Psychogeriatric Day Research Articles

Clinical and social evaluation of depressed patients in a Psychogeriatric Day Hospital program

The aim of this study was to identify the problems of patients with severe depressive symptoms (GDS>9) according to the HoNOS+65 scale, to evaluate the effectiveness of a partial hospitalization program to reduce severe depressive symptoms, and to identify independent predictors. Pre-post study of patients with depression treated at the psychogeriatric Day Hospital (HDPG) of Pamplona (Spain). The scores obtained on the HoNOS+65, MMSE, GDS, BARTHEL, ALSAR, and COTE scales were compared at admission and discharge, and the prognostic factors for no improvement of severe depressive symptoms were determined. The 75.3% of the 81 patients were women, with a mean age of 69.9 years (range: 57-88). At discharge, severe depressive symptoms only remained for 25.9%, who significantly improved on the HoNOS+65 total and COTE scales while problems of physical deterioration were maintained and cognitive ones increased. Patients with GDS <9 at discharge showed significant reductions in all the problems presented at admisión, except for the level of dependency (Barthel). On admission, the patiens who did not improve showed more severe despressive symptoms and greater behavioral and social problems: the three variables were independent predictors for no improvement of severe depressive symptoms. The HDPG program had a positive impact on patients with severe depressive symptoms. The clinical and social improvement achieved supports the HDPG format as an adequate alternative for the care of elderly patients with severe depressive symptoms.

Development of an autobiographical memory test for older electroconvulsive therapy candidates.

To develop a test of autobiographical memory for monitoring of older people during a course of electroconvulsive therapy (ECT). A list of events commonly experienced in later life was gathered from older people (n = 26) at a psychogeriatric day clinic and from psychiatrists (n = 23) who work with older depressed patients. The most common events were chosen as question domains for an autobiographical memory interview. This was piloted with 12 severely depressed older patients. A list of 15 common life events was developed. After pilot testing, a final 30-item questionnaire covering six common life events was proposed. This study developed an autobiographical memory test with good face validity and potential for clinical use. It was modelled on a well-validated scale (The Columbia University Autobiographical Memory Interview, CUAMI-SF) and represented a useful first step in the development of a test for memory loss in older patients receiving ECT. The proposed test may be particularly sensitive to autobiographical memory loss in older people undergoing ECT because it uses recent personal memories, which are relatively commonly experienced in the older depressed population.

The Visual Association Test to study episodic memory in clinical geriatric psychology

The Visual Association Test (VAT) is abrief learning task that consists of six line drawings of pairs of interacting objects (association cards). Subjects are asked to name or identify each object and later are presented with one object from the pair (the cue) and asked to name the other (the target). The VAT was administered in aconsecutive sample of 174 psychogeriatric day care participants with mild to major neurocognitive disorder. Comparison of test performance with normative data from non-demented subjects revealed that 69% scored within the range of amajor deficit (0-8 over two recall trials), 14% aminor, and 17% no deficit (9-10, and ≥10 respectively).VAT-scores correlated with another test of memory function, the Cognitive Screening Test (CST), based on the Short Portable Mental Status Questionnaire (r= 0.53). Tests of executive functioning (Expanded Mental Control Test, Category Fluency, Clock Drawing) did not add significantly to the explanation of variance in VAT-scores.Fifty-five participants (31.6%) were faced with initial problems in naming or identifying one or more objects on the cue cards or association cards. If necessary, naming was aided by the investigator. Initial difficulties in identifying cue objects were associated with lower VAT-scores, but this did not hold for difficulties in identifying target objects.A hierarchical multiple regression analysis was used to examine whether linear or quadratic trends best fitted VAT performance across the range of CST scores. The regression model revealed alinear but not aquadratic trend. The best fitting linear model implied that VAT scores differentiated between CST scores in the lower, as well as in the upper range, indicating the absence of floor and ceiling effects, respectively. Moreover, the VAT compares favourably to word list-learning tasks being more attractive in its presentation of interacting visual objects and cued recall based on incidental learning of the association between cues and targets.For practical purposes and based on documented sensitivity and specificity, Bayesian probability tables give predictive power of age-specific VAT cutoff scores for the presence or absence of amajor neurocognitive disorder across arange of apriori probabilities or base rates.

Quality of life of the elderly residents of nursing homes and patients of the Psychogeriatric Day Ward

Introduction. Due to the prolonged average life span and constantly increasing number of the elderly, research of this population’s quality of life (QoL) is being conducted to assess the spheres requiring improvement. Aim. To assess and compare the life quality in different domains between residents of nursing homes (NH) and patients of the Psychogeriatric Day Ward (PDW).Material and Methods. The study encompassed 68 PDW patients and 62 NH residents. The WHOQOL-BREF questionnaire and a structured interview concerning diseases, different forms of support and activities preferred were used. Results. Women predominated among the subjects (83%). The elderly aged 75–90 constituted the majority (64.62%). The average assessment of QoL in the whole group amounted to 3.6 points. No significant differences in the assessment of QoL satisfaction and one’s own health satisfaction were observed between PDW patients and NH residents. The participants of both groups assessed the highest QoL in the environment domain and the lowest in the social relationships domain. A relationship between higher QoL in the physical health domain and participation in social forms of spending free time was observed. Relationships between QoL in particular domains and age, marital status and length of stay in NH were found.Conclusions. Elderly people’s QoL, similarly to their satisfaction with health, were on an average level regardless of the institutional care. The QoL remains in a significant relationship with health. The changing needs of the elderly should be the basis for creating an individual plan of professional support.

Community day care with carer support versus usual nursing home-based day care: effects on needs, behavior, mood, and quality of life of people with dementia.

Several studies have shown that the combined community-based Meeting Centres Support Programme (MCSP) for people with mild to moderate dementia and their carers were more effective in reducing behavior and mood problems of people with dementia than traditional nursing home-based (NH) day care. We therefore investigated in this study whether community-based (CO) psychogeriatric day care for people with mild to severe dementia combined with carer support (in accordance with the MCSP), is more effective than regular NH day care. A pre-test-post-test control group design was used to compare the effect of CO and NH day care on care needs, behavior and mood problems, and quality of life of people with dementia. 138 dyads of people with mild to severe dementia and family carers participated in the study: 70 from (new and longer existing) CO day cares (experimental group), and 68 from NH day cares (control group). ANCOVAs were performed at post-tests, including baseline data as covariates. After six months, no overall differences on outcome measures were found between CO and NH day cares. However, participants of recently started CO day cares showed fewer neuropsychiatric symptoms, whereas carers in the longer existing CO day cares reported fewer care needs compared to the control group (large effects). Persons with dementia cohabiting with their carer benefitted most from CO day care. This study shows that combined CO day care has promising added value compared to NH day care, especially for participants with dementia cohabiting with their carer.

Transforming nursing home-based day care for people with dementia into socially integrated community day care: process analysis of the transition of six day care centres.

The community-based Meeting Centres Support Programme for people with dementia and their carers has been proven more effective in influencing behaviour and mood problems of people with dementia and improving sense of competence of carers compared to nursing home-based day care centres for people with dementia. Six Dutch nursing home-based day care centres were transformed into Community-based day care centres with carer support, according to this Meeting Centres model. To determine which factors facilitate or impede the transition to Community-based day care. A process evaluation was conducted with a qualitative study design. Six nursing home-based day care centres transformed into Community-based day care centres for people with dementia and their carers. Stakeholders (n=40) that were involved during the transition. Factors that facilitated or impeded the transition were traced by means of (audiotaped and transcribed) interviews with stakeholders and document analysis. All data were coded by two independent researchers and analyzed using thematic analysis based on the Theoretical framework of adaptive implementation. Six nursing home-based day care centres successfully made the transition to Community-based day care with carer support. Success factors for the start of the project were: the innovation being in line with the current trend towards more outpatient care and having motivated pioneers responsible for the execution of the transition. Barriers were difficulties reaching/recruiting the target group (people with dementia and carers), inflexible staff and little or no experience with collaboration with community-based care and welfare organizations. Facilitating factors during the implementation phase were: finding a suitable location in the community, positive changes in staff attitude and adoption of the new vision, and good cooperation with care and welfare organizations. Barriers were insufficient involvement of, and support from the managers of the responsible organizations, and communication problems with referrers of other organizations, including the GPs and case managers. The transition from nursing home-based psychogeriatric day care support to a community-based combined support programme for people with dementia and their informal carer is shown to be feasible. Successful implementation of this community-based combined support programme requires - besides motivated pioneers, a change in staff attitude and working style, a suitable pleasant location and collaboration with other care and welfare organizations - special attention for effective communication with the target user group and the referrers, and also how the management of the pioneer organizations can facilitate the staff during the transition process.

INDICATORS OF EMOTIONAL WELL-BEING IN PSYCHOGERIATRIC CARE

Responses of 1,442 consecutive participants in psychogeriatric day care (mean age 78.8; SD 6.5) to 15 items of a mood questionnaire were analyzed by Mokken scale analysis which is based on nonparametric item response theory models. As from 2002, 825 participants also answered eight self-esteem questions. For the purpose of an exploratory and confirmatory study the sample was split into random halves. The sample represented a broad range of cognitive impairment, from moderately severe to mild dementia. An automated item selection procedure available in the R package mokken revealed a scale for emotional well-being consisting of nine items fitting the monotone homogeneity model of unidimensionality and adequate person separation (Loevingers H=0.37; SE=0.02; Cronbach's coefficient alpha=0.79; SE=0.02). A confirmatory analysis in the second random half of the sample confirmed these results. The scale for emotional well-being consists of the items feeling 'contented', 'healthy', 'tired', 'lonely', 'down', 'in good spirits', 'helpless', 'weak' and 'having faith in the future'. Mokken scale analysis of the eight self-worth items confirmed the unidimensionality and discriminatory power of the self-esteem scale (H=0.41; SE=0.03; Cronbach's alpha=0.80; SE=0.02). Emotional well-being was positively associated with self-worth (Spearman correlation=0.56; 95%-confidence interval [0.49;0.62]). The two scales allow the objective ordering of persons on the latent variables of emotional well-being and self-worth by their test scores. Three case vignettes illustrate application of the indicators in clinical psychogeriatric practice.

TRANSITION OF A PSYCHOGERIATRIC DAY CARE IN THE NURSING HOME TO EASY-ACCESS DAY CARE PLUS CAREGIVER SUPPORT IN THE COMMUNITY: A PILOT STUDY

In this study, the transition of a nursing home based psychogeriatric day care centre to an easy-access community day care centre plus caregiver support (DC-plus CS) is followed closely. The transition was based on the proven effective Meeting Centres Support Program. By means of qualitative analysis of documents and interviews with key persons (n=11) we investigate facilitating and impeding factors for making this transition. Besides, we evaluate the satisfaction of participants and informal caregivers that used the new support program longer than 6 months. Several characteristics of the innovation (DC-plus CS) help to establish cooperation with other care and welfare services in the region, such as: the easy-access location, the social integration in the community, and the focus on combined support for people with dementia and their informal carers. The good cooperation and the suitable location in the community facilitate the implementation. At first, the presence of other community care-centres for people with dementia and their informal carers in the neighbourhood impedes the recruitment of new participants for the DC-plus CS. In general, the satisfaction of participants and informal carers about the support program is high. The transition is made successfully and this study gives other psychogeriatric day care centres in the nursing home insight in how to make a similar transition to DC-plus CS.

A behavioural rating scale of activity engagement in psychogeriatric day care

The Participation Scale was developed as an observational measure of activity engagement (as rated by group facilitators) of adult day care clients with mild to moderate dementia. In a consecutive sample of 448 subjects Mokken scaling procedure was conducted to assess the latent structure of 27 questionnaire items. The study included an exploratory and a confirmatory approach. For that purpose the sample was randomly divided into two halves. Exploratory analysis revealed three dimensions of participation that adequately captured the item structure: motivation (10 items; Loevinger's H = 0.48), competence (7 items; H = 0.56) and self-confidence (4 items; H = 0.57). The structure was validated in a confirmatory analysis. In a stepwise multiple regression model 49% of the variance in motivation was explained by independent behavioural measures of apathy and affect. Apathy and cognitive impairment were significant predictors of competence in participation (R(2) = 31.2%). Negative affect was the main predictor of reduced self-confidence (R(2) = 37.9%). Cross-validation of these exploratory regression models on the confirmatory sample explained 39.6%, 29.2% and 23.1% of the variance in motivation, competence and self-confidence, respectively. Test-retest intraclass correlation coefficients (ICC2(A,1)) as determined in a random subsample of 56 participants, were 0.77 (motivation), 0.85 (competence) and 0.76 (self-confidence). The three measures allow the differentiation and ordering of individual participants on separate dimensions of activity engagement in psychogeriatric day care.

Wat is een reëel verschil bij herhaalde metingen met de Gedragsobservatieschaal voor de Intramurale Psychogeriatrie (GIP)?

The Behavioural Rating Scale for Geriatric Inpatients (GIP) consists of fourteen, Rasch modelled subscales, each measuring different aspects of behavioural, cognitive and affective disturbances in elderly patients. Four additional measures are derived from the GIP: care dependency, apathy, cognition and affect. The objective of the study was to determine the reproducibility of the 18 measures. A convenience sample of 56 patients in psychogeriatric day care was assessed twice by the same observer (a professional caregiver). The median time interval between rating occasions was 45 days (interquartile range 34-58 days). Reproducibility was determined by calculating intraclass correlation coefficients (ICC agreement) for test-retest reliability. The minimal detectable difference (MDD) was calculated based on the standard error of measurement (SEM agreement). Test-retest reliability expressed by the ICCs varied from 0.57 (incoherent behaviour) to 0.93 (anxious behaviour). Standard errors of measurement varied from 0.28 (anxious behaviour) to 1.63 (care dependency). The results show how the GIP can be applied when interpreting individual change in psychogeriatric day care participants.

Aandacht voor visuele inattentie. De Balloons Test in de psychogeriatrie

The Balloons Test is a paper-and-pencil target cancellation task designed to detect visual inattention. The test consists of two subtests: subtest A for parallel, automatic processing and detection of twenty circles with an adjoining vertical line ('balloons') among a much larger number of circles as distractors. Subtest B asks for serial and effortful search of twenty circles among balloons. Among 191 consecutive participants of a psychogeriatric day care program (mean age 78 yr) 28.2% scored below 17 on subtest B, which is indicative of generalized visual inattention. Bivariate analyses showed that visual inattention was associated with deficiencies on tasks of visuospatial, constructional and executive mental control functions. Using multivariate logistic regression analysis, two tests of visuospatial perception (clock reading and picture description) retained an independent effect in the association with visual inattention. Only three participants (1.6%) were unable to take the Balloons Test. The results of this clinical study are in favour of the Balloons Test as a useful addition to inattention measurement in psychogeriatric patients.

Dementelcoach: effect of telephone coaching on carers of community-dwelling people with dementia

Dementelcoach is a new telephone intervention to support informal caregivers of community dwelling people with dementia. The effectiveness of this intervention was evaluated on burden and mental health problems of informal caregivers. A pre-test/post-test comparison group design was used with three groups of informal caregivers.Two of the groups were experimental and received either (1) telephone coaching or (2) telephone coaching in combination with respite care (psychogeriatric day care); the third was a comparison group which received day care only. Telephone coaching was offered by trained coaches once every two to three weeks over a period of 20 weeks. Informal caregivers who received telephone coaching in combination with respite care reported significantly less burden compared to caregivers who received telecoaching only, and they experienced significantly fewer mental health problems than those who received day care only. Telecoaching according to the principles of Dementelcoach combined with respite care(psychogeriatric day care) is more effective in reducing burden and health complaints in informal caregivers of community-dwelling people with dementia than telecoaching or day care only.

A Mental Health Assessment and Support Team for Community Elders in Fife (EAST)

The aging population combined with the increased recognition of the need to assess elderly patients with mental health difficulties in their own environment encouraged service redesign in Fife with the focus on community assessment of older people with mental health needs. To establish and assess the functioning of a joint Health and Social Services enhanced assessment and support team (EAST) for community-dwelling elders with significant mental health needs living in a Scottish health region, and to determine the impact of this team on the requirement for acute psychogeriatric hospital services. Prospective three-year data collection of service activity involving EAST and the local psychogeriatric acute inpatient and day hospital facilities. EAST assessed 111 patients during the study, 83% with a diagnosis of dementia. The mean duration of assessment was six weeks with 9% of patients receiving an overnight home assessment and 6% requiring hospital admission. Overall there was a substantial reduction in utilization of both acute psychogeriatric admission beds and day hospital placements. Multi-agency community assessment of elders with mental health problems can be addressed effectively without recourse to hospital admission, which may allow resource release for further service developments.

De Cognitieve Screening Test (CST) getoetst aan het schaalmodel van Mokken

The Cognitive Screening Test (CST) is a twenty-item orientation questionnaire in Dutch, that is commonly used to evaluate cognitive impairment. This study applied Mokken Scale Analysis, a non-parametric set of techniques derived from item response theory (IRT), to CST-data of 466 consecutive participants in psychogeriatric day care. The full item set and the standard short version of fourteen items both met the assumptions of the monotone homogeneity model, with scalability coefficient H = 0.39, which is considered weak. In order to select items that would fulfil the assumption of invariant item ordering or the double monotonicity model, the subjects were randomly partitioned into a training set (50% of the sample) and a test set (the remaining half). By means of an automated item selection eleven items were found to measure one latent trait, with H = 0.67 and item H coefficients larger than 0.51. Cross-validation of the item analysis in the remaining half of the subjects gave comparable values (H = 0.66; item H coefficients larger than 0.56). The selected items involve year, place of residence, birth date, the monarch's and prime minister's names, and their predecessors. Applying optimal discriminant analysis (ODA) it was found that the full set of twenty CST items performed best in distinguishing two predefined groups of patients of lower or higher cognitive ability, as established by an independent criterion derived from the Amsterdam Dementia Screening Test. The chance corrected predictive value or prognostic utility was 47.5% for the full item set, 45.2% for the fourteen items of the standard short version of the CST, and 46.1% for the homogeneous, unidimensional set of selected eleven items. The results of the item analysis support the application of the CST in cognitive assessment, and revealed a more reliable 'short' version of the CST than the standard short version (CST14).

High colour temperature lighting for institutionalised older people with dementia

Non-pharmacologic interventions, such as high-intensity white light with a high output in the short-wavelength part of the spectrum can play an important role in the care for older people with dementia. In order to assess the effects of prolonged exposure to low intensity light, i.e., E < 500 lx, from a light source with a high correlated colour temperature (17,000 K versus 2700 K) on behaviour and circadian rhythmicity of institutionalised older adults with dementia, a cross-over design field study was carried out in a psychogeriatric day care ward in May and June 2008. Effects of the lighting intervention were assessed by the Dutch Behaviour Observation Scale for Intramural Psychogeriatrics (GIP), and tympanic temperature measurements. The two lighting solutions installed, particularly the 17,000 K lighting, led to much lower colour temperatures at eye level in practice. No significant improvements in behaviour and in the range of tympanic temperature were found for the lighting interventions tested. This might indicate that higher illuminance levels are the important factor in establishing successful light therapy, and that higher colour temperature may add up to the effectiveness. At the same time, the 17,000 K light tubes did not result in ultrahigh colour temperatures at the eye level of the subjects, and may even have an adverse effect on some persons with dementia.

Participatie in psychogeriatrische dagbehandeling. Ontwikkeling van een meetinstrument

Participants in psychogeriatric day care differ in their ability to enjoy the activities and to be engaged in the day care program. In order to reveal individual differences in the quality of participant engagement, an 18-item questionnaire was drafted and completed for 126 visitors of a psychogeriatric day care centre. Scalability of the items was tested according to criteria of nonparametric item response theory (IRT). Construct validity was determined by comparing the results with independent behaviour ratings of cognitive impairment and apathy, and scores on the Amsterdam Dementia Screening Test (ADS), a neuropsychological test of multiple cognitive domains. Nine items formed a strong primary Participation Scale with a coefficient H of 0.63. Behaviour ratings of cognitive impairment and apathy were significant predictors of the participation score. The same was true for the subtests Design Copying and Category Fluency of the ADS. Two meaningful small secondary scales were found, representing motivation and emotional stability, which add to the predominantly cognitive content of the primary scale. Total scores of the secondary scales correlated with affective parameters, but not with cognitive indices. The Participation Scale deserves to be expanded with items referring to motivation and emotional experience.

Discrepanties tussen de Informantvragenlijst (IQCODE) en cognitieve tests bij deelnemers aan psychogeriatrische dagbehandeling

The IQCODE is an informant-rated scale of estimated cognitive decline. This study examined the scalability of the 16-item form of the IQ-CODE and its validity to predict performance on a comprehensive cognitive battery.The medical files of 169 psychogeriatric day care attendants contained an IQCODE. Mokken's nonparametric item response model for polytomous items was used to assess the unidimensionality of the IQ-CODE. Tests of orientation, episodic memory and executive functioning (Behavioral Dyscontrol Scale, Category Fluency, and Expanded Mental Control Test) were administered in order to examine predictive validity.Hi-coefficients of scalability for the 16 items of the IQCODE ranged from 0.33 to 0.50. Loevinger's H was 0.40 for he full scale, which makes it a moderately strong, unidimensional scale. A 'strong' scale (H = 0.54) was found by selecting a subset of seven items, representing the latent construct of problem solving ability. The correlations of the total IQCODE score with neuropsychological tests differed significantly from zero but the coefficients were quite small, ranging from -0.12 to -0.25. A nonparametric optimal discriminant analysis (ODA) was used to derive a cutoff score for the IQCODE that would maximize the classification accuracy in differentiating patients with comparatively high or low levels of cognitive functioning. Given an effect strength for sensitivity (ESS) of 21%, the optimal IQCODE cutoff score (3.75) did not reliably discriminate between different levels of cognitive ability. More than half of the patients (56%) who were predicted to belong to a group of low cognitive ability, in fact performed at a higher level. Conversely, overestimation of cognitive ability occurred less often (20%).In this sample of psychogeriatric day care attendants the IQCODE tended to underestimate the patient's cognitive scores. In order to understand deficits or find remaining competencies, direct assessment of cognitive abilities may be preferred to informant based measures.

Art et cognition : atelier d’expression artistique dans un hôpital de jour spécialisé Alzheimer

Art therapy is one of the non-pharmacological measures used in the management of elderly people with cognitive deficit and dementia. This article provides a description of an atelier of art-therapy for patients suffering from different degrees of cognitive deficit, going from mild cognitive impairment to severe dementia. MMSE is 18 on average (range: 3-27). The atelier is implemented at the neuro- psycho-geriatric day care unit, located at Charles-Richet Geriatric University Hospital, in the north suburb of Paris. Participants are 8 to 10 persons per session, having a similar degree of cognitive deficit. Each session lasts approximately two hours in which patients are invited to express themselves by using different techniques of plastic art such as painting, sculpture, and modelling. Sessions as well as artistic productions of patients are quantitatively and qualitatively evaluated by using new tools under validation. Preliminary data suggests that participation in art-therapy activities contribute to the quality of life and the well-being of patients.

Constructvaliditeit van enkele tests voor episodisch geheugen in de psychogeriatrie

Episodic memory is the conscious recollection of personal experiences. In clinical practice several episodic memory tests are used, but their validity as measures of an episodic memory construct is not clear. The sensitivity and specificity of variables hypothesized to represent a distinct psychological construct is established by a pattern of convergent and discriminant validity. Confirmatory factor analysis was used to analyse the correlations between four episodic memory tests: a standardized orientation questionnaire, free recall, and two delayed recognition memory tests. The episodic memory construct was contrasted with an executive functioning construct, measured by three variables: two tasks of semantic word fluency and the Expanded Mental Control Test. The measures were taken from 813 consecutive visitors of a psychogeriatric day care centre. As a set the four indicators of episodic memory provided reliable measurement of the construct. The same was true for the three measures of the executive functioning construct. However, the strong correlation (0.89) between the two constructs implies a lack of discriminant validity and suggests that processes of executive control contribute to the successful performance on episodic memory tasks. Episodisch geheugen is de bewuste herinnering van gebeurtenissen die iemand zelf heeft meegemaakt. In de klinische praktijk worden diverse episodische geheugentests gebruikt. Onderzoek van de constructvaliditeit laat zien of de gebruikte tests sensitieve en specifieke indicatoren zijn van het beoogde psychologische construct. In een confirmatieve factoranalyse werden de correlaties onderzocht tussen vier episodische geheugentaken (Cognitieve Screening Test, Vijf Afbeeldingen Test, Uitgestelde Herkenning en Visueel Geheugen uit de Amsterdamse Dementie Screeningstest) en drie niet-episodische taken als indicatoren van het construct uitvoerende controlefuncties (Categoriegebonden Woordproductie, ADS-Fluency en de Expanded Mental Control Test). De tests zijn afgenomen bij 813 achtereenvolgende bezoekers van een psychogeriatrische dagbehandeling. De vier episodische geheugentaken hebben confirmerende validiteit en zijn sensitieve indicatoren voor het episodisch geheugenconstruct. De drie andere taken hebben confirmerende validiteit voor het construct uitvoerende controlefuncties. De hoge correlatie (0,89) tussen de twee constructen wijst echter op het ontbreken van discriminerende validiteit. De indicatoren zijn weinig specifiek. Het verband tussen de constructen suggereert dat cognitieve controleprocessen belangrijk zijn voor een goede uitvoering van de hier gebruikte episodische geheugentaken.

Effect of the Meeting Centres Support Program on informal carers of people with dementia: Results from a multi-centre study

Because of the complex nature of the problems that carers of persons with dementia encounter, several comprehensive support programs for carers were developed in the past decade. One such program is the Meeting Centres Support Program (MCSP) that integrates different types of support for persons with dementia and their carers, which have proved to be effective in practice and/or research. Within the framework of a study into the national implementation of the MCSP, it was investigated whether the positive effects found in carers that participated in the first Amsterdam Meeting Centres, were also achieved in other regions of The Netherlands. A pre-test–post-test control group design with matched groups was applied. In total, 94 carers in the MCSP in eight meeting centres and 34 carers of dementia patients who frequented regular psychogeriatric day care (PDC) in three nursing homes were included in the study. During the study period 23 carers of the MCSP group and 21 carers of the PDC group dropped out. At baseline and after seven months indicators of burden (psychological and psychosomatic symptoms, feelings of burden and time between start of support and institutionalization of the persons with dementia) were measured, as well as potential determinants of burden (sense of competence, coping strategies, experienced support, loneliness and the emotional impact of behaviour problems). Though on a group level no effect was found, either in psychological and psychosomatic symptoms or in the determinants of burden, a subgroup of carers who felt lonely (n = 22) at baseline benefited significantly more from the MCSP than from PDC in terms of psychological and psychosomatic symptoms. A majority of MCSP carers (82.1%) experienced less burden and more professional support. After seven months significantly fewer persons with dementia in the MCSP (4%) were institutionalized as compared to the patients in PDC (29%). Patients in the MCSP participated for a longer period of time before institutionalization. Although the effect on sense of competence of carers that was found in the Amsterdam study was not found in this multi-centre study, the effect on burden and delayed institutionalization of the person with dementia were confirmed. The integrated MCSP also proved more effective than PDC in decreasing psychological and psychosomatic symptoms in lonely carers. Further dissemination of the MCSP is therefore recommended.