Persoonsgerichte zorg in verpleeghuizen

Is Dementia Care Mapping (kosten)effectief?

  • 10 min.
  • Shortpaper

Summary

Effectiveness and costs of dementia care mapping intervention in Dutch nursing homes Geertje van de Ven

Aim
The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and job dissatisfaction, workrelated stress and high illness among the staff. Dementiacare mapping (DCM) is a personcentred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursinghome dementia care.

Methods
Dementia special care units were randomly assigned to DCM or usual care. Ten nurses from the intervention care homes received DCM training and conducted two DCM-cycles of observation of residents and staff, feedback to the staff and action plans. The primary outcome was residents’ agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents’ neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and at two follow-up moments with 4-month intervals. We collected the data from the questionnaires and electronic registration systems. We employed linear mixed-effect models to evaluate the outcomes. We set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementiacare mapping.

Results
34 units from 11 care homes, including 434 residents and 382 nursing staff members were included. Intention-to-treat analysis showed no statistically significant effect on agitation (CMAI). Significant more NPSs were reported in the intervention group than in usual care (p=0.02). Intervention staff reported fewer negative and more positive emotional reactions during work. Analyses showed no difference in total costs.

Conclusions
We did not find an effect of DCM on our primary outcome measure (CMAI) and DCM turned out to be a costneutral intervention. Adherence to the intervention protocol varied considerably across the units, and there were some serious barriers to the implementation of the DCM intervention, which may explain the lack of effect.

Keywords: dementia-care mapping, nursing home, person-centred care

 

 

Inleiding

De zorg voor mensen met dementie is complex en er is ruimte voor verbetering. Veel van de cliënten in verpleeghuizen (gemiddeld ruim 80%) hebben neuropsychiatrische symptomen, zoals depressie, agitatie en apathie.1 Daarnaast ervaren veel medewerkers die te maken hebben met cliënten met dementie werkstress, is er veel ziekteverzuim en wisselen medewerkers in de zorg vaak van baan.2 Uit literatuur blijkt dat persoonsgerichte zorg bij zowel patiënten als medewerkers verbeteringen kan opleveren.3 Persoonsgerichte zorg is

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