Japan from October 2019 to February 2020. The level of neuropsychiatric symptoms for the participants was evaluatedusing the Neuropsychiatric Inventory (NPI: 0–144). The time investment was reported by participating professionals. A totalof 125 persons with dementia were included at baseline. Results: Neuropsychiatric symptoms were significantly decreased at the final follow-up in all types of providers (Cohen’sdrm = 0.44–0.61). The mean (SD) time required for the five-month implementation was 417.9 (219.8) minutes. There wasa mean (SD) decrease of 8.6 (14.0) points in the total NPI score among the 103 persons with completed interventions. The time investment was significantly lower in in-home care management agencies than in group homes, and lower infollow-ups than at baseline assessment. Conclusion: The program implementation may incur a substantial time investment regardless of setting. An additional benefitscheme to reward the time investment would be helpful to encourage implementation until the follow-ups., Funding agencies: The Ministry and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare under Project Number Tsuika24; Tokyo Metropolitan Institute of Medical Science.

Virtual Coaches, also known as e-coaches, are a disruptive technology in healthcare. Indeed, among other usages, they might provide cost-effective solutions for increasing human wellbeing in different domains, such as physical, nutritional, cognitive, social, and emotional. This paper presents a systematic review of virtual coaches specifically aimed at improving or maintaining older adults' health in the aforementioned domains. Such digital systems assume various forms, from classic apps, to more advanced conversational agents or robots. Fifty-six articles describing a virtual coach for older adults and aimed at improving their wellbeing were identified and further analyzed. In particular, we presented how previous studies defined their virtual coaches, which behavioral change models and techniques they adopted and the overall system architecture, in terms of monitoring solutions, processing methods and modalities for intervention delivery. Our results show that few thorough evaluations of e-coaching systems have been conducted, especially regarding multi-domain coaching approaches. Through our analysis, we identified the wellbeing domains that should be addressed in future studies as well as the most promising behavior change models and techniques and coaching interfaces. Previous work illustrates that older adults often appreciate conversational agents and robots. However, the lack of a multidomain intervention approach in the current literature motivates us to seek to define future solutions.

Undernutrition is a major health problem in the growing elderly population. It is estimated that one in ten Dutch community-dwelling older adults is suffering from undernutrition, and one in three Dutch older adults who receive home care. Undernutrition may lead to many negative consequences, ranging from fatigue and falls to impaired immune function and death. This makes undernutrition an obvious target for preventive measures. Undernutrition can be defined as “a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function, and clinical outcome”. In addition, it is often described as protein energy malnutrition. Adequate protein intake may to some extent prevent and reverse this process. However, throughout ageing, it becomes increasingly difficult to reach adequate protein intake due to higher protein needs and lower protein intakes. Finding solutions to assist older adults in reaching their optimal protein intake is necessary. In our overall research project, we considered 1.2g protein per kg weight per day (g/kg/d) as adequate protein intake. In Dutch community-dwelling older adults, protein intake is around 1.0 g/kg/d, implying room for improvement. However, it is possible that many of these older adults deal with physiological changes, medical conditions, and physical and mental limitations that impair their appetite and food provision. For these older adults with higher protein needs, merely recommending that they eat more would not be realistic. It would be more realistic to explore strategies that increase protein intake without having to increase food intake. This calls for the exploration of instruments that match the needs and preferences of older adults: protein-enriched regular products. One particular group that can be identified as a target group for such products, are older adults who receive home care. U