The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia.
The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design.
There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing.
A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care.
"Evidence suggests that different types of person-centered care (PCC) may reduce NPSs and improve both resident and staff outcomes –. There are examples of PCC interventions for nursing home residents with dementia that have been shown to lower the rate of NPSs, falls, and the use of psychotropic drugs , . Dementia-care mapping (DCM) is a person-centred, multicomponent intervention developed by the Bradford Dementia Group at the University of Bradford in the UK and is based on Kitwood’s social-psychological theory of personhood in dementia . "
[Show abstract][Hide abstract] ABSTRACT: Dementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes.
Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units.
34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0(.)05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0(.)02).
DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they adopt the DCM method.
Dutch Trials Registry NTR2314.
PLoS ONE 01/2014; 9(1):e86662. DOI:10.1371/journal.pone.0086662 · 3.23 Impact Factor
"As a research instrument, DCM has been used in cross-sectional surveys to compare quality of care and QOL across facilities, and to examine the relationship between resident characteristics and activity (Potkins et al., 2003; Chung, 2004; Kuhn et al., 2004; Kuhn et al., 2005). DCM has also been used to evaluate the impact of interventions on the lives of people with dementia, including a hospital ward merger (Bredin and Kitwood, 1995), group reminiscence (Brooker and Duce, 2000), aromatherapy (Ballard et al., 2002a), sensory stimulation groups (Maguire and Gosling, 2003), intergenerational programs (Jarrott and Bruno, 2003), horticultural therapy (Gigliotti et al., 2004), and psychiatric consultation (Ballard et al., 2002b). This paper uses data from multiple studies across a variety of settings, to present a comprehensive picture of DCM item distribution, inter-rater reliability, validity, and alternative data collection and coding methods. "
[Show abstract][Hide abstract] ABSTRACT: Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals.
Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized.
Issues and problems identified include: complex scoring algorithms, inter-rater reliability of the BCCs, limited variability of WIB values, associations between resident characteristics and DCM assessments, rater time burden, and comparability of results across study settings.
Despite the identified limitations, DCM has promise as a research measure, as it may come closer to rating QOL from the perspective of persons with dementia than other available measures. Its utility will depend on the manner in which it is applied and an appreciation of the measure's strength and limitations. Possible changes that might improve the reliability, validity, and practicality of DCM as a research tool include coding the predominant event (rather than the 'best' event), shortening the observation period, and adding '0' as a neutral WIB coding option.
International Journal of Geriatric Psychiatry 06/2007; 22(6):580-9. DOI:10.1002/gps.1721 · 2.87 Impact Factor
"All the existing evidence demonstrates the superior effectiveness of specialist older people's mental health services when compared with any other approach or provides the only evidence for effectiveness. The benefit and superiority of specialist older people's mental health services has been shown in community, inpatient and day hospital services (Draper, 2000) general hospital liaison psychiatry (Royal College of Psychiatrists, 2005; Anderson, 2005a) and care homes (Ballard et al, 2002; Fossey et al, 2006). Specialist inpatient care is of higher quality (Draper & Low, 2005) and preferred by patients and carers (Healthcare Commission, 2009). "
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