Psychogeriatric Unit Research Articles

Benzodiazepine-receptor agonist prescription in a population of hospitalised patients in four psychogeriatric units in Switzerland.

The aim of this study is to describe the patterns of prescription of benzodiazepine-receptor agonists in hospitalised patients in four psychogeriatric units in Switzerland. This is a retrospective cross-sectional study that included patients aged 65 years or more hospitalised in one of the four psychogeriatric units of a university hospital in Switzerland during 2019. The presence, type and dose of benzodiazepine-receptor agonists was assessed at admission and at discharge. Three-hundred and eighty-six patients (214 women, 78.2 ± 8.1 years) were included in the study; 33.4% of patients had at least one benzodiazepine-receptor agonist at admission and 22.5% at discharge. The relative reduction of benzodiazepine-receptor agonists prescription in standardised dose was 78%. Age was found to be a protective factor against benzodiazepine-receptor agonists prescription at admission (adjusted odds ratio 0.94, confidence interval 0.91-0.98), and diagnosis of substance abuse was found to be a risk factor (adjusted odds ratio 4.43, confidence interval 1.42-17.02). Longer hospital stays (> 14 days) were associated with higher reduction of benzodiazepine-receptor agonists. The prevalence of a prescription of benzodiazepine-receptor agonists at admission was high, but during the psychogeriatric hospitalisation benzodiazepine-receptor agonists prescription decreased both in absolute and relative terms.

Impact of an improved outdoor space on people with dementia in a hospital unit.

Gardens and outdoor spaces are an important part of institutional environments for people with dementia. However, evidence regarding the benefits these spaces have for people with dementia is still limited. This paper presents the evaluation of the redevelopment of an inaccessible outdoor space into a therapeutic garden on a high dependency psychogeriatric unit in an acute hospital. A Mixed methods evaluation was undertaken. An interrupted time series analysis investigated the impact of the garden on falls and challenging behaviours of patients using routinely collected data. Perspectives of the redeveloped garden were captured through (a) a staff survey and (b) semi-structured interviews with families of patients. Rates of falls and challenging behaviours dropped at the time of the garden opening but showed increasing rates each month both before and after the garden opened. Most staff believed that the garden provided benefits for patients however limited staff time and concerns over patient safety were barriers to use. Families identified four main themes related to garden use including: (1) being outside (2) occupation and identity, (3) being stimulating, and (4) barriers and facilitators. The garden was regarded positively by families and staff however, there were barriers that prevented it from being better utilised. Staff concerns over risk were not reflected in falls and challenging behaviour outcomes. Further research into how barriers to garden use may be overcome is justified.

Tecuide. Telemonitorización de pacientes con deterioro cognitivo y sus cuidadores

IntroductionGiven the growing increase in dementia, the need to control these patients, together with the rise of new technologies, makes a change in the current control system imperative. Material and methodWe have carried out a single-center, clinical study with two groups, a control group of 72 patients/caregivers, who followed the usual controls in consultations, and another telematic group of 76 patients/caregivers, who followed the controls through of the Tecuide platform. The platform had a survey part to detect problems in patients and caregiver claudication, another training part and another chat for direct communication when the caregiver needed it and also served to respond when a problem was detected. ResultsAfter a year of monitoring with the platform we have obtained: a)in patients, reduce behavioral disorders and use of drugs, increase physical exercise and delay institutionalization (DS not found); b)in caregivers there is an improvement in satisfaction with respect to the control of patients with cognitive impairment, and c)in terms of resources, visits to emergency services and dementia consultations have decreased, although admissions to the psychogeriatric unit have increased. ConclusionsThe use of Tecuide as a telematic tool in the control of patients with cognitive impairment does not seem to be inferior to the usual controls in consultations and improves caregiver satisfaction.

ELECTROCONVULSIVE THERAPY FOR TREATMENT OF TACTILE HALLUCINATIONS

Abstract Tactile hallucinations can be highly distressing and lead to psychiatric morbidities and functional impairments. There are no established treatments for tactile hallucinations that occur outside of primary psychotic disorders, and available pharmacologic and nonpharmacologic therapies may have limited effectiveness. We present a case of a 75-year-old female with treatment-refractory tactile hallucinations successfully treated with electroconvulsive therapy (ECT). She endorsed 13 months of distressing tactile hallucinations described as slimly substances on her skin. Symptoms started insidiously, became more severe with time and refractory to multiple antipsychotic medications. She became so severely distressed from the tactile hallucinations that she developed a major depressive episode and became suicidal. Relevant medical history included one prior depressive episode, occipital lobe stroke, restless legs syndrome, and obstructive sleep apnea. She was hospitalized in an inpatient psychogeriatric unit and treated with ECT for 12 sessions over 3.5 weeks. Hallucinations responded well to ECT. Patient experienced some mild memory impairment from treatment. Treatment was optimized with duloxetine titration, addition of mirtazapine and repletion of B6 vitamin. Following the acute course of ECT, she reported an 80 % improvement in tactile hallucinations. Depressive symptoms improved, and suicidal thoughts resolved. She was able to discharge from the hospital and continued with maintenance ECT. Our case illustrates the potential therapeutic role of brain stimulation in the treatment of refractory cases of tactile hallucinations. Further studies are needed to determine effective treatment strategies for treatment-refractory tactile hallucinations to prevent progression to severe psychiatric disturbances and improve quality of life.

Day hospital for psychogeriatric patients: implementation of best practice

AbstractBackgroundPsychogeriatric day hospitals best practices deliver integrated patient and family centered care by multidisciplinary teams, providing a safer transition between acute psychogeriatric units to rehabilitation services and outpatients clinical care. This reduces inpatient length of stay and rehospitalization rates, favoring a successful daily routine care at home. We implemented in 2022 an elderly day hospital service at the Institute of Psychiatry USP Medical School, Brazil. This case report illustrates how day hospitals can contribute to a better clinical outcome.Case report64 year‐old male patient with bipolar disorder (BD), recurrent readmissions in our psychogeriatric unit due to either complications from bipolar disorder or clinical conditions and family burden (2020 for 90 days due to rapid cycling BD and 2021 to treat clinical conditions 4 days). When he was at home his family reported increased burden and difficulty in daily care. They asked for readmissions in this period .The cognitive impairment and functional decline were associated with neuroprogression in BD.The lack of adequate treatment worsened psychiatric, cognitive symptoms and the capacity to maintain his activities of daily living (ADL).In 2022 he was admitted due to behavior symptoms (irritability and aggressivity) in our inpatient unit for 19 days. Transitioned to day hospital, he attended activities for two months, twice a week. The intervention provided cognitive and functional stimulation, caregivers training and psychoeducation. It was performed in groups and individually (patient and family).We observed improvement in cognition, basic daily life activities and social support. Admission and transition to outpatient care were CGI‐04‐04, MMSE 20‐23 and Katz 02‐04. We observed reduction in family burden and management of psychiatric and behavior symptoms.ConclusionPatient and family needs were identified and cared for, and we achieved an improved health outcome by creating a safe transition, reducing length of stay and preventing readmission. This present intervention demonstrates a clinical example of the coordinated approach in order to provide transitional care and enable rehabilitation (cognition, basic daily life and bipolar symptoms).The benefits of the patient‐ family centered care provides consistent recovery and decreased length of hospital stay and risk of readmission.

FC47: To use or not to use? Multiple perspectives on residents’ alcohol and tobacco use in residential care facilities

Objectives:Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities. RCFs aim to provide person-centred care (PCC) to enhance the quality of life (QoL) of residents. Residents are dependent on their environment to fulfil their needs and wishes, such as drinking alcohol or smoking tobacco. Although alcohol and tobacco use can be experienced as a part of QoL in the final phase of life and the motivation to quit these substances is low, it can cause severe health problems in older adults. In RCFs this may cause a dilemma between the QoL of individual residents and the health and safety problems of all residents. This study aims to explore multiple perspectives on alcohol and tobacco use within the RCF.Methods:A qualitative research design was chosen, and semi-structured interviews were conducted. A various sample was purposively selected in two organizations on two types of units (psychogeriatric units and units providing care for residents with mainly physical disabilities): residents who use alcohol and/or tobacco and those who do not. Subsequently, four of these 16 residents were invited to participate in an in-depth case study. To explore the dynamics of the social environment, both formal and informal caregivers were invited to participate.Results:Residents are satisfied with their current use and value their autonomy regarding alcohol and tobacco use. Residents acknowledge that their use could cause a nuisance to others. Multiple caregivers are involved in their use and residents experience dependency on these caregivers to smoke tobacco or drink alcohol. There was limited interaction between the residents and their (in)formal caregivers and amongst the caregivers on this topic. Moreover, caregivers tended to act from their own perspectives, based on their professional expertise, knowledge, and attitudes towards residents’ alcohol and tobacco use.Conclusion:A dilemma arises between protecting residents from the adverse (health) outcomes of alcohol and tobacco use and sustaining their QoL by optimizing their autonomy. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health, and safety risks for all.

Results from multidisciplinary patient‐centered program implemented in a psychogeriatric unit in Brazil

AbstractBackgroundPatient and families/caregivers centered care programs reduce the negative impact of hospitalizations in old age and improve health outcomes. We started an individual‐centered multidisciplinary program that contemplated hospitalization and day‐hospital care at Institute of Psychiatry USP Medical School, Brazil in march 2022 .Our program involves specific goals for inpatients and family members / caregiver’s integrating pharmacology and a multidisciplinary approach.MethodOur program involves interventions during the hospitalization, day‐hospital and transition to outpatient care. Individual specific needs are assessed at the admission, and an individualized specific plan centered on patient and caregiver is designed and carried on. The therapeutic program provides patients cognitive and functional stimulation and caregivers training in order to adapt to behavior changes and together develop a successful daily routine care at home. The multidisciplinary team involves: medical team, nurse, psychologist, speech therapist, physiotherapist, occupational therapist, nutritionist and social worker. The intervention involves psychoeducation, cognitive and social stimulation/training for patients and/or caregivers/family in groups (60‐90 min), 5‐days a week, twice a day and individual sessions. Assessments include clinical and sociodemographic data, days of hospitalization, clinical global impression, MADRAS, MMSE and KATZ scales.ResultThere were 61 consecutive admissions in the 10 months after the program implementation, main diagnosis at admission were depression and dementia . The mean age was 69,73, gender 40 female, 21 male, average hospital stay was 26,66 (inpatient unit), bed turnover 85,81%. Zero patient was readmitted in a period of 30 days after discharge. Admission mean: CGI 4,98, MADRAS 17,66,MMSSE 16,43 KATZ 3,98 and discharge: CGI 3,47,MADRAS 7,26. MMSSE 19,4.KATZ 4,36 .The reduction in CGI 31,3%, Madras 58,89% and improvement in MMSE 18%, KATZ 9,5%.ConclusionOur findings demonstrated confirmed that a patient‐centered program results in improvement in cognition, basic activities of daily life and reduction of depressive symptoms. The present intervention provides consistent recovery of hospitalization. It is an important strategy to improve health quality and recovery for old age psychiatric patients.Descriptors: psychiatry; aging; multiprofessional intervention

Aggression Severity as a Predictor of Mortality in Dementia

ObjectivesIn psychogeriatric units for patients with dementia and behavioral problems, aggression is prevalent. Predictions and timely interventions of aggression are essential to create a safe environment and prevent adverse outcomes. Our study aimed to determine whether aggression severity early during admission to these units could be used as an indicator of adverse outcomes. DesignDuring one year, all aggressive incidents on a psychogeriatric unit were systematically recorded using the Revised Staff Observation of Aggression Scale (SOAS-R). The study investigated the link between the severity of incidents within the first 48 hours of admission and adverse outcomes. Setting and ParticipantsAll patients included in the study were admitted to a psychogeriatric unit for dementia and behavioral problems between November 2020 and October 2021. MethodsThe study population was categorized into groups according to the level of aggression severity during the first 48 hours of admission. The impact of aggression severity on the duration of admission, aggression frequency and severity during admission, medication usage at discharge, discharge destination, and mortality risk were examined. ResultsDuring the initial 2 days of admission, 9 of 88 patients had 1 or more severe aggression incidents. An early manifestation of severe aggression was significantly associated with more incidents during hospitalization, a higher total SOAS-R score, and a sevenfold higher 1-year mortality risk compared with patients who did not or only mildly manifested aggression in the first 48 hours of admission. Conclusions and ImplicationsAn early manifestation of aggression not only poses a direct safety risk to all involved but is also an early indicator of patients at risk for more detrimental outcomes, specifically mortality risk. By identifying patients at higher risk for adverse outcomes early, health care providers can provide preventive or timelier interventions, mitigating the risk of adverse outcomes and optimizing care services.

How Long-Term Care Quality Measures Address Alzheimer's Disease and Related Dementias in European Countries.

Alzheimer's disease and related dementias (ADRD) are prevalent conditions in long-term care homes (LTCHs) with most LTCH residents living with ADRD in many countries. Despite the prevalence of ADRD in LTCHs, a recent examination of LTCH quality measurement programs in 4 countries revealed few LTCH quality measures addressed ADRD, most commonly as a risk adjuster. We sought to better understand how quality measurement programs address ADRD internationally. International comparative analysis. We examined LTCH quality measures in 4 European countries-Germany, Switzerland, Belgium, and the Netherlands. The specifications to calculate each measure were assessed to determine whether the measure was calculated without assessing for ADRD, included only residents with ADRD, excluded residents with ADRD, or was risk adjusted for the presence of ADRD among the LTCH residents. A total of 143 measures were examined across 4 quality measurement programs. Thirty-seven percent of the measures explicitly address ADRD. The programs addressed ADRD in starkly different ways. In Germany, most (13 of 15) measures addressed ADRD, and did so as an exclusion or inclusion criterion, and in Switzerland all the measures addressed ADRD through risk adjustment. In Flanders, Belgium, all measures were calculated without assessing for ADRD. In the Netherlands, one-third of the measures explicitly addressed ADRD by restricting the measure to psychogeriatric units. Although limited to examining measures from LTCH quality measurement programs in 4 European countries, this study adds evidence that ADRD tends not to be addressed by LTCH quality measures, but when ADRD is addressed, it tends to be through inclusion or exclusion criteria. LTCH regulators, policymakers, and providers can use this information to assess options for addressing ADRD in quality measurement programs. Future research is needed to assess how standard indicators of ADRD care quality differ across quality measurement programs.

Anxiété, dépression et évolution du coping durant la pandémie de Covid-19 dans une population de patients âgés avec troubles psychiatriques

Lockdown over the Covid-19 pandemic might have had a major impact on people's mental health. The present longitudinal study was aimed to explore the impact of the two first lockdowns on anxious and depressive symptoms of older subjects suffering from psychiatric disorders and to highlight their strategies to cope with the stress induced by these lockdowns. Twenty-one outpatients from psychogeriatric units benefited from a follow-up visit phone. They filled out questionnaires assessing their anxious (GAD-7) and depressive (Mini-GDS) symptomatology and a questionnaire about their coping strategies (Brief COPE). The depressive symptomatology significantly decreased between the 1stlockdown and the second assessment 9 months later with a GDS score significantly decreasing from 1.7 ± 1.2 to 0.9 ± 1.0. Conversely, anxiety remained stable with a mean GAD-7 score from 6.2 ± 5.1 to 6.3 ± 4.4. Furthermore, coping strategies were correlated with both depressive symptomatology and anxiety. At the same time, coping strategies focused on emotional support, acceptance, selfdistraction, and expression of feeling during the first lockdown had shifted 9 months later towards positive reframing and problem-solving strategies (active coping and planification) with a significant increase of active coping. The study showed that during the Covid-19 pandemic and its lockdown, older subjects with psychiatric disorders were able to engage coping strategies and to mitigate their depressive symptomatology and these coping strategies were flexible according to the context.

Live and let live: Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities.

Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents. This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all. This study could help care professionals to become aware of the habits and wishes of residents regarding alcohol and tobacco use and to discuss the possibilities and limitations within RCFs.

Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic.

BackgroundTo limit the introduction of coronavirus disease 2019 (COVID-19) into nursing homes, restrictive measures and social distancing were implemented; however, these caused an increase in affective disorders such as depression and anxiety and an alteration of the behavioral and psychological symptoms of dementia. Therefore, it is expected that prescription trends of psychotropic drugs in nursing homes during the pandemic may have changed significantly.ObjectiveThis study aims to compare patterns of prescribing psychotropic drugs in nursing homes during the COVID-19 pandemic to those of the pre-pandemic period.MethodsThis cross-sectional multicenter study was conducted in geriatric units and psychogeriatric units in seven nursing homes in Gipuzkoa, Spain. On 1 March, 2020, data regarding 511 residents in geriatric units and 163 in psychogeriatric units were recorded. This study examined utilization percentages for psychotropic drugs before the pandemic (April 2018–March 2020) and during the pandemic (April 2020–March 2021) in light of projected usage based on previous years. Following the Anatomical, Therapeutic, Chemical Classification System, four therapeutic groups were analyzed: antipsychotics (N05A), benzodiazepines (N05B and N05C), antidepressants (N06A), and antiepileptic drugs (N03A).ResultsIn the case of geriatric units, a downward trend of prescription was reversed for antipsychotics (−0.41; 95% confidence interval [CI] −1.41, 0.60). Benzodiazepine use also decreased less than expected (−2.00; 95% CI −3.00, −1.00). Antidepressant use increased more than predicted (0.02; 95% CI −0.97, 1.01), as did antiepileptic drug use (2.93; 95% CI 2.27, 3.60). In the psychogeriatric units, the drop in antipsychotic utilization was less than expected (−2.31; 95% CI −3.68, −0.93). Although it was expected that the prescription of benzodiazepines would decrease, usage remained roughly the same (−0.28; 95% CI −2.40, 2.34). Utilization of antidepressants (8.57; 95% CI 6.89, 10.24) and antiepileptic drugs (6.10; 95% CI 3.20, 9.00) increased significantly, which was expected, based on the forecast.ConclusionsFor all categories, usage of psychotropic drugs was higher than anticipated based on the forecast; this increase might be related to the worsening of emotional and behavioral disorders caused by the restrictive measures of the COVID-19 pandemic.

Measuring Delirium Severity in Patients with Dementia: A Nurses’ ‘Delirium in Dementia Assessment Scale’ (DIDAS)

Objectives: Prevalence of delirium is increased in patients with dementia. Monitoring of the severity of Delirium Superimposed on Dementia (DSD) may help to improve the quality of care in patients suffering from this condition. This proof-of-concept study aims to provide a first exploration of the reliability, validity and sensitivity to change of the Delirium-In-Dementia-Assessment-Scale (DIDAS), a 10-item nurses’ observation scale to be used as a tool to screen for symptoms and measure severity of DSD. Methods: A first cross sectional and repeated measurement study of the DIDAS was conducted in a closed psychogeriatric unit of a general psychiatric hospital. All patients admitted to this ward were enrolled in this study to assess DIDAS’ validity, reliability, discriminative power and ability to measure delirium severity. Results: 589 DIDAS questionnaires were completed in 17 patients yielding a high internal consistency (a = 0.86) for the total DIDAS scores. Mean day DIDAS scores were significantly higher in patients with DSD compared to patients without DSD (Cohen’s d 1.02). The effect size on item level ranged from Cohen’s d of 0.27 to 0.72. A statistically significant correlation (Spearman’s Rho 0.626) was found between the mean DIDAS score per patient per day and a Likert score for global clinical severity. Conclusion: The DIDAS seems a reliable instrument for nurses to measure severity of DSD and monitor the course of DSD severity over time.

A Survey of Basic Daily Living Assistance in Dependency Units during the Morning First Period at Nursing Homes with a Healthcare Dysfunction.

(1) Background: It is important to evaluate the attention in the basic activities of daily life in the early hours of the day to evaluate the quality of care and to be able to increase the attention of human resources in case of observing an increase in dependency. The purpose was to improve healthcare quality in nursing homes, correctly identifying the work burden and incidents of daily planning, and completing the work plan by nursing assistant staffing. (2) Methods: The sample is based on 70 elderly people. The analysis used an observational trial every workday over a six-month period. An ad hoc sheet was prepared to collect socio-demographic data on each participant, and the Barthel Index was applied to the study subjects. A daily record of three basic activities of daily living (BADL), such as dressing, bathing, and eating, was kept. (3) Results: Our results showed a significant evolution in both units, but it was in the psychogeriatric unit in which higher compliance with the schedule and higher maintained stability was reached. (4) Conclusions: The use of some BADL registers helped us address situations of imbalance in terms of user assistance and establish an interdisciplinary communication with the nursing team as a way of achieving better organization and compliance with care protocols.

Baseline prolactin monitoring in patients admitted to a specialized psychogeriatric unit.

Baseline prolactin monitoring in patients admitted to a specialized psychogeriatric unit.

Factors contributing to person‐centered care provisioning for people with dementia in Dutch long‐term care facilities

AbstractBackgroundPerson‐centered care provisioning (PCC) is seen as the golden standard for dementia care. Positive evidence has been found for PCC, the level of person‐centeredness of care is positively associated with residents’ quality of life, quality of care an wellbeing. When providing PCC, care and support are provided in line with the needs, preferences and capacities of people with dementia.In long‐term care facilities, needs and preferences of people with dementia are not always obvious, due to the relatively high levels of cognitive impairment. This, and amongst others time constraints might hinder high PCC by care professionals. However, there is some evidence that certain organizational and environmental conditions, such as satisfactory leadership, interdisciplinary collaboration, and continuing education, lead to higher PCC. In order to facilitate care professionals as much as possible in providing PCC, more insight is desirable.This study aims to provide more insight into the modifiable factors that contribute to person‐centered care for people with dementia in Dutch long‐term care facilities.MethodA cross‐sectional design was applied. Data were collected during the fifth assessment of the Living Arrangements for people with Dementia (LAD)‐study from April 2019 until February 2020. Care professionals working in psychogeriatric units in long‐term care facilities filled in an online survey. Organizational characteristics of participating long‐term care facilities were inventoried.The Dutch version of the ‘Person‐centred care questionnaire’ (PCCq) was used to assess the degree of person‐centred care provided in a long term care unit/location. Modifiable factors potentially impacting the level of provided person‐centred care with regard to staff characteristics (e.g. autonomy, education), organizational features (size, involvement of family in care), and culture (e.g. learning climate) were included in multiple regression analyses.ResultIn total 58 long‐term facilities were included in the study, and 814 care professionals completed the survey. Average PCCq score was 3.2 (range 0 to 4, higher scores indicating higher PCC).ConclusionFactors with regard to staff, and organizations that contribute to PPC will be presented. The outcomes of the study will provide input for optimalization of the organization of dementia care in long‐term care facilities.

Variation of the Occurrence of Physical Restraint Use in the Long-Term Care: A Scoping Review.

Physical restraints in the long-term care setting are still commonly used in several countries with a prevalence ranging from 6% to 85%. Trying to have a broad and extensive overlook on the physical restraints use in long-term care is important to design interventions to prevent and/or reduce their use. Therefore, the aim of this scoping review was to analyze the range of occurrence of physical restraint in nursing homes, long-term care facilities, and psychogeriatric units. Pubmed, CINAHL, Ovid PsycINFO- databases were searched for studies with concepts about physical restraint use in the European long-term care setting published between 2009 and 2019, along with a hand search of the bibliographies of the included studies. Data on study design, data sources, clinical setting and sample characteristics were extracted. A total of 24 studies were included. The median occurrence of physical restraint in the European long-term care setting was still high (26.5%; IQR 16.5% to 38.5%) with a significant variability across the studies. The heterogeneity of data varied according to study design, data sources, clinical setting, physical restraint’s definition, and patient characteristics, such as ADLs dependence, presence of dementia and psychoactive drugs prescription.

Ethical dilemma for healthcare professionals facing elderly dementia patients during the COVID-19 pandemic

The management of elderly patients with dementia and COVID-19 infections without access to an intensive care unit gives rise to serious ethical conflicts. Therapeutic decisions have been made in psychogeriatric units, leaving a heavy moral burden on staff. They had to deal with the most difficult patients without the support of appropriate guidelines. The gap between established rules and hospital reality led to psychological distress and burnout. Managing uncertainty in medical decisions is a skill that doctors and staff learn through experience. However, with the COVID-19 pandemic, uncertainty about patient outcomes seems no longer acceptable. Geriatric triage has challenged professional conscience, emotions and values. The principle of distributive justice, which consists of giving each person in society what is rightfully his or hers, is not being respected during this pandemic. Charity has been reduced to patient survival. Staffs need to make decisions together, and it is important to allow all carers access to a space for reflection. In our unit, the involvement of nurses and care assistants in the decision-making process for patient care is crucial especially for refusal of care. Their view of the patient's condition is different from that of the doctors, as they provide daily care to the patient and stay in the wards for several hours with them. By including as many people as possible in the reflection, we could avoid moral or personal prejudices related to these difficult decisions. The current pandemic can give new meaning to team thinking, giving everyone a voice without hierarchical barriers. With these new waves of COVID-19, we need to rethink our therapeutic conduct for elderly patients with dementia to avoid ethical failure.

414 - Supporting staff delivering person-centered care to people with dementia in Dutch nursing homes

BackgroundPositive evidence has been found for person-centered care provisioning (PCC), the level of person- centeredness of care is positively associated with residents’ quality of life, quality of care an wellbeing.When providing PCC, care and support are provided in line with the needs, preferences and capacities of people with dementia. PCC is seen as the golden standard for dementia care. However, in nursing homes, needs and preferences of people with dementia are not always obvious, due to the relatively high levels of cognitive impairment. This, and amongst others time constraints might hinder high PCC by care professionals. Limited evidence show that certain organizational and environmental conditions, such as satisfactory leadership, interdisciplinary collaboration, and continuing education, lead to higher PCC. In order to facilitate care professionals as much as possible in providing PCC, more insight is desirable.ObjectiveThis study aims to provide more insight into the modifiable factors that contribute to PCC for people with dementia in Dutch nursing homes.MethodsA cross-sectional design was applied. Data were collected during the fifth assessment of the Living Arrangements for people with Dementia (LAD)-study from April 2019 until February 2020. Care professionals working in psychogeriatric units in nursing homes filled in an online survey. Organizational characteristics of participating nursing homes were inventoried.The level of PCC was assessed with the Dutch version of the ‘Person-centred care questionnaire’ (PCCq). Modifiable factors potentially impacting the level of provided PCC with regard to staff characteristics (e.g. autonomy, education), organizational features (e.g. size, involvement of family in care), and culture (e.g. learning climate) were included in multiple linear modelling.Preliminary resultsIn total 58 nursing home facilities were included in the study, and 814 care professionals completed the survey. Average PCCq score was 3.2 (SD = 0.4; range 0 to 4, higher scores indicating higher PCC).ConclusionFactors related to staff, and organizational features and culture, that contribute to PPC will be presented. The outcomes of the study will provide input for the optimal organization of dementia care, in order to support care professionals working in nursing homes to provide PCC.

Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study

BackgroundBarriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity.ObjectiveThis study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia.MethodsA intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data.ResultsOverall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants’ self-reports. Several items were associated with and able to predict depression.ConclusionsThe mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms.