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ABSTRACT: To establish the point prevalence and characteristics of patients with locked-in syndrome (LIS), particularly of the classic type, residing in Dutch nursing homes, a cross-sectional survey of Dutch nursing homes was conducted. The classic form of LIS was defined according to the criteria of the American Congress of Rehabilitation Medicine (1995). All Dutch long-term care organisations (n = 187) were asked if they had any patients with classic LIS as of December 5, 2011. The treating Elderly Care Physicians were then contacted to provide patient characteristics. Of all organisations, 91.4 % responded, and 11 organisations reported a total of 12 patients. After analysing the questionnaires, it was determined that ten patients had LIS, and two patients were characterised with vegetative state. Only two patients met the criteria for classic LIS, while six patients showed partial LIS. One of these patients was admitted to the nursing home after December 5, 2011, and was therefore, excluded. LIS without accompanying pontine lesion was observed in the remaining two patients. For the first time, the prevalence of classic LIS has been established at 0.7/10,000 somatic nursing home beds in all Dutch long-term care organisations. Possible explanations for this low prevalence could be the Dutch provision of home care or the influence of end-of-life decisions, such as euthanasia and withholding or withdrawing all medical treatment, including artificial nutrition and hydration. These alternate outcomes should be explored in further studies.
Journal of Neurology 01/2013; · 3.47 Impact Factor
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ABSTRACT: Behavioural problems in dementia are a burden for patients and caregivers and are often the main reason for admission to a
nursing home. Research on the prevalence of behavioural problems is scarce. In this study the prevalence of behavioural problems
was estimated in nursing home patients with dementia. In 59 demented patients the Neuropsychiatric Inventory (NPI-NH) and
the Cohen-Mansfield Agitation Inventory were used to measure behavioural problems over the last two weeks. Behavioural problems
were present in about 85% of the study group. Using the NPI-NH aggression/agitation and apathy were present in almost 40%
of the patients. Delusions, hallucinations, depression and anxiety were present in 10-15% of the patients. Using the CMAI
cursing/verbal aggression, restlessness, complaining, negativism, and mannerisms were prevalent in 30%-50% of the patients.
Larger studies on the prevalence of problem behaviour and possibly influencing factors are necessary.
Probleemgedrag bij dementie is belastend voor patiënt en partner en is vaak de reden voor opname in een verpleeghuis. Onderzoek
naar prevalentie van probleemgedrag is schaars. In dit onderzoek werd bepaald hoe vaak probleemgedrag bij dementerende verpleeghuis
patiënten voorkomt. Bij 59 patiënten met dementie in twee Nederlandse verpleeghuizen werd de Neuropsychiatrische Vragenlijst
(NPI-NH) en de Cohen-Mansfield Agitatie Vragenlijst (CMAI) gebruikt om het probleemgedrag over de afgelopen twee weken in
kaart te brengen. Probleemgedrag kwam bij ongeveer 85% van de onderzochte groep voor. Gemeten met de NPI-NH bleken agressie/agitatie
en apathie bij bijna 40% van de patiënten voor te komen . Wanen, hallucinaties, depressie en angst kwamen bij 10-15% van de
patiënten voor . Gemeten met de CMAI kwamen vloeken/verbale agressie, algemene rusteloosheid, klagen, negativisme en herhaalde
gedragingen bij 30-50% van de patiënten voor. Grootschaliger onderzoek naar de prevalentie van probleemgedrag en de mogelijk
van invloed zijnde factoren is nodig.
probleemgedrag-dementie-verpleeghuis
Tijdschrift voor gerontologie en geriatrie 04/2012; 37(1):18-23.
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American Journal of Geriatric Psychiatry 11/2011; 19(12):1046–1047. · 3.64 Impact Factor
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The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 08/2011; · 3.35 Impact Factor
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ABSTRACT: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.
This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either "present" or "absent".
The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.
PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.
International Psychogeriatrics 06/2011; 23(8):1249-59. · 2.24 Impact Factor
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ABSTRACT: From November 2007 for a period of three years (2007-2009), we conducted an annual one-day prevalence study of healthcare-associated infections (HAIs) among nursing home residents in the Nijmegen region of The Netherlands. In the absence of national HAI definitions applicable to the nursing home setting, we used modified definitions based on US Centers for Disease Control and Prevention criteria for bloodstream infection, lower respiratory tract infection, bacterial conjunctivitis, and gastroenteritis. For the surveillance of urinary tract infection (UTI), criteria established by the Dutch Association of Elderly Care Physicians were used. Resident characteristics were recorded and data collection was performed by the attending elderly care physicians. For the three-year period, 1275, 1323, and 1772 nursing home residents were included, resulting in a prevalence of HAIs of 6.7%, 7.6% and 7.6%, in 2007, 2008 and 2009, respectively. The demographics with respect to age (mean 81 years) and sex (31% men, 69% women) were almost identical in all three years. UTI was the most prevalent HAI with 3.5%, 4.2%, and 4.1% respectively. Most HAIs occurred among residents of rehabilitation units. The prevalence of HAIs varied by nursing home (range: 0.0-32.4%). We present the results of the first prevalence study of HAIs in Dutch nursing homes. Point prevalence studies of HAIs, as part of a quality improvement cycle, are an important cornerstone of infection control programmes in nursing homes, allowing us to further increase patient safety efforts in this setting.
The Journal of hospital infection 03/2011; 78(1):59-62. · 3.01 Impact Factor
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ABSTRACT: The goal of this study is to assess the relationship between quality of life (QoL), neuropsychiatric symptoms (NPS), psychotropic drug use (PDU) and patient characteristics in a large group of nursing home residents with dementia.
This cross-sectional observational study included 288 individuals with dementia who reside in 14 special care units in 9 nursing homes. The following measures were used: the Qualidem scale to assess QoL, the Neuropsychiatric Inventory-Nursing Home version, the Global Deterioration Scale (GDS), the Severe Impairment Battery-short version, an Activities of Daily Living scale and PDU. Associations between QoL and NPS were examined using multivariate linear regression models with corrections for potential covariates.
The average age of the residents was 84 years (SD = +/-7). Agitation, depression, psychosis, psychomotor agitation and psychotropic drugs were independently associated with poor QoL. In patients with mild to moderately severe dementia (GDS 4-6), NPS, PDU and cognitive impairment explained almost half of the variance in QoL scores. Agitation and depression were particularly strong predictors of poor QoL. In patients with severe dementia (GDS 7), agitation, depression, psychosis and cognitive impairment were associated with poor QoL.
NPS, cognition and PDU independently impair QoL for patients in both the moderate and advanced stages of dementia. These results challenge existing pharmacological intervention strategies and highlight the need for psychosocial interventions in the treatment of NPS.
Dementia and Geriatric Cognitive Disorders 03/2010; 29(3):189-97. · 2.14 Impact Factor
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ABSTRACT: Disease management of dementia in general practice (GP) is hampered by a lack of data on the prognosis of dementia.
To gain more insight into the life expectancy of and the effects of cardiovascular and cerebrovascular co-morbidity in dementia patients in GP.
Historical cohort.
4 general practices in Nijmegen, The Netherlands.
All patients in these practices participating in the Continuous Morbidity Registration (CMR).
The patient cohort was diagnosed with dementia between January 1st 1985 and December 31st 2002. The control cohort consisted of patients matched one-to-one with demented patients on age, sex, and socio-economic status. Cardiovascular and cerebrovascular co-morbidity was studied from 5 years before the diagnosis of dementia till the endpoints of data collection.
251 couples of patients and controls were formed (79 men, 172 women, mean age 81.4+/-7.0 years). The median life expectancy after diagnosis was 2.3 years for the dementia patients, and 3.7 years for the controls. Median time from diagnosis till nursing home placement was 1.4 years. Cerebrovascular and cardiovascular morbidity preceding dementia diagnosis decreased survival of cases with dementia with a relative risk of 1.54 (95%CI: 1.13-2.09) and in controls with a relative risk of 1.91 (95%CI: 1.48-2.46). Obesity was associated with a lower risk of dementia (RR=0.77 (95%-CI 0.63-0.94)). Hypertension and obesity diagnosed after the dementia diagnosis were significantly associated with an increase in survival.
In general practice, the diagnosis of dementia is made at a late stage, when patients will continue to live at home only for a short time. Moreover, life expectancy at diagnosis is very limited and prognosis is furthermore negatively influenced by preceding cardio- and cerebrovascular co-morbidity.
The Journal of Nutrition Health and Aging 03/2008; 12(2):145-50. · 2.69 Impact Factor
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R T C M Koopmans
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ABSTRACT: In 1993 Ribbe en Hertogh published a paper in which they expressed their concern about the high prevalence of psychotropic drug use in Dutch nursing homes. Since then, this situation does not seem to have been changed significantly. Recent figures from psychotropic drug use in patients with dementia show prevalence rates of over 60%. The Dutch government decided to choose the prevalence of psychotropic drug use as an indicator of the quality of care and invested in a specific improvement project that aims to reduce psychotropic drug use among nursing home patients. There is a small body of evidence from international research that antipsychotics safely can be reduced without a rise in problem behaviours. In combination with the limited effectiveness and the risk of stroke and increased mortality, the question raises whether these agents should be prescribed at all at least for patients with dementia. A recent study from the UK however, found a significant decrease of antipsychotic drug use by heavily investing in all kinds of person-centered care skills of the nursing staff. These findings underscore the necessity of investing in the caregivers of nursing homes to be able to cope with the complex problems they are faced with.
Tijdschrift voor gerontologie en geriatrie 01/2008; 38(6):270-3.
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R T C M Koopmans
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ABSTRACT: The number of people suffering from dementia in The Netherlands is expected to rise from 175,000 in 2006 to 400,000 by the year 2050. Stella Braam recently wrote a book in which she described the experiences of her father, a former psychologist with the attitudes and knowledge of professionals concerning communication and coping with dementia, when he became dement himself. She reports that hardly anyone actually listened to the emotions and wishes of her father. Coping with dementia constitutes a major challenge to society. A working-group of the Dutch Institute for Healthcare Improvement CBO recently advised psychological approaches as the first-line treatment for the neuropsychiatric symptoms of dementia; however, they decided not to give concrete guidelines because of the lack of evidence. A study of the literature reveals that the effects of psychosocial interventions are certainly promising even though the evidence is weak. Investment in more research in this field and immediate implementation of the existing knowledge by caregivers and professional workers are recommended.
Nederlands tijdschrift voor geneeskunde 08/2006; 150(30):1653-6.
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ABSTRACT: To assess the efficacy and adverse reactions of typical and atypical antipsychotics in the treatment of neuropsychiatric symptoms in dementia, and to examine the evidence for the cerebrovascular events warning for atypical antipsychotics.
Systematic review.
Using Medline, Cinahl, PsyclNFO, Embase and the Cochrane central register of controlled trials (1980-2005), double-blind randomized controlled trials with intention-to-treat analysis were selected, which evaluated efficacy and adverse reactions of antipsychotics in the treatment of neuropsychiatric symptoms in dementia. The studies underwent a standardised validity assessment.
After screening 950 studies, 14 studies on the effect of haloperidol, risperidone, olanzapine, quetiapine, tiapride, loxapine and perphenazine were selected. In 7 out of 10 studies, haloperidol, risperidone and olanzapine appeared to be more effective than placebo in the treatment of aggression and psychosis. Direct comparison between typical and atypical antipsychotics revealed no statistically significant difference. The most common adverse reactions were extrapyramidal symptoms and somnolence. These adverse reactions were less frequent with low-dose risperidone than with haloperidol or olanzapine, but risperidone and olanzapine were found to be associated with a higher risk of cerebrovascular events in two studies.
The efficacy of typical and atypical antipsychotics is comparable, but only low-dose risperidone seems to be associated with fewer (extrapyramidal) side effects. The adverse reactions are inadequately described in the published data and consequently the warning of an increased risk of mortality could not be confirmed.
Nederlands tijdschrift voor geneeskunde 08/2006; 150(28):1565-73.
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ABSTRACT: Behavioural problems in dementia are a burden for patients and caregivers and are often the main reason for admission to a nursing home. Research on the prevalence of behavioural problems is scarce. In this study the prevalence of behavioural problems was estimated in nursing home patients with dementia. In 59 demented patients the Neuropsychiatric Inventory (NPI-NH) and the Cohen-Mansfield Agitation Inventory were used to measure behavioural problems over the last two weeks. Behavioural problems were present in about 85% of the study group. Using the NPI-NH aggression/agitation and apathy were present in almost 40% of the patients. Delusions, hallucinations, depression and anxiety were present in 10-15% of the patients. Using the CMAI cursing/verbal aggression, restlessness, complaining, negativism, and mannerisms were prevalent in 30%-50% of the patients. Larger studies on the prevalence of problem behaviour and possibly influencing factors are necessary.
Tijdschrift voor gerontologie en geriatrie 04/2006; 37(1):19-24.
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ABSTRACT: To establish the prevalence of vegetative state in Dutch nursing homes, describe the patient characteristics, and highlight the possible influence of medical decisions at the end of life.
A cross-sectional survey. The vegetative state was defined according to the Multi Society Task Force on PVS. All Dutch nursing homes were approached to provide data on patients in a vegetative state. In cases of doubt, the researcher discussed the diagnosis with the patient's physician and, if necessary, examined the patient. Information on patients in a vegetative state in care between 2000 and September 2003 and end of life decisions for them were also recorded.
All nursing homes and physicians participated. After assessment of 12 doubtful patients, 32 met the criteria of vegetative state lasting longer than one month, a prevalence of 2/1,000,000. Of these, 30 patients' data were analysed: age 9-90 years; 73% female; duration of vegetative state 2 months-20 years (26 surviving >1 year, 13 >5 years). Stroke was the commonest cause. Between 2000 and September 2003, there were 76 patients in a vegetative state in care of whom 34 died of complications and nine after withdrawal of artificial nutrition and hydration.
The prevalence of vegetative state in Dutch nursing homes has been established for the first time. The figures are lower than suggested in the literature. The study included a heterogeneous group of patients, of which a substantial number survived for many years. The results cannot be explained by a policy of systematically withdrawing artificial nutrition and hydration.
Journal of Neurology Neurosurgery & Psychiatry 10/2005; 76(10):1420-4. · 4.76 Impact Factor
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ABSTRACT: There is scant literature about patients in the final phase of dementia. Uniform terminology and operational definition of the final phase of dementia is lacking. Furthermore, it is difficult to monitor these patients because existing assessment scales face bottom- or ceiling effects in this population. The aim of this study was to assess the prevalence and the characteristics of patients in the final phase of dementia in a group of 210 Dutch nursing home patients with dementia. Stage 7 of the Global Deterioration Scale of Reisberg et al. was used to operationally define the final phase of dementia. All patients were scored on a self-constructed assessment scale. Furthermore, treatment aspects and advance directives were registered.
Tijdschrift voor gerontologie en geriatrie 06/2005; 36(2):72-6.
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ABSTRACT: The aim of this study was to describe the use of psychotropic drugs in a psychogeriatric nursing home, Joachim en Anna, in Nijmegen, the Netherlands. To this end the medical records of 890 nursing home patients with dementia, admitted between 1980 and 1989, were analysed retrospectively. Each time pattern of psychotropic drug use was registered. Drugs were coded by means of the Anatomical Therapeutic Chemical classification system. The daily dose was expressed as the ratio of the mean prescribed daily dose and the defined daily dose. Side-effects and changes in prescription patterns throughout the years patients were admitted were analysed. A total of 3,090 time patterns of exposure to psychotropics were registered. Neuroleptics, benzodiazepines, and antidepressants accounted for 58, 32, and 9% of the time patterns, respectively. For almost every drug prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of these nursing home patients had at least one prescription for a psychotropic drug during institutionalization. One or more side-effects were observed in 50% of the patients who used a neuroleptic. The total number of patients receiving psychotropics did not change throughout the study. Psychotropics were prescribed for long-term use, but in a low dose. Side-effects were frequently observed while the correct individual dose was being determined.
Pharmacy World amp Science 12/1995; 18(1):42-47. · 1.22 Impact Factor
