1
|
Palm R, Fahsold A, Roes M, Holle B. Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology. PLoS One 2021; 16:e0259496. [PMID: 34784375 PMCID: PMC8594822 DOI: 10.1371/journal.pone.0259496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. Methods The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. Results We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. Discussion As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.
Collapse
Affiliation(s)
- Rebecca Palm
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- * E-mail:
| | - Anne Fahsold
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Martina Roes
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Bernhard Holle
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| |
Collapse
|
2
|
Siewert JS, Alvarez AM, Santos SMAD, Brito FA, Hammerschmidt KSDA. Institutionalized elderly people with dementia: an integrative review on nursing care. Rev Bras Enferm 2020; 73 Suppl 3:e20180419. [PMID: 32756799 DOI: 10.1590/0034-7167-2018-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To ascertain the characteristics of the nursing care provided to institutionalized elderly people with dementia. METHODS Integrative review of studies published between 2013 and 2017, in English, Spanish, and Portuguese, from the databases BDENF, LILACS, CINAHL, PubMed, SciELO, TRIP, and National Guideline Clearing House. Thematic data analysis was used. RESULTS From the data collected in the 41 included studies, three themes emerged: Care with a focus on the needs of elderly people in LTCIEs; Care based on the work process of the nursing team; and Shared care. Final considerations: Elderly care can take place from different perspectives: that of the elderly; the nursing team; and it can be shared among the different parties involved. The importance of communication must be stressed, as do the development of skills and attitudes of the team, as well as proper training and support, good environment in the care process, and an approach centered on the institutionalized elderly.
Collapse
|
3
|
Puurveen G, Cooke H, Gill R, Baumbusch J. A Seat at the Table: The Positioning of Families During Care Conferences in Nursing Homes. THE GERONTOLOGIST 2020; 59:835-844. [PMID: 30169610 DOI: 10.1093/geront/gny098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current nursing home policy emphasizes the need for collaborative, team-based care planning in which families and/or residents are actively involved. Resident care conferences are common where care providers, families, and/or residents discuss and coordinate resident care needs and evaluate care goals. This study critically examines the process, structure, and content of care conferences to expand our understanding of how resident care is negotiated among care providers and families in this context. RESEARCH DESIGN AND METHODS This study was part of a larger critical ethnography examining the negotiation of care work among care providers, families, and residents in three purposively selected nursing homes in British Columbia, Canada. Thirty-seven care conferences were observed. Field notes and interview data were thematically analyzed with a focus on what was said, who said what and to whom, whose voice was privileged, and how power manifested between care providers, families, and/or residents. RESULTS As illustrated by three key themes, Exclusion by Process-Following Script, Exclusion by Content-Scripted Reports, and Exclusion through Devalued Knowledge, families were overtly and covertly excluded from contributing to the care conferences. As such, families' presence did not guarantee open communication or active solicitation of their perspectives. DISCUSSION AND IMPLICATIONS The use of predetermined agendas and processes, clinically generic reporting, and technical jargon reproduced the structural inequality between care providers and families making collaboration difficult to effectively negotiate. For care conferences to meaningfully contribute to person-centered care, it is imperative that mutual exchange be promoted and families empowered to participate as equals.
Collapse
Affiliation(s)
- Gloria Puurveen
- School of Nursing, The University of British Columbia, Wesbrook Mall, Vancouver, Canada
| | - Heather Cooke
- School of Nursing, The University of British Columbia, Wesbrook Mall, Vancouver, Canada
| | - Rupali Gill
- School of Nursing, The University of British Columbia, Wesbrook Mall, Vancouver, Canada
| | - Jennifer Baumbusch
- School of Nursing, The University of British Columbia, Wesbrook Mall, Vancouver, Canada
| |
Collapse
|
4
|
Palm R, Trutschel D, Sorg CGG, Dichter MN, Haastert B, Holle B. Quality of Life in People With Severe Dementia and Its Association With the Environment in Nursing Homes: An Observational Study. THE GERONTOLOGIST 2020; 59:665-674. [PMID: 29566150 DOI: 10.1093/geront/gny017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Theoretical models propose the environment as a factor influencing the quality of life (QoL) of nursing home residents with dementia. This study investigates whether the observed QoL differs depending on the type of care unit. RESEARCH DESIGN AND METHODS DemenzMonitor is an exploratory, observational study involving annual data collection in German nursing homes (2012-2014). For this analysis, we selected residents with a recorded diagnosis of dementia and severe cognitive impairment. QoL was measured with the proxy assessment QUALIDEM. Four care unit types were investigated: large integrated, large segregated, small integrated, and small segregated. RESULTS We did not find a significant difference between the care units. During the 2 years, the observed QoL was not affected by any of the care unit types in a statistically significant or clinically relevant manner. However, a significant interaction effect between time and care unit types was found. DISCUSSION AND IMPLICATIONS Structural and organizational characteristics of care units, which in turn have implications for residents characteristics and the quality of care, may influence the QoL of residents. This may explain the interaction we observed.
Collapse
Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | - Diana Trutschel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,Institute of Informatics, Martin-Luther University Halle/Wittenberg, Halle/Saale, Germany
| | - Christian G G Sorg
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | - Martin N Dichter
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| | | | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Germany
| |
Collapse
|
5
|
Holle D, Müller-Widmer R, Reuther S, Rosier-Segschneider U, Graf R, Roes M, Halek M. Process evaluation of the context, reach and recruitment of participants and delivery of dementia-specific case conferences (WELCOME-IdA) in nursing homes (FallDem): a mixed-methods study. Trials 2019; 20:45. [PMID: 30642387 PMCID: PMC6332590 DOI: 10.1186/s13063-018-3147-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background A system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD. Methods This study was part of a larger process evaluation using a mixed-methods design. Standardised questionnaires, semi-structured interviews, attendance lists, standardised protocols and written self-reports were used to collect the data. The quantitative data were analysed by calculating descriptive statistics. The qualitative interviews were analysed using deductive content analysis and the self-reports were analysed using a documentary analysis. Results None of the NHs had prior experience with dementia-specific case conferences on a specific concept related to BPSD. The number of residents for whom a dementia-specific case conference was held was lower than expected. The number of nursing staff reached was high, although as defined in the study protocol, core nursing teams continuously participating in all components of the intervention were not established throughout the study. An analysis of the delivery of the intervention showed a reduction in the frequency of dementia-specific case conferences and deviations in the process structure and role structure of WELCOME-IdA. The strategy used to facilitate the implementation of WELCOME-IdA was mostly followed. An analysis of the recruitment of residents indicated that the variation in which residents were included in the study sample was high and that the intended sample size required to achieve a power >80% was not reached. Conclusion An analysis of the process evaluation data indicated that there were inaccuracies in the implementation of WELCOME-IdA and there were methodological limitations within the design of the effectiveness trial, both of which could explain the lack of effectiveness of WELCOME-IdA. To optimise the process structure of WELCOME-IdA, an assessment of BPSD and a pre-selection of possible domains for the behavioural analysis could be conducted prior to a dementia-specific case conference. Trial registration ISRCTN20203855. Registered on 10 July 2013.
Collapse
Affiliation(s)
- Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany. .,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Rene Müller-Widmer
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Sven Reuther
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Ute Rosier-Segschneider
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rabea Graf
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| |
Collapse
|
6
|
Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: a cross-sectional survey. Int Psychogeriatr 2018; 30:1279-1290. [PMID: 29198221 PMCID: PMC6190067 DOI: 10.1017/s1041610217002708] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED ABSTRACTBackground:Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). METHODS Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. RESULTS Higher levels of PCC were associated with a greater job satisfaction, three years or more of health-related education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. CONCLUSION This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
Collapse
|
7
|
Moniz-Cook E, Hart C, Woods B, Whitaker C, James I, Russell I, Edwards RT, Hilton A, Orrell M, Campion P, Stokes G, Jones RSP, Bird M, Poland F, Manthorpe J. Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, UK
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Cathryn Hart
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Chris Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Ian James
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Russell
- Swansea Trials Unit, Swansea University, Swansea, UK
| | | | - Andrea Hilton
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Martin Orrell
- Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Peter Campion
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Robert SP Jones
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Mike Bird
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
| |
Collapse
|
8
|
Trutschel D, Palm R, Holle B, Simon M. Methodological approaches in analysing observational data: A practical example on how to address clustering and selection bias. Int J Nurs Stud 2017; 76:36-44. [PMID: 28915416 DOI: 10.1016/j.ijnurstu.2017.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Because not every scientific question on effectiveness can be answered with randomised controlled trials, research methods that minimise bias in observational studies are required. Two major concerns influence the internal validity of effect estimates: selection bias and clustering. Hence, to reduce the bias of the effect estimates, more sophisticated statistical methods are needed. AIM To introduce statistical approaches such as propensity score matching and mixed models into representative real-world analysis and to conduct the implementation in statistical software R to reproduce the results. Additionally, the implementation in R is presented to allow the results to be reproduced. METHOD We perform a two-level analytic strategy to address the problems of bias and clustering: (i) generalised models with different abilities to adjust for dependencies are used to analyse binary data and (ii) the genetic matching and covariate adjustment methods are used to adjust for selection bias. Hence, we analyse the data from two population samples, the sample produced by the matching method and the full sample. RESULTS The different analysis methods in this article present different results but still point in the same direction. In our example, the estimate of the probability of receiving a case conference is higher in the treatment group than in the control group. Both strategies, genetic matching and covariate adjustment, have their limitations but complement each other to provide the whole picture. CONCLUSION The statistical approaches were feasible for reducing bias but were nevertheless limited by the sample used. For each study and obtained sample, the pros and cons of the different methods have to be weighted.
Collapse
Affiliation(s)
- Diana Trutschel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany; Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
| | - Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany; University Witten/Herdecke, Witten, Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Michael Simon
- University of Basel, Basel, Switzerland; University Hospital Inselspital, Bern, Switzerland
| |
Collapse
|
9
|
Palm R, Jünger S, Reuther S, Schwab CGG, Dichter MN, Holle B, Halek M. People with dementia in nursing home research: a methodological review of the definition and identification of the study population. BMC Geriatr 2016; 16:78. [PMID: 27052960 PMCID: PMC4823911 DOI: 10.1186/s12877-016-0249-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are various definitions and diagnostic criteria for dementia, leading to discrepancies in case ascertainment in both clinical practice and research. We reviewed the different definitions, approaches and measurements used to operationalize dementia in health care studies in German nursing homes with the aim of discussing the implications of different approaches. Methods We conducted a systematic search of the MEDLINE and CINAHL databases to identify pre-2016 studies conducted in German nursing homes that focused on residents with dementia or cognitive impairment. In- or exclusion of studies were consented by all authors; data extraction was independently carried out by 2 authors (RP, SJ). The studies’ sampling methods were compared with respect to their inclusion criteria, assessment tools and methods used to identify the study population. Results We summarized case ascertainment methods from 64 studies. Study participants were identified based on a diagnosis that was evaluated during the study, or a recorded medical dementia diagnosis, or a recorded medical diagnosis either with additional cognitive screenings or using screening tests exclusively. The descriptions of the diagnostics that were applied to assess a diagnosis of dementia were not fully transparent in most of the studies with respect to either a clear reference definition of dementia or applied diagnostic criteria. If reported, various neuropsychological tests were used, mostly without a clear rationale for their selection. Conclusion Pragmatic considerations often determine the sampling strategy; they also may explain the variances we detected in the different studies. Variations in sampling methods impede the comparability of study results. There is a need to consent case ascertainment strategies in dementia studies in health service research in nursing homes. These strategies should consider resource constraints and ethical issues that are related to the vulnerable population of nursing home residents. Additionally, reporting about dementia studies in nursing homes need to be improved. If a diagnosis cannot be evaluated based on either ICD or DSM criteria, the study population may not be reported as having dementia. If a diagnosis is evaluated based on ICD or DSM criteria within the study, there is a need for more transparency of the diagnostic process. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0249-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany. .,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany.
| | - Saskia Jünger
- Hannover Medical School, Institute of General Medicine, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sven Reuther
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Christian G G Schwab
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Martin N Dichter
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Margareta Halek
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| |
Collapse
|
10
|
Albert SM. Role of Case Conferences in Dementia-Specific vs Traditional Care Units in German Nursing Homes. J Am Med Dir Assoc 2015; 17:12-3. [PMID: 26597420 DOI: 10.1016/j.jamda.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|