Dementia Care Management Research Articles

Clinical Outcomes and Cost-Effectiveness of Collaborative Dementia Care

Long-term evidence for the effectiveness and cost-effectiveness of collaborative dementia care management (CDCM) is lacking. To evaluate whether 6 months of CDCM is associated with improved patient clinical outcomes and caregiver burden and is cost-effective compared with usual care over 36 months. This was a prespecified secondary analysis of a general practitioner (GP)-based, cluster randomized, 2-arm clinical trial conducted in Germany from January 1, 2012, to December 31, 2014, with follow-up until March 31, 2018. Participants were aged 70 years or older, lived at home, and screened positive for dementia. Data were analyzed from March 2011 to March 2018. The intervention group received CDCM, comprising a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia care collaborating with GPs and health care stakeholders over 6 months. The control group received usual care. Main outcomes were neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]), caregiver burden (Berlin Inventory of Caregivers' Burden in Dementia [BIZA-D]), health-related quality of life (HRQOL, measured by the Quality of Life in Alzheimer Disease scale and 12-Item Short-Form Health Survey [SF-12]), antidementia drug treatment, potentially inappropriate medication, and cost-effectiveness (incremental cost per quality-adjusted life year [QALY]) over 36 months. Outcomes between groups were compared using multivariate regression models adjusted for baseline scores. A total of 308 patients, of whom 221 (71.8%) received CDCM (mean [SD] age, 80.1 [5.3] years; 142 [64.3%] women) and 87 (28.2%) received usual care (mean [SD] age, 79.2 [4.5] years; 50 [57.5%] women), were included in the clinical effectiveness analyses, and 428 (303 [70.8%] CDCM, 125 [29.2%] usual care) were included in the cost-effectiveness analysis (which included 120 patients who had died). Participants receiving CDCM showed significantly fewer behavioral and psychological symptoms (adjusted mean difference [AMD] in NPI score, -10.26 [95% CI, -16.95 to -3.58]; P = .003; Cohen d, -0.78 [95% CI, -1.09 to -0.46]), better mental health (AMD in SF-12 Mental Component Summary score, 2.26 [95% CI, 0.31-4.21]; P = .02; Cohen d, 0.26 [95% CI, -0.11 to 0.51]), and lower caregiver burden (AMD in BIZA-D score, -0.59 [95% CI, -0.81 to -0.37]; P < .001; Cohen d, -0.71 [95% CI, -1.03 to -0.40]). There was no difference between the CDCM group and usual care group in use of antidementia drugs (adjusted odds ratio, 1.91 [95% CI, 0.96-3.77]; P = .07; Cramér V, 0.12) after 36 months. There was no association with overall HRQOL, physical health, or use of potentially inappropriate medication. The CDCM group gained QALYs (0.137 [95% CI, 0.000 to 0.274]; P = .049; Cohen d, 0.20 [95% CI, -0.09 to 0.40]) but had no significant increase in costs (437€ [-5438€ to 6313€] [US $476 (95% CI, -$5927 to $6881)]; P = .87; Cohen d, 0.07 [95% CI, -0.14 to 0.28]), resulting in a cost-effectiveness ratio of 3186€ (US $3472) per QALY. Cost-effectiveness was significantly better for patients living alone (CDCM dominated, with lower costs and more QALYs gained) than for those living with a caregiver (47 538€ [US $51 816] per QALY). In this secondary analysis of a cluster randomized clinical trial, CDCM was associated with improved patient, caregiver, and health system-relevant outcomes over 36 months beyond the intervention period. Therefore, it should become a health policy priority to initiate translation of CDCM into routine care. ClinicalTrials.gov Identifier: NCT01401582.

Implementing Dementia Care Management into routine care: protocol for a cohort study in Siegen-Wittgenstein, Germany (RoutineDeCM)

IntroductionDementia Care Management is an evidence-based model of care. It has proven its efficacy and cost-effectiveness and has been applied to different settings and different target groups. However, it is...

Adapting Dementia Care Management to a Regional German Context: Assessment of Changes in Acceptability, Appropriateness, and Feasibility.

Dementia care management, an evidence-based care concept in Germany, optimizes care for people with dementia and their caregivers. Implemented by qualified professionals, it comprises intervention modules addressing treatment and care, medication management, and caregiver support. Positively evaluated in one federal state, it's recommended for nationwide integration into routine care. Since the infrastructure of the German healthcare system differs regionally, the concept underwent adaption for regional implementation in a participatory, iterative process. Five local healthcare experts as co-researchers tested and adjusted selected components of the concept in a pilot study. This trend analysis aims to assess the adapted concept for acceptance, appropriateness, and feasibility. A total of 89 intervention modules were tested over 18weeks, and the co-researcher's assessment was gathered through an accompanying online survey. The participatory process itself was rated positively overall, but technical problems had a negative impact on the implementation and evaluation of the care concept.

Care management improves total cost of care for patients with dementia.

To examine a 12-month dementia care management program's effect on health care cost, utilization, and overall return on investment in a Medicare managed care population. Pre-post analysis of participants (n = 121) enrolled in Ochsner's Care Ecosystem program from 2019 through 2021 compared with propensity-matched controls (n = 121). The primary outcome comparison was total cost of care. Secondary outcomes included components of total cost of care (eg, inpatient, outpatient, emergency department [ED] costs), health care utilization (eg, number of ED visits), and differences in Hierarchical Condition Category (HCC) risk scores. Difference-in-differences analyses were conducted from baseline through 12 months comparing various financial metrics and utilization between groups. Care Ecosystem participants had significantly lower total cost of care at 12 months, mean savings of $475.80 per member per month compared with controls. Care Ecosystem participants had fewer ED, outpatient, and professional visits. HCC risk scores were also better relative to matched controls. A collaborative dementia care program demonstrated significant financial benefit in a managed Medicare population.

Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers.

This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis. The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.

‘Letting it be’: a grounded theory about dementia care in Fiji

Objectives This research study aimed to discover how dementia affecting older people was perceived, experienced, and managed by stakeholders in the Pacific Island country of Fiji. Method A transformational grounded theory approach was used. Semi-structured interviews and focus groups with key stakeholders in the major towns of Suva, Lautoka, and Nadi were carried out. Transcripts were analysed in line with transformational grounded theory methods. Results A total of 50 participants (40 service providers, eight family caregivers, one person with dementia, and one village elder) shared their views and experiences about dementia. A grounded theory about dementia care management was constructed. ‘Letting it be’ is the grounding socio-cultural construct that interweaves and binds together the processes of dementia care management. It expresses a compassionate approach to caring for older people with dementia that involves searching for knowledge and support, and application of traditional care practices within the strength of family and community networks. Conclusion In Fiji, support for dementia centres on the integration of community understandings, and promotion of cultural values of wellbeing and care, with service provision. It also focuses on support for families and communities through social welfare, community networks, and education.

What Makes a Better Life for People Facing Dementia? Toward Dementia-Friendly Health and Social Policy, Medical Care, and Community Support in the United States.

Taking steps to build a more dementia-friendly society is essential for addressing the needs of people experiencing dementia. Initiatives that improve the quality of life for those living with dementia are needed to lessen controllable factors that can negatively influence how people envision a future trajectory of dementia for themselves. Programs that provide better funding and better coordination for care support would lessen caregiver burden and make it more possible to imagine more people being able to live what they might consider a "good life" with dementia. Specific proposals, such as payment for dementia care managers and new systems to support high-quality, symptom-based palliative care beyond the hospice benefit of only six months, would improve and reframe how many people in the United States experience a dementia illness. Such changes should be incorporated into discussions about improving and respecting preferences in the later stages of dementia.

ASSOCIATION BETWEEN MOTOR ACTIVITY AND TOTAL NEUROPSYCHIATRIC INVENTORY NURSING HOME VERSION SCORES

Abstract Accurate neuropsychiatric symptoms (NPS) assessment monitoring is crucial for person-centered dementia care management. Doing so, however, is challenging, since current assessment tools rely on clinical observations, are time consuming, and are somewhat subjective in nature. The Neuropsychiatric Inventory Nursing Home Version (NPI-NH) is an informant-based assessment of 10 sub-domains of behavioral functioning where total NPI-NH score represents an overall behavioral disturbance level. We investigated the evidence pertaining to the diagnostic test accuracy (DTA) of motor activity tracking obtained via wearable sensor technology (WST) using total NPI-NH score as the gold standard in persons living with dementia (PLWD). This was part of a larger systematic review assessing the use of WST for NPS detection and monitoring carried out from inception until September 2022 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219917). A systematic literature search carried out in 7 library databases produced 12,928 articles from which 84 titles were retained for analysis. In total, 8 articles examined the validity of WST for assessing and monitoring of overall behavioral disturbance in PLWD, among which 5 studies used motor activity trackers. Dementia participants predominantly had Alzheimer’s, vascular or mixed dementia (40%, 20%, and 40% respectively), with mild-moderate severity. Three studies reported correlations between motor activity and total NPI score that ranged from 0.35 to 0.38. A random effects model indicated that the pooled correlation across studies was 0.37 (0.22-0.51), with no heterogeneity (I2=0%). While our sample reveals WST test accuracy as being consistently moderate, more research is necessary for confirmation.

THE ASSOCIATION OF CAREGIVER STRAIN AND NEEDS OF CAREGIVERS AND PEOPLE LIVING WITH DEMENTIA

Abstract Caregivers play a vital part of dementia care management and are key to keeping people living with dementia at home. Providing this care can result in caregiver strain, especially among those who live in low or under resourced communities, such as rural or impoverished areas. One instrument for measuring caregiver strain among this population is the BRI caregiver strain instrument, which includes four dimensions of strain including caregiver mastery, relationship strain, health strain and social isolation. To date, little research assessing the validity of the instrument. We assessed the validity using confirmatory factor analysis in a cohort of 930 caregivers providing care to people undergoing assessment for dementia representing four diverse regions in Georgia (Atlanta, Albany, Augusta, and Macon). Then, we examined the associations of the lack of caregiver knowledge of dementia, care recipient function, and challenging behaviors using univariate and multivariate linear regression. We found that the four-factor solution showed good model fit and was appropriate for subsequent analysis with this population. In our regression models, we found that caregiver lack of understanding of dementia significantly predicted caregiver strain (β=2.09, P&amp;lt;.001). When controlling for care recipient function, lack of knowledge decreased in strength, but remained significant (β=1.86, P&amp;lt;.001). When adding challenging behaviors, lack of dementia knowledge lost significance and challenging behaviors became the strongest predictor of caregiver strain (β=2.03, P&amp;lt;.001). Caregiver strain is a multifactorial process and tools to reduce challenging behaviors and increase caregiver knowledge are promising points of intervention early in the diagnostic process.

DEMENTIA INTERVENTION STAFF AND CAREGIVER PERSPECTIVES ON THE DELIVERY OF ADS PLUS

Abstract Interventions targeting persons living with dementia (PLWDs) provide an optimal touchpoint in the service delivery continuum for addressing the growing unmet needs of unpaid/family dementia caregivers. Services such as Adult Day Services (ADS) that generally target PLWDs can be enhanced by embedding an intervention that specifically targets informal caregivers. In a trial evaluating the ADS Plus intervention, open-ended feedback from ADS intervention staff and participants provided insights to improve the administrative, programmatic, and user experience of ADS Plus. Drawing on individual qualitative interviews (n=24), we conducted a thematic analysis revealing insights into the critical implementation factors supporting the effective delivery of ADS Plus. Identified themes included: 1) the relational, or person-centered, nature of the ADS Plus program, 2) the role of learning throughout implementation, 3) the influence of administrative structure on program delivery, and 4) contributors to the acceptability of ADS Plus. Our findings suggest that caregivers draw on multiple supports but that individually tailored supports for dementia care management must address the emotional needs of caregivers through relational intervention models. The effective delivery of ADS Plus was facilitated by perceived intervention benefits to caregivers, robust yet reasonable training for intervention staff, and the opportunity for adaptability in program delivery.

A Collaborative Care Coordination Model: Reaching older adults living alone with cognitive impairment.

AbstractBackgroundThe number of persons aged 65+ with Alzheimer’s Disease who live alone in Virginia was estimated at 42,000 in 2018. This population commonly has need for therapeutic, social, and other services, however, therapists and social and other service providers commonly lack knowledge of how to reach this population. We sought to identify people with dementia who live alone in Virginia, and to provide services that would be beneficial for psychological health.MethodWe conducted multifaceted outreach and delivered two programs for people with dementia living alone, (1) individualized care coordination provided by a Dementia Care Manager that focuses on behavioral symptom management training and education, (n = 51) and (2) the Effective Strategies Program (ESP) which includes education and support in memory, practical strategies, exercise, diet, home, and safety (n = 11). We assessed outcomes on depression using the Center for Epidemiologic Studies Depression Scale‐Revised and on behavioral symptoms using the Revised Memory and Behavior Problem Checklist &amp; Neuropsychiatric Inventory‐Questionnaire in the Care Coordination participants.ResultAt 12‐month follow‐up in the Care Coordination Program, depression significantly decreased and behavioral symptoms were significantly lower. Almost all (94%) of the participants reported overall the program in which they participated was beneficial.ConclusionDespite numerous challenges with reaching this population, gaining trust, and maintaining contact, it is possible to reach and provide beneficial services for people with dementia who live alone. Successes partnering with pre‐existing resources and recommendations for sustainability are highlighted.

Impact on End‐of‐life Planning of a Care Coordination Program for persons living with dementia

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) afflict over five million persons in the U.S., and persons living with dementia (PLWD) have been shown to receive poor quality care and have worse health outcomes compared to those without ADRD. We developed a population‐based dementia care management program to support the care of PWLD in a large U.S. healthcare system.MethodsIn a large multi‐specialty medical group practice, we identified patients enrolled in a value‐based insurance program (Medicare Advantage) using the EPIC electronic health record (EHR), and eligible patients were invited to enroll in the CARES dementia care program. Patients were eligible if they had an ICD‐10 diagnosis of ADRD in the EHR problem list and/or past medical history, or currently taking an FDA‐approved medication for ADRD. We additionally included patients with ADRD who have a primary care provider in the affiliated academic health system. During an in‐person intake visit, a study‐assigned nurse practitioner (NP) engaged in advance care planning discussion with patients and caregivers and completed advance directives (AD) and Physician Order for Life Sustaining Treatment (POLST). We assessed the rate of completion of the AD and POLST pre‐program and post‐enrollment.ResultsWe enrolled 195 patients in the CARES dementia care program. After enrollment, participants increased completion of advanced directives from 27.7% to 30.8% (p = 0.25) and the POLST from 13.3% to 23.1% (p = 0.006). Of the POLST forms completed, 70.7% indicated that the patient was ‘do not attempt resuscitation’ (DNAR) (65.2% of those who completed the POLST pre‐program, 77.8% for those who completed after enrollment, p = 0.19). Among those who completed the POLST, 55.0% indicated selective medical interventions (63.6% pre‐program, 47.1% post‐enrollment, p = 0.15), 40.0% wanted full medical interventions (31.8% pre‐program, 52.9% post‐enrollment, p = 0.10), and 5.0% wanted comfort‐focused interventions (4.5% pre‐program, 5.9% post‐enrollment, p = 0.43). Trial period of nutritional supports was indicated by 69.2% (72.7% pre‐program, 64.7% post‐enrollment, p = 0.28), while 28.2% wanted no artificial treatment (27.2% pre‐program, 29.4% post‐enrollment, p = 0.45), and 2.6% wanted long‐term nutritional support (0% pre‐program, 5.9% post‐enrollment, p = 0.13).ConclusionA dementia care coordination program shows signs of increased completion of end‐of‐life planning, with the majority choosing ‘do not attempt resuscitation’ (DNAR).

Identification of Persons Living with Dementia Using the Electronic Health Record

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) are underdiagnosed in the primary care setting. Proactive screening for cognitive impairment and subsequent evaluation and diagnosis of patients who screen positive are not routinely and reliably performed. As a result, identification of persons living with dementia (PLWD) for enrollment in clinical programs, clinical trials, and research studies can be challenging. The electronic health record (EHR) represents a potentially viable tool to efficiently and accurate identify PLWD.MethodsIn a large academic health care system in the U.S., we performed an EPIC EHR search for PLWD with the intent of enrolling them in an outpatient dementia care management program. The EHR algorithm used the following criteria for dementia: (1) an ICD‐10 dementia diagnosis in the problem list or past medical history or (2) an FDA‐approved drug on their active medication list. We performed chart review for patients who were identified to have potential dementia using this algorithm to confirm dementia diagnosis is documented in clinical notes.ResultsA total of 985 patients were identified by EHR criteria as potentially having dementia. After chart review, 747 (75.8%) were confirmed to have dementia documented in their clinical history and progress notes. One hundred thirty (13.2%) did not have a confirmed dementia diagnosis, 58 (5.9%) had an incomplete dementia evaluation, and 50 (5.0%) had only mild cognitive impairment. In addition, 55 (5.6%) were deceased.ConclusionWe found that an EHR algorithm can identify patients with dementia in a health plan population. This model may be a useful tool for a focused recruitment of potential participants in clinical trials, research studies, and clinical programs.

Exploring specialist dementia nursing models and their impact on people living with dementia and their family: A systematic review

AbstractBackgroundEvidence that brings together the attributes, specialist knowledge, skills, and competencies required by specialist dementia nurses to fulfil their role is currently lacking, making it difficult to assess the effectiveness of specialist nurse‐led interventions. We systematically reviewed the evidence for specialist dementia nursing to determine how it is defined in terms of key skills, models of delivery, and the impact on families and people living with dementiaMethodWe searched for papers using three databases (MEDLINE, CINAHL, PsycINFO), grey literature (EThOS), and the National Institute for Health and Care Excellence (NICE) evidence search. Search terms related to ‘specialist nursing’ and ‘dementia’ were used. We screened titles and abstracts of identified articles and conducted forward searches for additional relevant studies. Two authors independently rated study quality. Findings were synthesised narratively.Result31 studies were included in the review; 26 were conducted in the UK or USA using a range of methodologies. Role titles varied to include “Admiral Nurses”, “Nurse Practitioners” and “Clinical Nurse Specialists”. We found limited evidence comparing the knowledge, skills, and competencies required by specialist nurses except Admiral Nursing where these were described in three studies. In RCTs (n = 2), specialist nursing did not improve donepezil adherence; and personalised emails to family carers from a nurse specialist did not increase carer self‐efficacy when compared to less intensive interventions. In non‐randomised studies, a USA Nurse Dementia Care Manager service was associated with fewer emergency room and hospital admissions; there were no differences in clinical or cost outcomes in an Admiral Nursing service; and training inpatient specialist nurses in a behavioural intervention increased use of pain‐ relief medication and reduced patient length of stay. Of the 31 studies, 4 reported high carer satisfaction with specialist nursing.ConclusionWe identified only one framework defining specialist dementia nursing competencies, and limited evidence for effectiveness of specialist nursing dementia services on families affected by dementia, despite care received being highly valued. No RCT has measured the impact of specialist nursing on family carer and client outcomes relative to less specialist care.

Evaluation of a care management program on family caregivers of persons with dementia

As the U.S. population ages, dementia due to Alzheimer's or other disease is concerning for healthcare providers. Family caregivers (FCGs) of persons with dementia (PWDs) may experience negative outcomes. The University of California, Davis, Health (UCDH) Alzheimer's and Dementia Care (ADC) Program provides care management for PWDs and their FCGs. This pilot study evaluates the program's effect on FCG depression, strain, and distress. Despite an increase in dementia severity in PWDs, FCGs experienced decreased levels of depression, strain, and distress following 12 to 18 months in the UCDH ADC Program. Other findings include PWDs experiencing reductions in severity of neuropsychiatric symptoms and remaining at home with FCGs. Despite limitations, such as a relatively small sample size and lack of sample diversity, this pilot study demonstrated positive outcomes to both PWDs and their FCGs and contributes to the literature supporting dementia care management programs. Future projects should address these limitations to understand the experiences of a diverse population and to make dementia care management programs sustainable.

A - 29 Understanding the Role of Caregiver Self-Efficacy in Dementia Healthcare: Findings from the Care Ecosystem Program.

Identify changes in healthcare utilization (HCU) and admission risk scores (ARS) by caregiver self-efficacy levels (CGSE) in persons with dementia (PWD). 179 community-dwelling dyads (PWD-CG) with at least 1 emergency or hospital admission 12-months prior to enrollment in the Care Ecosystem (dementia care-management program), provided data at baseline, 6, and 12-months. Analyzed data included caregiver self-reported HCU, dementia ratings (QDRS, NPI), wellbeing (ZBI-12, NPI-Distress, PHQ9), and CGSE scales. HCU confirmation and ARS were extracted from electronic medical records. Repeated measures ANOVA and paired sample t-tests compared ARS and HCU across time points by baseline CGSE. On average, PWD and caregivers were 80 (SD:8) and 64years-old (SD:11); predominantly female (PWD:63%, CG: 77%) and white (62%), with 12+ years of education (PWD: 84%, CG: 98%). Self-efficacy improved over time [F(1.92, 281.74 = 11.56, p < 0.001, ηp2 = 0.13]; post-hoc Bonferroni indicated increases from 19.37 to 20.62 at 6-months (95% CI, 0.59-1.92) and 20.56 at 12-months (95% CI, 0.41-1.98). Reductions in ARS [t(178) = 2.63, p = 0.009, MD = 3.34, d = 0.2] and HCU [t(177) = 5.37, p < 0.001, MD = 0.85, d = 0.4] were observed at program completion. The high-CGSE group demonstrated significant ARS [t(98) = 3.43, p = 0.001, d = 0.4] and HCU reductions [t(98) = 3.65, p < 0.001, d = 0.4]. HCU also decreased for the moderate-CGSE cohort [t(43) = 4.17, p < 0.001, d = 0.6]. Groups with higher CGSE experienced greater reductions in ARS and HCU compared to lower CGSE. Self-reported measures and CGSE-group sample sizes may limit our findings.

Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study

BackgroundMore than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out.MethodsWe conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used.ResultsFear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia.ConclusionsAlthough the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.

Implementation of dementia care management in routine care (RoutineDeCM): a study protocol for process evaluation

IntroductionDementia care management is a complex intervention intended to support persons with dementia and their (caring) relatives in home-based care arrangements. Dementia care management was developed in the federal state...

Development of an instrument to elicit patient preferences for Person‐Centered Dementia Care – insights from a formative pilot study to design a dementia‐friendly Analytic Hierarchy Process‐Survey

AbstractBackgroundPerson‐Centered Care (PCC) requires knowledge about patient preferences for multiple components (criteria) of care. The Analytic Hierarchy Process (AHP) is one approach to measure the importance of individual criteria from the patient perspective and to identify quantitative preferences for PCC. The AHP is expected to be suitable for People living with Dementia (PlwD) due to its simple pairwise comparisons with individual criteria of a complex decision problem. The aim of this pilot study was to design a dementia‐friendly assisted AHP‐survey with PlwD.MethodWe conducted two expert panels with n = 4 Dementia Care Managers and n = 4 physicians to ensure content validity, as well as individual “thinking aloud”‐interviews with n = 11 PlwD and n = 3 informal caregivers (CGs) to ensure face validity. Interviews followed a semi‐structured interview guide. Participants were asked to assess the survey’s appropriateness, coherence, and to provide information about the motivation for their answers. Main source of data were field notes. Interviews were recorded and partially transcribed. To follow an iterative constant comparative approach, data were analyzed and patient’s feedback incorporated on a continuous basis by two reviewers until the patients had no further comments and no struggles with completion of the survey. Survey data were analyzed with Microsoft®Excel and ExpertChoice Comparion®, to i.a. assess consistency ratios (CRs).ResultThree main categories with several sub‐categories emerged from data analysis: 1) content including clear introduction, description of (sub)criteria, homogeneity of criteria, appropriateness of (sub)criteria, inclusion of re‐test questions, sociodemographic questions to consider heterogeneity of respondents, 2) format including structure of an AHP‐survey for PlwD, sequence of pairwise‐comparison questions, length of survey, visual formatting (incl. AHP‐scale), explanation of survey procedure, assistance during survey, perspective during completion of survey, and 3) layout including easy wording, avoidance of long sentences, and use of ICONs as visual aids. Individual CRs ranged from 0.08 to 0.859, whilst the consolidated CR was 0.038.ConclusionOur study provides insights from a formative pilot study to design a dementia‐friendly AHP‐Survey. Consideration of our findings may contribute to content‐ and face validity, acceptability, feasibility and internal consistency, as well as reproducibility in future dementia‐focused quantitative preference research.

Development, reliability, and validity of a self-assessment scale for dementia care management.

This study aimed to develop a self-assessment scale for care management of people with dementia and examine its reliability and validity. Based on Bloom's Taxonomy, previous research, and experts' opinions on dementia and care management, a scale consisting of 18 items was developed to assess care managers' attitudes, knowledge, and skills in their management of people with dementia. To examine the scale's reliability and validity, data were collected from 638 care managers. Construct validity using exploratory factor analysis, known-group validity, and internal consistency reliability of the scale were evaluated. Exploratory factor analysis supported the construct validity with a four-factor model and explained 59.1% of the total variance. Following were the four factors: Factor I 'Person centred care'; Factor II 'Understanding of disease characteristics, treatment and care'; Factor III 'Understanding of people with dementia and care management according to their characteristics'; and Factor IV 'Utilization of local resources surrounding people with dementia'. Regarding the known-group validity, results showed that the group with a qualified chief care manager scored significantly higher than the group without one on Factors I (P=0.013) and III (P=0.026). Cronbach's alpha coefficient for the 18 items was 0.928. The findings prove that the scale has acceptable reliability and validity, and can help care managers reflect on their practice. Future research is desirable to measure the validation of change in the scale.