1 / 17

Hilde Verbeek, PhD Department of Health Services Research ADI Conference, March 8th 2012

QUALITY OF LIFE IN SMALL-SCALE, HOMELIKE CARE ENVIRONMENTS: A QUASI-EXPERIMENTAL STUDY INTO EFFECTS ON RESIDENTS. Hilde Verbeek, PhD Department of Health Services Research ADI Conference, March 8th 2012. The Netherlands. Dutch government stimulates small-scale, homelike care settings

katherinesaunders
Download Presentation

Hilde Verbeek, PhD Department of Health Services Research ADI Conference, March 8th 2012

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. QUALITY OF LIFE IN SMALL-SCALE, HOMELIKE CARE ENVIRONMENTS: A QUASI-EXPERIMENTAL STUDY INTO EFFECTS ON RESIDENTS. Hilde Verbeek, PhDDepartment of Health Services Research ADI Conference, March 8th 2012

  2. The Netherlands • Dutch government stimulates small-scale, homelike care settings • 80 million euro program (2009-2011) • Development of new small-scale living facilities • ICT and assistive technology in facilities • In 2010 ± 25% small-scale living facilities in institutional dementia care • Aim within 5 year: 33% • Little knowledge on effects

  3. Small-scale homelike facilities General characteristics of 28 units included: Small resident group (6-7) Familiar, homelike environment Joint daily household Integrated tasks nursing staff Resemblance archetypal home Worldwide several similar concepts (Verbeek et al. 2009. Int Psychogeriatr. 21:252-264)

  4. Control group: Regular wards Criteria regular wards:(n=21 wards) Min. 20 residents per group Staff have differentiated tasks Organization daily life mainly determined by routines of the nursing home Matching of residents at baseline on cognition and ADL profile Previous research: differences between residents in small-scale living and regular wards (Verbeek et al., 2010;Te Boekhorst et al. 2009)

  5. Small-scale Baseline 124 residents 135 residents FU 6 months 111 residents 111 residents FU 12 months 93 residents 97 residents Regular wards

  6. Residents’ baseline characteristics

  7. Primary outcome measures Quality of Life (as measured with Qualidem) Neuropsychiatric symptoms (NPI-NH) Agitation (CMAI) Mixed-model multi-level analyses (Verbeek et al. 2010. J Am Med Dir Assoc11:662-670)

  8. Quality of life No effects on total QoL No differences in trend and no difference in mean total score between groups Small-scale living facilities: adjusted mean score 18.3 Regular wards: adjusted mean score 18.5

  9. Quality of Life - Subscales Assessed by nursing staff: Two scales significantly differed: Residents in small-scale living had… Higher QoL “having something to do” (p<.001) Lower QoL regarding “negative affect” (p=.01) Assessed by family caregivers: Residents in small-scale living had… higher QoL regarding “having something to do” (p=.018), “ feeling at home” (p=.023) and “social relations” (p=.020)

  10. Neuropsychiatric symptoms No overall effect No differences in trend and no difference in mean total score between groups Small-scale living facilities: adjusted mean score NPI-NH 15.8 Regular wards: adjusted mean score 14.5

  11. Agitation Difference in trend Small-scale living: agitation stable over time Regular wards: agitation decreased over time Significant difference after 12 months: Residents in small-scale living facilities displayed more agitated behavior (p=.035)

  12. Secondary outcomes Use of physical restraints (yes/no) Psychotropic drug use (yes/no) Generalized Estimating Equations (GEE) Social engagement (ISE from RAI-MDS) Mixed-model multi-level analyses

  13. Promising results Fewer physical restraints (p=.003) and psychotropic drug use (p=.023) in small-scale living facilities Differences were present at baseline and remained stable over time E.g use of belts: 1% vs 10% More social engagement for residents in small-scale living, although this disappeared over time (only at baseline after 6 months)

  14. Neuropsychiatric symptoms & agitation Residents in small-scale living displayed:… More aberrant motor behavior at all measurements (p=.020; NPI-NH) More physically non-aggressive behavior (e.g. wandering) after 12 months (p=.001; CMAI) …than residents in regular wards

  15. Conclusion No effects on primary outcomes Influence Dutch health care policy? Some promising effects on secondary outcomes (physical restraints, psychotropic drugs) Inconclusive effects behavior Automatic transition towards small-scale homelike care environments is not recommended Focus should be on care program

  16. Implications • Changing role of nursing staff: adequate training and education of staff is essential • Knowledge and skills • Attitude towards care • Small-scale homelike facilities have encouraged development of new care concepts • Which elements are effective, how and for whom? • Which and how can active ingredients be transferred to other dementia care settings as well?

  17. Thank you Email: h.verbeek@maastrichtuniversity.nl Research group: dr. Hilde Verbeek dr. Erik van Rossumdr. Sandra MG Zwakhalenprof. Gertrudis IJM Kempen prof. Jan PH Hamers Funding:Maastricht UniversityProvince of Limburg5 Health care organizations(MeanderGroep, Orbis, Sevagram, Vivre & De Zorggroep)

More Related