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Oral presentations / European Geriatric Medicine 6S1 (2015) S5
–
S31
S21
O-055
Recommendations for non-pharmacological interventions
to prevent behavioural disturbances in older patients with
dementia. Applying the GRADE approach. The SENATOR project
ONTOP series
I. Abraha
1
, A. Cherubini
2
, F. Trotta
1
, J. Rimland
1
, G. Dell’Aquila
1
,
V. Pierini
1
, A.J. Cruz-Jentoft
3
, R. Soiza
4
, D. O’Mahony
5
1
Geriatrics and Geriatric Emergency Care, Italian National Research
Center on Aging (IRCCS-INRCA), Ancona, Italy;
2
IRCCS INRCA, Ancona,
Italy;
3
Hospital Universitario Ram´on y Cajal, Madrid, Spain;
4
NHS
Grampian, Aberdeen, United Kingdom;
5
Department of Medicine,
University College Cork, Dublin, Ireland
Objectives:
To develop explicit and transparent recommendations
for non-pharmacological interventions to prevent behavioural
disturbances in older adults with dementia.
Methods:
A multidisciplinary panel was constituted comprising
geriatricians, nurses and a clinical epidemiologist. The evidence
was compiled from a systematic overview of published reviews. A
Delphi method was used to establish critical outcomes. The Grading
of Recommendations, Assessment, Development and Evaluation
(GRADE) approach was used to rate the evidence and to formulate
recommendations.
Results:
The systematic overview identified 34 reviews. Behavioral
disturbances was rated as critical outcome. Based on low quality
of evidence, the panel formulated weak recommendations for
Behavior Management Techniques (4 SRs; 7 RCTs; 791 participants),
Person-centered care interventions (1 RCT, 289 participants),
Reminiscence therapy (4 SRs; 6 RCTs; 235 participants), Music
therapy (7 SRs; 10 trials), and Aromatherapy (4 SRs; 7 RCTs; 428
participants).
The panel also provided weak recommendations, supported by
very-low quality of evidence, for Validation therapy (2 SRs; 3 RCTs;
153 participants), Snoelzen therapy (2 SRs; 3 RCTs; 311participants)
and Exercise therapy (11 SRs; 3 RCTs; 268 participants).
Due to low/very low quality of evidence and conflicting results,
the panel did not recommend the use of the following non-
pharmacological interventions: Animal assisted therapy (2 SRs; 6
primary studies); Light therapy (3 SRs, 4 RCTs, 250 participants);
Transcutaneous Electrical Nerve Stimulation (1 SRs; 9 trials).
Conclusions:
The panel developed the most recent, systematic
and transparent recommendations for non-pharmacological
interventions to manage behavioral disturbances in patients with
dementia.
Funding:
European Union Seventh Framework Programme
(FP7/2007–2013), grant no. 305930 (SENATOR).
O-056
Health-related quality of life in a multidomain intervention
trial to prevent cognitive decline (the FINGER Study)
T. Strandberg
1
, T. Ngandu
2
, R. Antikainen
3
, T. Laatikainen
2
,
J. Lindstr ¨om
2
, S. Pajala
4
, J. Tuomilehto
5
, H. Soininen
6
,
M. Kivipelto
7
1
University of Helsinki, Helsinki, Finland;
2
THL, Helsinki, Finland;
3
Oulu University, Oulu, Finland;
4
University of Jyv¨askyl¨a, University
of Jyv¨askyl¨a, Finland;
5
National Public Health Institute, Helsinki,
Finland;
6
University of Kuopio, Kuopio, Finland;
7
Karolinska Institute,
Stockholm, Sweden
Objectives:
FINGER successfully demonstrated that a multidomain
intervention can prevent cognitive decline. We investigated
whether the intervention also affected health-related quality of
life (HRQoL).
Methods:
1260 community-dwelling individuals aged 60 to 77
years at risk of cognitive decline were randomized to intervention
(I, n = 631) and control (C), n = 629) groups. Two-year intervention
included healthy diet, exercise, cognitive training, and vascular risk
management and monitoring. HRQoL was assessed at baseline, 12,
and 24 months using RAND-36 (SF-36) instrument, which includes
8 scales: Physical Function (PF), Role Physical (RP), Role mental
(RM), Vitality (VT), Mental Health (MH), Social Function (SF), Bodily
Pain (BP), and General Health (GH). The changes in scales were
adjusted for age, sex, education, and MMSE.
Results:
At baseline, the scores in all RAND-36 scales were
considerably higher in the FINGER participants compared with
Finnish population of similar age. During the 2-year intervention
period mean scores in all scales decreased in C, but increased in I
for VT (12 and 24 months), SF (12 months), and especially GH at
both 12 and 24 months. The differences between I and C groups
were significant for GH at 12 (P
<
0.001) and 24 months (P
<
0.001),
PF at 12 months (P
<
0.01), and RP at 12 months (P = 0.03). The net
differences in GH scores between groups were
>
3 points, which is
considered clinically meaningful in RAND-36.
Conclusions:
In the FINGER study with good HRQoL at baseline,
multidomain intervention to prevent cognitive decline had also
positive effect on some scales of RAND-36, especially general
health.
O-057
Periodic measurement of quality of life and perseverance in
dementia care stimulates improvement
C. van der Ziel
1
, M. van den Hurk
1
, R. Huijsman
1
1
Zilveren Kruis (Achmea), Amersfoort, Netherlands
Objectives:
There is a lack of insight in care-outcomes for people
with dementia. In this project we evaluated QoL of people with
dementia and perseverance time and QoL of informal caregivers.
The objective is to stimulate use of these outcome indicators for
continuous improvement.
Methods:
We developed a questionnaire that measures QoL
(Sch ¨olzel), perseverance time (Kraijo) and Subjectively Experienced
Health (Bloem). The care professional that coordinates or provides
most care asks these questions during regular contacts two times
a year. Subsequent measurements follow changes over time.
The outcomes are shared with care professionals and their
organizations**, stimulating dialogue about the care provided.
Results:
Preliminary results on 200 cases* show:
•
People with dementia living independently, experience fewer
problems compared to inpatient care.
•
People with dementia score their QoL higher than informal and
professional caregivers
•
Slightly more than half of the informal caregivers reported a
perseverance time of more than two years.
•
Perseverance time seems better after institutionalization of the
person with dementia.
•
There is a relation between caregivers perseverance time and
their QoL.
•
Caregivers associate their good QoL with words as: peace, enjoy,
cozy, nice. Restlessness and anger are associated with bad Qol.
•
A first comparison between six organizations** shows significant
differences in QoL of people with dementia, suggesting there is
room for improvement.
*The final analysis on more than 1.000 cases is work in progress.
**Organizations are health care providers and regional dementia
care networks.
Conclusions:
The dialogue on QoL and perseverance time helps
care professionals to decide on appropriate care, stimulates
advanced care planning and shared decision making. We expect
that subsequent measurements and comparing results between
organizations** stimulates further improvement of daily practice.