Nursing home residents and professional caregivers may engage in behaviors that, although not considered formal treatments for depression, can improve residents’ mood. To support future studies aiming to explore ways to complement formal depression care in nursing homes, reliable and valid instruments for measuring these informal mood-improving behaviors are needed. This project developed and evaluated inventories to measure mood-improving behaviors in Dutch and Belgian nursing homes. Study 1 followed an iterative mixed-methods approach to develop two inventories: the Actions to Improve Mood by Residents (AIM-R) and the Actions to Improve Mood by Caregivers (AIM-C), and to assess their content validity (N = 31 residents; N = 35 caregivers, respectively). Study 2 evaluated test-retest agreement (N = 206; N = 125) and inter-rater agreement (AIM-C: N = 81) using a test-retest design. Study 3 explored the inventories’ practical application through semi-structured interviews (N = 12; N = 6). Data were analyzed through thematic analysis, content validity indices, and Gwet’s AC2 agreement coefficients. Both inventories demonstrated acceptable content validity, with moderate to very good test-retest agreement. Inter-rater agreement for most AIM-C items was classified as “fair,” and appeared lower when caregivers completed the inventories for residents with moderate to severe cognitive decline compared to residents with no to mild cognitive decline. Thematic analysis suggested that using the inventories increased awareness of mood-improving behaviors and contributed to better knowledge about residents. Challenges regarding usability and interpretability were identified, along with suggestions for refinement. The inventories appear to adequately capture mood-improving behaviors and show consistency over time. Nevertheless, their usability and interpretability could benefit from further refinement. Pending additional research, these inventories hold promise for assessing mood-improving behaviors in nursing homes, aiding future efforts to explore new ways to enhance depression care alongside traditional treatments.

Objective: To develop and evaluate instruments for measuring implicit associations of nursing home care providers with behaviours aimed at improving resident mood. Method: Study 1 (N = 41) followed an iterative approach to develop two implicit association tasks measuring implicit attitude (positive versus negative valence) and motivation (wanting versus not wanting) regarding mood-improving behaviours, followed by an evaluation of the content validity for target stimuli representing these behaviours. In Study 2 (N = 230), the tasks were assessed for stimulus classification ease (accuracy and speed) and internal consistency. A subsample (n = 111) completed additional questionnaires to evaluate convergent validity (with self-reported attitudes towards depression, altruism, and mood-improving behaviours), and discriminant validity (against social desirability), and repeated the tasks after 2 weeks to assess test-retest reliability. Results: Content validity indexes for target stimuli were satisfactory. Error rates were acceptable for attribute stimuli, but exceeded the 10 % limit for target stimuli. Response times for all stimuli exceeded the 800-millisecond threshold. Both tasks demonstrated good internal consistency but poor test-retest reliability. Regarding convergent validity, both tasks significantly correlated with altruism, the implicit attitude task associated with self-reported mood-improving behaviours, and the implicit motivation task correlated with the behavioural scale of attitudes towards depression. Discriminant validity was supported as neither task was significantly associated with social desirability. Conclusions: The implicit association tasks show potential for measuring implicit associations with mood-improving behaviours of care providers, offering an innovative pathway for exploring processes influencing caregiving behaviours. However, limitations in psychometric properties were identified, aligning with challenges observed in similar measures.

Objective: In nursing home residents, outcomes are often assessed using proxies, especially in residents with severe cognitive problems. Although caregivers are commonly involved as proxies, studies assessing their agreement for proxy measures are scarce. Therefore, secondary analysis was performed on a dataset with proxy-reported scores of several scales in Dutch and Flemish nursing home residents with and without dementia. Methods: To assess the agreement between the observations of 81 pairs of caregivers, we calculated Cohen’s Kappa, Weighted Kappa, and Prevalence- and Bias-Adjusted Kappa (PABAK and PABAK- OS for ordinal data) coefficients for the items on the Nijmegen observer-rated depression scale for detection of depression in nursing home residents (NORD), the social wellbeing of nursing-home residents scale (SWON-3), and two subscales (i.e., “social relations” and “having something to do”) of the QUALIDEM. In addition, coefficients were calculated for the item concerning subjective judgment of the residents’ depressive symptoms (“no,” “yes, mild or light,” or “yes, severe”) and for the item concerning whether the caregivers believed a depression diagnosis had been established (“yes,” “no”). Results: In general, PABAK and PABAK-OS coefficients were higher than the Cohen’s and Weighted Kappa coefficients, suggesting a considerable amount of prevalence or bias. For the total sample, most items were above .40, indicating acceptable agreement. The results showed higher levels of agreement for proxy scores of residents with lower levels of dementia, compared to residents with more severe dementia. Conclusion: The general finding of different levels of agreement between coefficients with and without correction for prevalence and bias, suggest the importance of exploring both values to enable adequate interpretation of the reliability of these items. The result of limited levels of agreement between caregivers concerning residents with more severe dementia underscores challenges for measurements in this population. We believe that practitioners and researchers should be aware of these challenges when using and interpreting scores derived from proxies. Moreover, understanding why different raters reach different conclusions regarding the same residents is important for interpreting the meaning of proxy-reported scores.

Objectives To identify and structure potential informal antidepressant strategies that can be used in daily practice for nursing home residents alongside formal treatments. Methods In a first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies residents could use to prevent or alleviate depression. In a second study, the same participants (N = 110) reported strategies for use by others. Furthermore, participants rated the expected effectiveness and feasibility of the suggested strategies. Simultaneously, all strategies were sorted by experts and clustered using multidimensional scaling and hierarchical cluster analysis. Results Six clusters emerged for strategies by residents themselves and five clusters for strategies by others. For residents' strategies, the clusters Being socially connected and Participating in activities were perceived as most effective, as was the cluster Offering personal attention for strategies by others. Participants perceived Creating a healthy living environment as the most feasible cluster executed by residents. Within strategies by others, the clusters Offering personal attention, Using positive treatment/approach, and Using or adapting the physical environment were perceived as the most feasible. Conclusion The results indicated the importance of social connectedness, a personalized and positive approach by significant others, and tailored activity programs. The results also suggest that adaptations to the physical environment within nursing homes may be an easy applicable strategy to prevent or alleviate depression in residents. Although more research is needed, these findings may guide daily practice and the development of interventions that include informal strategies. Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2057427 .

BACKGROUND Periodontal disease and hepatitis C virus (HCV) represent chronic infectious states that are common in elderly adults. Both conditions have independently been associated with an increased risk for dementia. Chronic infections are thought to lead to neurodegenerative changes in the central nervous system possibly by promoting a proinflammatory state. This is consistent with growing literature on the etiological role of infections in dementia. Few studies have previously evaluated the association of periodontal disease with dementia in HCV patients. OBJECTIVE To examine whether periodontal disease increases the risk of developing Alzheimer's disease and related dementias (ADRD) among HCV patients in Medicare claims data. METHODS We used Medicare claims data for HCV patients to assess the incidence rate of ADRD with and without exposure to periodontal disease between 2014 and 2017. Cox multivariate regression was used to estimate the association between periodontal disease and development of ADRD, controlling for age, gender, race, ZIP-level income and education, and medical comorbidities. RESULTS Of 439,760 HCV patients, the incidence rate of ADRD was higher in patients with periodontal diseases compared to those without (10.84% versus 9.26%, p <  0.001), and those with periodontal disease developed ADRD earlier compared to those without periodontal disease (13.99 versus 21.60 months, p <  0.001). The hazard of developing ADRD was 1.35 times higher in those with periodontal disease (95% CI, 1.30 to 1.40, p <  0.001) after adjusting for all covariates, including age. CONCLUSION Periodontal disease increased the risk of developing ADRD among HCV patients in a national Medicare claims dataset.

The measures taken in Dutch nursing homes during the first wave of the COVID-19 pandemic resulted in both an increase and a decrease of challenging behavior in nursing home residents. Staff undertook various initiatives to reduce the negative effects. For example, video calling between residents and their relatives was facilitated. In addition, initiatives in digital care (telehealth) were deployed. The aim of this study was to explore nursing home practitioners' experiences with online communication between residents and relatives, working remotely in general and the remote treatment of challenging behavior in particular. One hundred and seventy-five nursing home professionals (psychologists, elderly care specialists, nursing specialists, daytime activities coordinators) completed an online questionnaire at the end of 2020/start of 2021. Open and closed questions showed that face-to-face contacts are preferred over online communication. Online communication was mainly seen as a (meaningful) addition. Although professionals wanted to continue some of their work remotely, and found this efficient and workload-reducing, they felt that this could impair their job satisfaction and the quality of care. For remote work and remote treatment, each task needs to be evaluated on whether it can be performed properly and whether that results in good care. More research into online communication, remote working and digital care in nursing homes is needed.

Samenvatting De maatregelen in Nederlandse verpleeghuizen tijdens de eerste golf van de COVID-19-pandemie leidden tot zowel een toename als een afname van probleemgedrag bij verpleeghuisbewoners. Medewerkers ondernamen diverse initiatieven om de negatieve effecten te verminderen. Zo werd beeldbellen tussen bewoners en hun naasten gefaciliteerd. Daarnaast werden initiatieven op het gebied van digitale zorg (telehealth) ingezet. Doel van dit onderzoek was het verkennen van ervaringen van verpleeghuisprofessionals met onlinecommunicatie tussen bewoners en naasten, het werken op afstand in het algemeen en de behandeling van probleemgedrag op afstand in het bijzonder. Honderdvijfenzeventig verpleeghuisprofessionals (psychologen, specialisten ouderengeneeskunde, verpleegkundig specialisten, medewerkers- welzijn en -dagbesteding) vulden eind 2020/begin 2021 een onlinevragenlijst in. Uit open en gesloten vragen bleek dat face-to-face-contacten de voorkeur genieten boven onlinecommunicatie. Onlinecommunicatie werd vooral als (zinvolle) aanvulling gezien. Hoewel professionals een deel van hun werk op afstand wilden voortzetten, en dit efficiënt en werkdrukverlagend vonden, vonden ze dat dit hun werkplezier en de kwaliteit van zorg kan verslechteren. Voor werken op afstand in het algemeen en behandelen op afstand in het bijzonder, moet steeds per taak beoordeeld worden wat goed uitvoerbaar is en tot goede zorg leidt. Meer onderzoek naar onlinecommunicatie, werken op afstand en behandelen op afstand in verpleeghuizen, is nodig. Abstract The measures taken in Dutch nursing homes during the first wave of the COVID-19 pandemic resulted in both an increase and a decrease of challenging behavior in nursing home residents. Staff undertook various initiatives to reduce the negative effects. For example, video calling between residents and their relatives was facilitated. In addition, initiatives in digital care (telehealth) were deployed. The aim of this study was to explore nursing home practitioners’ experiences with online communication between residents and relatives, working remotely in general and the remote treatment of challenging behavior in particular. One hundred and seventy-five nursing home professionals (psychologists, elderly care specialists, nursing specialists, daytime activities coordinators) completed an online questionnaire at the end of 2020/start of 2021. Open and closed questions showed that face-to-face contacts are preferred over online communication. Online communication was mainly seen as a (meaningful) addition. Although professionals wanted to continue some of their work remotely, and found this efficient and workload-reducing, they felt that this could impair their job satisfaction and the quality of care. For remote work and remote treatment, each task needs to be evaluated on whether it can be performed properly and whether that results in good care. More research into online communication, remote working and digital care in nursing homes is needed.

Abstract Background: Depression is common among nursing home residents and has a considerable impact on their quality of life. Therefore, there has been an increased interest in interventions aiming at the reduction of depression among nursing home residents. These interventions could be categorized into formal and informal depression care. Formal care includes psychosocial, psychotherapeutic and/or (neuro-)biological interventions. Informal care can be provided by nursing home staff, alongside the formal care (e.g., letting sunlight into the room when one believes in the positive effects of daylight). Although many studies have been done about depression treatment in nursing homes, there is still a lack of insight into the effectiveness of interventions and how they differ among specific target groups (e.g., residents with cognitive impairment versus residents with physical disabilities). Moreover, research into informal care is rather rare. More insight is needed into the effect of formal and informal depression care and the mutually reinforcing effects of those strategies on nursing home residents. This insight is essential to better match treatments with residents and to provide a more comprehensive approach to counter depression. Objectives: The aim of this study is to gain insight in the use of formal and informal depression care and their associations with depression among nursing home residents. Design: A six month cohort study will be conducted. Method: Residents will be recruited in nursing homes across the Netherlands and Flanders (Belgium). To measure formal and informal care, newly developed tools will be cross-culturally validated: one to assess the provided formal care in nursing homes, two tools for measuring the used informal strategies. Depression outcomes will be measured with the Geriatric Depression Scale, Cornell Scale for Depression in Dementia, and the Nijmegen-Observer-Rated Depression-scale). Baseline measurements and cross- sectional analyses will be performed and repeated after six months. The intended associations will be assessed using multiple regression analysis. Conclusion: To develop a good depression care policy, a more comprehensive approach is needed and may benefit both residents and staff.

Challenging behavior is common in nursing home residents, especially in those with dementia. Our previous study suggested that a decrease in environmental stimuli (i.e., events that take place around residents but are not specifically directed at them) in nursing homes due to restrictions during the COVID-19 pandemic, may affect residents differently. To improve future care, the experience of practitioners can be used to learn about the effects of environmental stimuli on challenging behavior in specific resident groups during the pandemic.From the perspective of practitioners, this study aimed to learn from successful initiatives and observed effects of decreased environmental stimuli on challenging behavior in residents during anti-pandemic measures.An online survey among 199 Dutch nursing home practitioners was conducted from November 2020 to January 2021. Practitioners were asked about alleged effects of diminished environmental stimuli in residents with different types of challenging behavior (i.e., psychotic, depressed, anxious, agitated, apathetic) and with mild vs. advanced or without dementia. Also, their opinion about strategies to limit environmental stimuli was explored.Residents with advanced dementia and those with psychotic and agitated behavior seemed to benefit from diminished environmental stimuli. In contrast, residents without dementia and those with depressive and apathetic behavior seemed to be negatively affected by decreased environmental stimuli. Practitioners indicated that they would like to preserve various strategies to limit environmental stimuli in the future such as reducing the use of corridors adjacent to residents’ rooms. Also, they planned to use adjustments and new initiatives regarding organized activities such as an increased use of small-scale and person-oriented activities. Opinions were divided on receiving visitors in the living room and on imposing visiting hours. In open-ended questions, other initiatives were mentioned that can be useful in nursing home care.Various strategies and initiatives in nursing homes during the pandemic seem promising to meet individual needs. While many residents may be negatively affected by restrictions during the pandemic, specific resident groups may benefit from a decrease in environmental stimuli. These findings underline the importance of a good balance between stimuli and rest in the nursing home, tailored to an individual resident.

Objectives To longitudinally explore the association between activities and depressive symptoms of nursing home (NH) residents, taking into account that each activity may contain multiple components (physical, creative, social, cognitive, and musical).Method Study with a baseline and two follow-ups (four and eight months). Participants were forty physically frail residents of four NHs in the Netherlands. Residents were interviewed about depressive symptoms (CES-D) and activities they conducted over the previous week. Three researchers independently rank ordered each activity on the degree to which it could be regarded as having physical, creative, social, cognitive, and musical components. Accounting for the rank score and the time the resident spent on that activity, residents were categorized per activity component into four levels: absent, low, medium, and high.Results Mixed models predicting depressive symptoms from individual activity components showed significant associations for the social and cognitive components. Compared with the lowest activity level, the analyses showed fewer depressive symptoms for all higher levels of the social and cognitive components. However, a mixed model adjusted for all activity components showed no unique effect of the cognitive component or other components, while the effects of the social component remained significant. The analyses did not show differences between the time points.Conclusion The results suggest that the effects of activities on depressive symptoms might be mainly explained by their social component. It is, thus, important to always stimulate social involvement and interaction when developing and applying depression interventions. However, intervention research is needed to confirm these findings.

Vooral bewoners met ernstige dementie en bewoners met geagiteerd en psychotisch gedrag lijken baat te hebben bij minder omgevingsprikkels. Bewoners zonder dementie en bewoners met depressief of apathisch gedrag kunnen juist negatieve gevolgen ondervinden van minder omgevingsprikkels.

Background: Although formal treatments like antidepressants and psychotherapy may effectively reduce depression in nursing home residents, side effects and poor treatment adherence are common. To improve depression care, it is important to also learn from informal strategies already used successfully in daily practice, alongside or in absence of formal treatment. For example, although not prescribed as formal treatment, a care provider may seat a resident with depression at a table near the window. This may have antidepressant effects due to extra day light or pleasant views from the window. Objectives: To identify, categorize, and prioritize informal antidepressant strategies for residents already used in daily practice as reported by residents themselves, their relatives, and professional caregivers. Method: In the first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies to prevent or improve depression that may be performed by residents themselves. In the second study, the same participants (N = 110) reported on strategies others involved in residents’ lives could perform. In a second round of both studies, participants rated the expected effectiveness (N = 54, N = 51 respectively) and feasibility (N = 50 for both studies) of the strategies mentioned. In addition, strategies for both studies were sorted based on similarity in meaning by experts. Results: Six clusters appeared for actions to be undertaken by residents themselves, and five clusters for actions by others. The results showed that, for strategies by residents, the clusters ‘Being socially connected’ and ‘Participating in activities’, and for strategies by others, the cluster ‘Offering personal attention’ stand out the most in terms of high expected effectiveness. The cluster with strategies executed by residents that stood out as the most feasible was ‘Having a healthy living environment’. The most feasible clusters performed by others were ‘Offering personal attention’, ‘Using positive treatment/approach’, and ‘Using or adapting the physical environment’. Conclusion: By using an innovative bottom-up participatory approach, this research shed light on various clusters of useful informal antidepressant strategies for daily practice. To test effectiveness and implementation, research is needed on these antidepressant strategies and their regular use in care.

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OBJECTIVES:From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners' involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff.METHODS:A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews.RESULTS:Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = -2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news.CONCLUSIONS:Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously.

Objectives To explore perceptions, experiences and expectations with respect to palliative care of patients with severe mental illness (SMI) and an incurable, life-limiting chronic illness. Methods Face-to-face semistructured interviews were conducted with 12 patients (10 of them living in a mental healthcare institution) with severe mental and physical health issues in the Netherlands. A semistructured interview guide was used to elicit perceptions of, experiences with and expectations regarding palliative care. Data were analysed using inductive content analysis. Results Analysis of the data revealed eight categories: perceptions on health and health issues, coping with illness and symptoms, experiences with and wishes for current healthcare, contact with relatives and coresidents, experiences with end of life of relatives and coresidents, willingness to discuss end of life and death, wishes and expectations regarding one’s own end of life and practical aspects relating to matters after death. These categories were clustered into two separate themes: current situation and anticipation of end of life. Interviewees with SMI appeared not accustomed to communicate about end-of-life issues, death and dying due to their life-threatening illness. They tended to discuss only their current situation and, after further exploration of the researcher, the terminal phase of life. They seemed not engaged in their future palliative care planning. Conclusions Findings of this study highlight inadequacies in advance care planning for patients with SMI. Results suggest using values, current and near wishes, and needs as a starting point for establishing a gradual discussion concerning goals and preferences for future medical and mental treatment and care.

P15. Depression is an undertreated problem in nursing home (NH) residents with dementia (RwD), associated with increased mortality and low quality of life. Our previous research on a multidisciplinary depression care program suggested that NH staff might change their behaviour towards a RwD alongside or in place of an official treatment after a depression has been diagnosed. A carer can act deliberately (intentionally) or intuitively (spontaneously, e.g. a spontaneous hug to comfort a sad RwD). Research on such informal Deliberate and Intuitive Antidepressant Strategies (DIAS) is lacking. We conducted a Group Concept Mapping to reveal potential DIAS that professional carers might use alongside or in place of an official treatment. We used an online package to combine qualitative and quantitative approaches for generating and structuring content. Individual coding schemes were aggregated across professional carers (N=15) to objectively reveal thematic clusters. First, participants provided their ideas on DIAS. Second, they sorted the strategies and rated them on feasibility and importance to reduce depression in RwD. The hierarchical cluster analysis revealed seven categories: Planned Activities (e.g. painting, petting animals); Physical Contact (e.g. holding hands); Physical Involvement (e.g. involvement in housekeeping activities); Family Input and Reminiscence (e.g. using familiar items in the residents’ room); Acknowledging Emotions (e.g. listening to the RwD); Empathetic and Structuring Actions of Carers (e.g. providing structure); and Pleasant and Stable Environment (e.g. pleasant odours in the living area). Surprisingly, carers rated Planned Activities as the least important and least feasible, while the category Pleasant and Stable Environment was rated as most important and Acknowledging Emotions as most feasible to reduce depression in RwD. It is necessary to repeat this study with a larger group of participants to seek confirmation of the DIAS categories. Further research is needed to explore which strategies are the most effective for reducing depression in RwD. Furthermore, more insight is needed to understand whether our results reflect the attitudes of NH staff that may affect their deliberate or intuitive actions.

Een groot deel van de bevolking voldoet niet aan de minimale hoeveelheid lichaamsbeweging die vanuit gezondheidsperspectief wenselijk is. Dit artikel presenteert onderzoek naar de invloed van autonomieondersteuning op motivatie om te bewegen. Deelnemers (N = 76) ontvingen een informatieve tekst over bewegen welke voorafgegaan werd met ofwel een autonomieondersteunende, ofwel een sturende instructie. Gevonden werd dat 1) autonomieondersteunende communicatie een negatief effect heeft op autonome motivatie, en 2) ongeacht het instructietype, het aanbieden van informatie over bewegen zowel intrinsieke als externe regulatie bevordert. Dit laatste kan ertoe leiden dat mensen meer gaan bewegen waardoor de kans op gezondheidsrisico’s afneemt.