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Dean, Rachel; Briggs, Kate; Lindesay, James
doi: 10.1002/gps.930081003pmid: N/A
This article reports the findings of a prospective study of the first year of operation of two residential domus units for elderly people with dementia (domus A) and chronic schizophrenia (domus B). Residents, staff and the process of care were assessed at baseline in long‐stay mental hospital wards, and at 3 months, 6 months and 12 months after the move to a domus. At 12 months, both domuses were providing more policy choice, resident control, provision for privacy and availability of social and recreational activities than a baseline psychogeriatric ward. Residents' cognitive function improved steadily over the follow‐up period in both domuses, significantly so in domus A. There was also some improvement in residents' self‐care (ADL) skills at follow‐up in both domuses. Residents' communication skills were rated as significantly improved by staff in domus A at all follow‐up assessments, and by staff in domus B at 6 months. Compared to baseline, substantially higher levels of activities and interpersonal interactions were observed at follow‐up in both domuses. There was no evidence that staff suffered from low job satisfaction or psychological impairment at either domus.
Dean, Rachel; Proudfoot, Roger; Lindesay, James
doi: 10.1002/gps.930081004pmid: N/A
The Quality of Interactions Schedule (QUIS) was developed as part of the prospective evaluation of two residential domus units for elderly people with severe mental illnesses. QUIS is an observational strategy in which social interactions between residents and care staff are coded as positive social, positive care, neutral, negative protective or negative restrictive. The interrater reliabilities of both the observational technique and the category codings were good. In the domus evaluation, QUIS demonstrated that the number and quality of interactions were significantly improved in both domuses compared to a baseline hospital ward at 3 months, 6 months and 12 months follow‐up. In particular, the number of negative interactions observed fell to almost zero in the domuses at 12 months.
Beecham, Jeni; Cambridge, Paul; Hallam, Angela; Knapp, Martin
doi: 10.1002/gps.930081005pmid: N/A
In this article we examine the costs and certain characteristics of domus care in two facilities. The domuses are registered mental health nursing homes and the charge made to residents covers many of the service needs of residents. All residents are dependent on social security benefits. The two facilities are highly staffed and each client receives between 17 and 25 hours per week of individual, one‐to‐one support. The research uses the Client Service Receipt Interview to gather data which allow measures of costs for all domus residents to be built up. Use of services based outside the domuses was rare, nevertheless a wide variety of professionals visited the domuses. The main service gaps and deficiencies related to day support services and the inputs of GPs. Accommodation (including in‐house services) dominated the aggregate total costs of care (96%). Average total community care cost was £951 per week for current domus A residents and £909 for domus B residents. Although the new service was more costly than the hospitals from which residents came, the results from the outcomes study suggest that domus residents are experiencing a better quality of life than in hospital.
Annerstedt, Lena; Gustafson, Lars; Nilsson, Karin
doi: 10.1002/gps.930081006pmid: N/A
Care of demented elderly in group living units is developing rapidly in Sweden. Group living (GL) offers a secure, small‐size, homelike physical setting and an individualized, psychosocial and integrity‐promoting therapy. Twentyeight patients suffering from dementia of Alzheimer type (DAT) or/and vascular dementias (VD) were evaluated before relocation from traditional long‐term care institutions (TI) into GL units and followed up 6 and 12 months later by psychogeriatric ratings, regional cerebral blood flow measurements, somatic investigations and registration of pharmacological treatment. The patients relocated into GL were compared to a matched sample of 28 patients permanently cared for in TI. GL patients showed less dyspraxia, dysphasia and less prominent symptoms of depression and anxiety after both 6 and 12 months compared to the control group. Restlessness diminished among GL patients while the patient group in TI got more restless. Neuroleptic treatment was found to be used significantly more often among the TI patients during the whole study and anxiolytic‐hypnotic treatment after 6 months. No difference was observed in antidepressive treatment. The results show that psychosocial stimulation and therapy offered in GL care has positive effects on emotional symptoms and performance compared to care in TI. These clinical changes abate later in the study as a consequence of the underlying organic disease. The major benefit of GL was slightly different between the diagnostic groups: for VD patients improvement of practical abilities, for AD patients abated agitation and restlessness.
Nösman, Birgitta; Bucht, Gösta; Eriksson, Sture; Sandman, P. O.
doi: 10.1002/gps.930081007pmid: N/A
A proportion of patients in long‐term care institutions have behavioural symptoms that increase the physical and psychiatric workload of those caring for them. We performed a cross‐sectional study in order to assess the prevalence of behavioural symptoms in patients in various types of long‐stay institutions. In addition, we studied behavioural patterns to find predictors for behavioural symptoms. Prevalence and pattern of behavioural symptoms were studied in 1350 patients in the long‐stay institutions in the county of Umeå using Gottfries and Gottfries Psychogeriatric and Sandman‐Adolfsson's Multi‐Dimensional Dementia Assessment Scales. The patients were in a psychogeriatric unit, a somatic long‐stay unit, eight nursing homes and 15 homes for the aged with a total number of 1403 beds. Behavioural symptoms were found in 65% of the patients and were classified into six syndromes: escape, aggression, restlessness, wandering, regression and verbally disruptive behaviour.
Verhey, Frans R. J.; Rozendaal, Nico; Ponds, Rudolf W. H. M.; Jolles, Jellemer
doi: 10.1002/gps.930081008pmid: N/A
We examined 170 outpatients, 103 with Alzheimer's disease, 43 with vascular dementia and 24 with various other causes, in order to investigate whether or not depressive symptoms were more likely to occur in dementia patients who had some degree of awareness of their cognitive deterioration. Awareness was rated on a four‐point scale that assessed discrepancies between the patient's and the caregiver's history. The level of awareness was significantly related to the severity of dementia but not to depression or to the score on Hamilton's depression scale. However, the score from the item “psychic anxiety” showed a weak but significant correlation with the level of awareness of one's deficits. It is concluded that intact awareness of deterioration was not clearly related to the development of depression or depressive symptoms in dementia.
doi: 10.1002/gps.930081009pmid: N/A
This article describes the development of a direct observation system for the assessment of the behaviour of elderly demented long‐stay patients. The technique of recording behaviour in real time has high face validity, and in conjunction with portable computers was found to be very reliable. The technique was used to assess the behaviour of patients during their waking day on seven wards. The findings suggest that almost two‐thirds of the day is spent doing nothing, with aimless or disruptive behaviours also accounting for a significant period of the day. Only a small proportion of the day was spent in self‐care or social behaviours.
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