BackgroundPeople with Alzheimer's disease or other types of dementia may experience stigma, which can influence their quality of life. Valid measurement instruments of public dementia-related stigma are lacking.ObjectiveWe aimed to translate and validate the 16-item Dementia Public Stigma Scale (DePSS) in Dutch.MethodsA survey was conducted among a nationally representative sample of the Dutch population (n = 524). A subset (n = 145) completed the DePSS again after one month. Following validation guidelines, floor and ceiling effects, structural validity, internal consistency, and test-retest reliability were assessed. We used open-ended questions to investigate content validity. The responses provided insights into respondents' perceptions of dementia and their interactions with people with dementia.ResultsForward-backward translation required minor adaptations. No floor or ceiling effects were observed. Confirmatory factor analysis indicated an acceptable fit (CFI = 0.988, RMSEA = 0.073, SRMR = 0.065). Internal consistency (α = 0.82, ω = 0.79) and test-retest reliability (ICC = 0.82, 95%CI 0.76-0.89) were good, with no significant differences between test and retest scores (t(144) = 0.135, p = .893). Responses to open-ended questions were largely clustered under DePSS items, indicating good content validity. Additional themes were disconnection from present reality; feeling pity for people with dementia; and manifestations of negative emotions.ConclusionsThe Dutch DePSS demonstrated good psychometric properties. Together with other versions, these findings enhance the generalizability of the DePSS across diverse populations. Further validation and application of the DePSS will help deepen our understanding of dementia-related stigma and may also inform stigma reduction interventions.

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.

Background: Pets can contribute to the wellbeing of people receiving home care but may also present practical challenges for clients, family caregivers, and professional caregivers. The Dutch PET@home Toolkit was developed to support stakeholders in addressing pet-related issues in home care. Differences in care practices and support infrastructure mean that the toolkit cannot simply be transferred to other national contexts. Objective: To adapt the Dutch PET@home Toolkit for use in the United Kingdom. Design: Participatory adaptation study using qualitative interviews and focus groups. Setting(s): Interviews and focus groups were conducted online with participants based in the United Kingdom. Participants: Twelve participants with backgrounds in social care, veterinary practice, animal welfare, and related fields contributed through individual interviews, focus groups, and/or member checking. Methods: The Dutch PET@home materials were translated into English and reviewed with UK-based stakeholders. Information relevant to adaptation was identified through a pragmatic and iterative analysis of interviews and focus groups. Suggested adaptations were incorporated into the materials and reviewed within the research team. Revised materials were subsequently returned to participants for member checking and review of UK English. Results: The adaptation resulted in the SAFEpet@home Toolkit. Key changes included greater emphasis on collaboration with veterinary practices, replacement of the Five Freedoms with the Five Domains Model, increased diversity in visual materials and represented companion animal species, and inclusion of UK-specific organisations and support resources. Other adaptations addressed practical issues such as planning for multiple pets and veterinary decision-making. Conclusions: The Dutch PET@home Toolkit was adapted to reflect UK care practices, animal welfare guidance, and support infrastructure while retaining the core principles of the original toolkit. The findings suggest that a participatory adaptation process is a feasible approach for adapting toolkits to different national contexts.

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.

BackgroundSocial isolation and feelings of loneliness are very prevalent in people with neurodegenerative diseases and are associated with a lower quality of life and other negative outcomes. These problems were increased during the COVID-19 pandemic resulting in initiatives to address social isolation. Given the potential benefits of nature-based and animal-assisted intervention strategies (NATAIS), it is crucial to further investigate if and how these strategies might minimize negative effects of social isolation and feelings of loneliness in this population. Therefore, the aim of this project was to develop a research agenda for NATAIS in people with neurodegenerative diseases, especially during challenging times, such as pandemics.MethodsThis article outlines the process and results of a group concept mapping procedure aimed at developing a research agenda based on a logic model. In total, 19 work group members participated through a combination of in-person and online group meetings. Additionally, face-to-face group sessions were held at two international scientific conferences, during which feedback was solicited from 12 experts in the field of NATAIS and psychogeriatrics.ResultsThe group concept mapping procedure resulted in 14 clusters describing various future research topics, which were further refined and detailed during group discussions. The remaining eleven clusters, encompassing important research themes within the field of NATAIS, were organized into a logic model and summarized into the research agenda. The overarching cluster 'ethical issues, possible risk factors, and their solutions' was considered the most relevant during times of increased social isolation, such as during a pandemic, along with the necessity for more accessible NATAIS.ConclusionsThis project resulted in a research agenda, directing future research and fostering collaboration between practitioners and researchers in the field of NATAIS. Such an enhanced partnership between science and practice has the potential to significantly contribute to the well-being of people with neurodegenerative diseases, in their daily lives and also during pandemics.

This cross-sectional study examined the psychometric properties of the Brief Sexual Attitudes Scale (BSAS) in Dutch heterosexual (N = 1129) and non-heterosexual (N = 200) samples. The study confirmed the previously reported factor structure and assessed the scale's reliability and construct validity. To evaluate construct validity, participants also completed the Sexual Opinion Survey, Sexual Disgust Questionnaire, International Index of Erectile Functioning or Female Sexual Function Index, Sexual Distress Scale, and Hospital Anxiety and Depression Scale. Confirmatory Factor Analyses supported a 17-item model with satisfactory fit indices. The four subscales-birth control, communion, and instrumentality (3 items each), and permissiveness (8 items)-were confirmed. Factorial invariance across gender (male vs. female) and sexual orientation (heterosexual vs. non-heterosexual) was established. The BSAS demonstrated adequate internal consistency and test-retest reliability over a four-week interval. Construct validity was supported by strong evidence for convergent validity with related measures of sexual opinions and sexual disgust, as well as for discriminant validity with respect to conceptually distinct constructs, including sexual functioning, sexual distress, and symptoms of anxiety and depression. While replication is needed, the BSAS appears suitable for use in research. Further investigation is recommended to determine its appropriateness in clinical contexts.

The Sexual Self-Consciousness Scale (SSCS) is an instrument for assessing dispositional propensities for self-consciousness experienced in a sexual context, with wide application in both clinical and research settings. The objective of the current study was to test some psychometric characteristics of the Portuguese version of the SSCS using a convenience sample of 210 men and 210 women. Participants completed a sociodemographic questionnaire and the Portuguese version of the SSCS. A subsample of 87 participants was assessed at a second time point after a 2-week period for measuring test-retest reliability of the instrument. Confirmatory factor analysis identified two factors and replicated the structure of the original instrument. Measurement invariance was confirmed for men and women with overall index scores indicating a good fit in all models. Reliability analyses indicated that the factors possessed both satisfactory internal consistency and stability over time. The Portuguese version of the SSCS was shown to be a useful and adequate instrument to assess dispositional propensities for self-consciousness in sexual situations within the Portuguese-speaking population.

Abstract Background Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents’ factors, and (2) components specific of interventions. Methods A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents’ factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity). Results Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without. Conclusions By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents’ factors and choose interventions and their components accordingly.

ObjectivesTo evaluate the effectiveness of the SPAN-intervention, a psychosocial intervention aiming at improving a sense of usefulness and engaging in meaningful activities, for community-dwelling people living with young-onset dementia (YOD) and their family caregivers.MethodsA cluster-randomized controlled trial with two parallel groups (SPAN-intervention vs. care as usual) with assessments at baseline and five-month follow-up was performed. Sixty-one persons living with YOD and their family caregivers were included (SPAN-intervention group: n = 35; care as usual group: n = 26). Outcomes included, for the person living with YOD, empowerment (operationalized by self-management abilities using the SMAS-30; primary outcome), quality of life, neuropsychiatric symptoms, disability, apathy; and, for the family caregiver, quality of life, emotional distress, sense of competence. Data were analyzed using linear mixed models.ResultsWe found no statistically significant effects of the SPAN-intervention on empowerment, nor on the secondary outcome measures for persons living with YOD or their family caregivers.ConclusionAlthough the SPAN-intervention may provide concrete opportunities to engage in activities and stimulate reciprocity, such as meaningful social activities, this study did not demonstrate intervention effects. Additional qualitative evaluations may provide more insight into the implementation process and experiences of people living with YOD and their family caregivers.This trial was registered at ClinicalTrials.gov (NCT02937883).ConclusionAlthough the SPAN-intervention may provide concrete opportunities to engage in activities and stimulate reciprocity, such as meaningful social activities, this study did not demonstrate intervention effects. Additional qualitative evaluations may provide more insight into the implementation process and experiences of people living with YOD and their family caregivers.This trial was registered at ClinicalTrials.gov (NCT02937883).

ObjectivesTo develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA).MethodsA theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6).ResultsSABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program's materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating.ConclusionsSABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.

The Dutch PET@home Toolkit was developed to mitigate challenges, foster conversations, and support planning concerning pets in long-term care at home. This process evaluation study aimed to evaluate the practical application of the toolkit on four topics: (1) satisfaction; (2) relevance; (3) feasibility; and (4) integration of the PET@home Toolkit materials in home care. Outcomes may be used to improve the toolkit materials to better align with the long-term care at home setting. Accounting for data saturation, professional caregivers (N = 6), clients (N = 2), and family caregivers (N = 2) who used toolkit materials participated in semi-structured interviews. Interviews were analyzed by two researchers in ATLAS.ti using an inductive-iterative approach. The researchers reached a consensus on themes and clustering within interview topics. This led to the identification of the following themes pertaining to each interview topic: satisfaction (general impression, suggestions for improvement); relevance (awareness, planning, pet-related aspects in practice, impact on healthcare quality); feasibility (healthcare practice, competence, quantity); and implementation (digitalization, task owner, piloting, timing). Several improvements were made to toolkit materials, such as providing clearer instructions for clients in the information booklet. Participants acknowledged the toolkit could lead to better planning while mitigating potential challenges concerning pets, which may lead to longer-lasting relationships between clients and their pets.

OBJECTIVES:In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients' relatives (HAP) with the present-time perspective of nursing staff (HAP-t). DESIGN:Cross-sectional. SETTING:Dutch gerontopsychiatric nursing home (GP-NH) units. PARTICIPANTS:Totally, 142 GP-NH residents with MPM (excluding dementia). MEASUREMENTS:NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0-10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (-10-10). RESULTS:78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: "disorderly" (30.3%), "unpredictable/impulsive" (29.1%) and "vulnerable" (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6-2.9, p = 0.002). After RT correction, the traits "vulnerable", "perfectionist" and "unpredictable/impulsive" behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6-1.7, p < 0.001; +2.1, 95% CI 1.3-2.8, p < 0.001; +0.6, 95% CI 0.1-1.1, p = 0.013), while "rigid" behavior scored lower (-0.7, 95% CI -1.3 to -0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58. CONCLUSIONS:Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.

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.

Achtergrond: Huisdieren zijn belangrijk in het leven van thuiswonende ouderen en van degenen die langdurige thuiszorg (LTZ) ontvangen. Het doel van dit project was om de betekenis van huisdieren voor thuiswonende ouderen te verkennen en te onderzoeken of deze ook van toepassing zijn op LTZ-cliënten. Daarnaast exploreerden we mogelijke huisdiergerelateerde uitdagingen en de invloed van huisdierbezit op zorgrelaties in de LTZ. Methoden: Het project startte met een systematische kwalitatieve literatuur review gevolgd door een studie met de Consensual Qualitative Research (CQR) methode en een onlinevragenlijst om de resultaten van de review in de LTZ te toetsen. LTZ-cliënten, mantelzorgers en professionele zorgverleners namen deel aan de CQR-studie en vragenlijst. De vragenlijst bevatte daarnaast open vragen over mogelijke huisdiergerelateerde uitdagingen en hun invloed op zorgrelaties in de LTZ. Resultaten: De review bevatte vijftien artikelen die achtentwintig rollen gerelateerd aan de betekenis van huisdieren beschreven, onderverdeeld in zeven categorieën. De uitkomsten van de CQR-studie en vragenlijst toonden dat huisdieren een vergelijkbare betekenis hebben voor thuiswonende ouderen en LTZ-cliënten. Deelnemers rapporteerden mogelijke uitdagingen en zowel positieve als negatieve effecten van huisdieren op zorgrelaties. Conclusies: Huisdieren hebben een vergelijkbare betekenis voor thuiswonende ouderen en LTZ-cliënten. Bovendien ervaren LTZ-cliënten mogelijke specifieke huisdiergerelateerde uitdagingen en kunnen huisdieren zorgrelaties beïnvloeden. Daarom is het noodzakelijk om rekening te houden met huisdieren in de LTZ.

Objective Western countries face ageing populations and increasing numbers of older adults receiving long-term care at home (home care). Approximately 50% of households in Western countries own pets, and while pets impact the health and wellbeing of their owners, most healthcare organisations do not account for the role of pets in the lives of their clients. Due to the lack of research in older adults receiving home care that own pets, this study aimed to review previous qualitative research about the role and significance of pets for older adults in general.Method PubMed and PsycINFO were systematically searched with variations on (MeSH) terms for older adults (mean age 65 years and older), pets, and qualitative study designs. Iterative-inductive thematic analyses were performed in ATLAS.ti.Results We included fifteen studies and extracted twenty-eight themes within seven categories: Relational Aspects, Reflection and Meaning, Emotional Aspects, Aspects of Caregiving, Physical Health, Social Aspects, and Bidirectional Behaviour. Older adults reported not only on positive aspects of pet ownership such as the emotional support their pets provided but also on negative aspects such as postponing personal medical treatment.Conclusion Older adults perceived pets as important for their health and wellbeing. This implies that care workers may be able to improve home care by accounting for the role of pets of older adults receiving home care. Based on our findings, we suggest that community healthcare organisations develop guidelines and tools for care workers to improve care at home for clients with pets.

Background Although apathy is common in people with dementia and has profound negative effects, it is rarely diagnosed nor specifically treated in nursing homes. The aim of this study is to explore experiences in identifying and managing apathy from the perspectives of people with dementia and apathy (PwA), family caregivers (FCs) and professional caregivers (PCs). Methods Descriptive qualitative study with purposive sampling, comprising eleven semi-structured in-depth interviews with PwA, FCs or PCs and focus groups with twelve PCs in Dutch nursing homes. Seventeen additional in-depth interviews with caregivers were held, after signals of increasing apathy during the first Covid-19 lockdown. Using an inductive approach, data was analysed thematically to explore the experiences in identifying and managing apathy from the perspective of different stakeholders. Results Three themes were identified: 1) the challenge to appraise signals, 2) the perceived impact on well-being, 3) applied strategies to manage apathy. Although participants described apathy in line with diagnostic criteria, they were unfamiliar with the term apathy and had difficulties in appraising signals of apathy. Also, the perceived impact of apathy varied per stakeholder. PwA had difficulties reflecting on their internal state. FCs and PCs experienced apathy as challenging when it reduced the well-being of PwA or when they themselves experienced ambiguity, frustration, insecurity, disappointment or turning away. Dealing with apathy required applying specific strategies that included stimulating meaningful contact, adjusting one’s expectations, and appreciating little successes. Conclusions When addressing apathy in nursing homes, it is important to consider that a) all stakeholders experience that appraising signals of apathy is challenging; b) apathy negatively influences the well-being of people with dementia and especially their FCs and PCs; and c) FCs and PCs can successfully, albeit temporarily, manage apathy by using specific strategies.