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Dementia care mapping: effects on residents’ quality of life and challenging behavior in German nursing homes. A quasi-experimental trial

Published online by Cambridge University Press:  03 July 2015

Martin Nikolaus Dichter ,
Tina Quasdorf ,
Christian Günter Georg Schwab ,
Diana Trutschel ,
Burkhard Haastert ,
Christine Riesner ,
Sabine Bartholomeyczik  and
Margareta Halek
Martin Nikolaus Dichter*
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
Tina Quasdorf
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
Christian Günter Georg Schwab
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
Diana Trutschel
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany Institute of Computer Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Burkhard Haastert
Affiliation:
mediStatistica, Neuenrade, Germany
Christine Riesner
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany Division “Nursing Science and Pedagogics” Ministry of Health, Equalities, Care and Ageing of the State of North Rhine-Westphalia, Düsseldorf, Germany
Sabine Bartholomeyczik
Affiliation:
School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
Margareta Halek
Affiliation:
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
*
Correspondence should be addressed to: Martin Nikolaus Dichter, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany. Phone: +49 2302 926 253; Fax: +49 2302 926 239. Email: Martin.Dichter@dzne.de.
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Abstract

Background:

Person-centered care (PCC) is a widely recognized concept in dementia research and care. Dementia Care Mapping (DCM) is a method for implementing PCC. Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia (PwD). We aimed to investigate the effectiveness of DCM with regard to quality of life (QoL) and challenging behavior in PwD in nursing homes (NHs).

Methods:

Leben-QD II is an 18-month, three-armed, pragmatic quasi-experimental trial. The sample of PwD was divided into three groups with three living units per group: (A) DCM applied since 2009, (B) DCM newly introduced during the study, and (C) a control intervention based on a regular and standardized QoL rating. The primary outcome was QoL measured with the Quality of Life-Alzheimer's Disease (QoL-AD) proxy, and the secondary outcomes were QoL (measured with QUALIDEM) and challenging behavior (measured with the Neuropsychiatric Inventory Nursing Home version, NPI-NH).

Results:

There were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes. At baseline, the estimated least square means of the QoL-AD proxy for groups A, B, and C were 32.54 (confidence interval, hereafter CI: 29.36–35.72), 33.62 (CI: 30.55–36.68), and 30.50 (CI: 27.47–33.52), respectively. The DCM groups A (31.32; CI: 28.15–34.48) and B (27.60; CI: 24.51–30.69) exhibited a reduction in QoL values, whereas group C exhibited an increase (32.54; CI: 29.44–35.64) after T2.

Conclusions:

DCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

Keywords

nursing homesdementiaquality of lifeperson-centered caredementia care mappingchallenging behaviorpsychosocial intervention
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 11 , November 2015 , pp. 1875 - 1892
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Aged Care Branch (2011). Dementia-Friendly Environments. A Guide for Residential care. Canberra: Department of Health, Australia.Google Scholar
Bartholomeyczik, S. et al. (2007). Guidelines for Handling Challenging behavior in People with Dementia Living in Nursing Homes. Berlin: Bundesministerium für Gesundheit (BMG).Google Scholar
Beerens, H. C., Zwakhalen, S. M., Verbeek, H., Ruwaard, D. and Hamers, J. P. (2013). Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. International Journal of Nursing Studies, 50, 1259–1270.Google Scholar
Brooker, D. (2004). What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 215–222.CrossRefGoogle Scholar
Brooker, D. and Surr, C. (2007). Dementia Care Mapping: Principles and Practice, Bradford: University of Bradford.Google Scholar
Brooker, D. J. and Surr, C. (2006). Dementia care mapping (DCM): initial validation of DCM 8 in UK field trials. International Journal of Geriatric Psychiatry, 21, 1018–1025.CrossRefGoogle ScholarPubMed
Brown, H. and Prescott, R. (2006). Applied Mixed Models in Medicine. Statistics in Practice. Hoboken: John Wiley & Sons.CrossRefGoogle Scholar
BSI - British Standards Institution and University of Bradford (2010). PAS 800: 2010. Use of Dementia Care Mapping for Improved Person-Centred care in a care Provider Organisation - Guide. London: BSI-British Standards Institution.Google Scholar
Chenoweth, L. et al. (2009). Caring for aged dementia care resident study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurology, 8, 317–325.Google Scholar
Cohen-Mansfield, J., Thein, K., Marx, M.S., Dakheel-Ali, M. and Freedman, L. (2012). Efficacy of non-pharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial. The Journal of Clinical Psychiatry, 73, 1255–1261.Google Scholar
Cooper, C. et al. (2012). Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia. International Psychogeriatrics/IPA, 24, 856–870.CrossRefGoogle ScholarPubMed
Dichter, M., Bartholomeyczik, S., Nordheim, J., Achterberg, W. and Halek, M. (2011). Validity, reliability, and feasibility of a quality of life questionnaire for people with dementia. Zeitschrift für Gerontologie und Geriatrie, 44, 405–410.Google Scholar
Dichter, M. N., Halek, M., Dortman, O., Meyer, G. and Bartholomeyczik, S. (2013). Measuring the quality of life of people with dementia in nursing homes in Germany - the Study Protocol for the Qol-Dem Project [Die Erfassung der Lebensqualität von Menschen mit Demenz in stationären Altenpflegeeinrichtungen in Deutschland - Studienprotokoll des Qol-Dem Projektes]. GMS Psychosoc Med, 10, Doc07. doi: 10.3205/psm000097.Google Scholar
Dichter, M. N., Schwab, C. G., Meyer, G., Bartholomeyczik, S., Dortmann, O. and Halek, M. (2014). Measuring the quality of life in mild to very severe dementia: testing the inter-rater and intra-rater reliability of the German version of the QUALIDEM. International Psychogeriatrics/IPA, 26, 825–836.CrossRefGoogle ScholarPubMed
Dichter, M. N. et al. (2013a). Scalability and internal consistency of the German version of the dementia-specific quality of life instrument QUALIDEM in nursing homes – a secondary data analysis. Health and Quality of Life Outcomes, 11, 91.Google Scholar
Donner, A. and Klar, N. (2000). Design and Analysis of Cluster Randomization Trials in Health Research. London: Arnold.Google Scholar
Ettema, T. P., Droes, R. M., de Lange, J., Mellenbergh, G. J. and Ribbe, M. W. (2007). QUALIDEM: development and evaluation of a dementia specific quality of life instrument. Scalability, reliability, and internal structure. International Journal of Geriatric Psychiatry, 22, 549–556.Google Scholar
Graske, J., Meyer, S. and Wolf-Ostermann, K. (2014a). Quality of life ratings in dementia care – a cross-sectional study to identify factors associated with proxy-ratings. Health Qual Life Outcomes (HQLO), 12, 177.Google Scholar
Graske, J., Verbeek, H., Gellert, P., Fischer, T., Kuhlmey, A. and Wolf-Ostermann, K. (2014b). How to measure quality of life in shared-housing arrangements? A comparison of dementia-specific instruments. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, care, and Rehabilitation, 23, 549–559.Google Scholar
Halek, M., Dichter, M. N., Quasdorf, T., Riesner, C. and Bartholomeyczik, S. (2013). The effects of dementia care mapping on nursing home residents’ quality of life and staff attitudes: design of the quasi-experimental study Leben-QD II. BMC Geriatrics, 13, 53.CrossRefGoogle ScholarPubMed
Kitwood, T. (1997). Dementia Reconsidered: The Person Comes first. Berkshire, UK: Open University Press.Google Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.Google Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510–519.Google Scholar
MDS - Medizinicher Dienst des Spitzenverbandes Bund der Krankenkassen (2009). Quality assurance criteria of the German medical advisory service of the statutory health insurance for institutional care. Essen.Google Scholar
Meleis, A. I., Sawyer, L. M., Im, E. O., Hilfinger Messias, D. K. and Schumacher, K. (2000). Experiencing transitions: an emerging middle-range theory. ANS. Advances in Nursing Science, 23, 12–28.Google Scholar
Moniz-Cook, E. et al. (2008). A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging & Mental Health, 12, 14–29.Google Scholar
Moyle, W., Mcallister, M., Venturato, L. and Adams, T. (2007). Quality of life and dementia. Dementia, 6, 175–191.CrossRefGoogle Scholar
NICE (2006). Dementia. Supporting people with dementia and their carers in health and social care. NICE Clinical Guideline Number 42. London: National Insitute for Health and Clinical Excellence.Google Scholar
O’Rourke, H. M., Fraser, K. D. and Duggleby, W. (2015). Does the quality of life construct as illustrated in quantitative measurement tools reflect the perspective of people with dementia? Journal of Advanced Nursing. doi: 10.1111/jan.12667.Google Scholar
Perales, J., Cosco, T. D., Stephan, B. C., Haro, J. M. and Brayne, C. (2013). Health-related quality-of-life instruments for Alzheimer's disease and mixed dementia. International Psychogeriatrics/IPA, 25, 691–706.CrossRefGoogle ScholarPubMed
Pickard, A. S. and Knight, S. J. (2005). Proxy evaluation of health-related quality of life: a conceptual framework for understanding multiple proxy perspectives. Medical Care, 43, 493–499.Google Scholar
R Core Team (2014). R: A Language and Environmental for Statistical Computing. Vienna, Austria: Foundation for Statistical Computing. Available at: http://www.R-project.org; last accessed 11 May 2014.Google Scholar
Reisberg, B. (2007). Global measures: utility in defining and measuring treatment response in dementia. International Psychogeriatrics/IPA, 19, 421–456.Google Scholar
Rokstad, A. M., Rosvik, J., Kirkevold, O., Selbaek, G., Saltyte Benth, J. and Engedal, K. (2013). The effect of person-centred dementia care to prevent agitation and other neuropsychiatric symptoms and enhance quality of life in nursing home patients: a 10-month randomized controlled trial. Dementia and Geriatric Cognitive Disorders, 36, 340–353.Google Scholar
Rosvik, J., Kirkevold, M., Engedal, K., Brooker, D. and Kirkevold, O. (2011). A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study. International Journal of Older People Nursing, 6, 227–236.Google Scholar
Scholzel-Dorenbos, C. J., van der Steen, M. J., Engels, L. K. and Olde Rikkert, M. G. (2007). Assessment of quality of life as outcome in dementia and MCI intervention trials: a systematic review. Alzheimer Disease & Associated Disorders, 21, 172–178.Google Scholar
van de Ven, G. et al. (2013). Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial. PloS one, 8, e67325.CrossRefGoogle Scholar
Vernooij-Dassen, M., Vasse, E., Zuidema, S., Cohen-Mansfield, J. and Moyle, W. (2010). Psychosocial interventions for dementia patients in long-term care. International Psychogeriatrics/IPA, 22, 1121–1128.CrossRefGoogle ScholarPubMed
Wood, S. et al. (2000). The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 8, 75–83.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (2003). Introduction to drug utilization Research. WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services. Oslo, Norway.Google Scholar
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