Zusammenfassung. Hintergrund: Regionale Demenznetzwerke (DNW) nehmen in der ambulanten Versorgung von Menschen mit Demenz (MmD) eine zunehmend wichtigere Stellung ein. Allerdings ist bislang unklar, wie die Lebensqualität von MmD in einem solchen Versorgungsmodell ist. Ziel ist es, die Lebensqualität von Nutzer/innen von DNW – auch hinsichtlich regionaler Unterschiede – zu untersuchen. Methodik: Im Rahmen der DemNet-D-Studie wurden MmD und deren Bezugsperson hinsichtlich typischer Versorgungsparameter (Lebensqualität: QoL-AD, Depression: GDS, herausfordernde Verhaltensweisen: CMAI, Alltagsfähigkeiten: IADL, Belastung der Bezugsperson: BIZA-D) befragt. Weiterhin wurden im Rahmen von Mixed-Model-Analysen auch regionale Unterschiede analysiert. Ergebnisse: Es liegen Daten für 560 MmD (79,7 Jahre; 57,0 % weiblich) sowie deren Bezugspersonen vor. Sowohl in der Selbst- als auch in der Fremdeinschätzung liegt die Lebensqualität auf moderatem Niveau. Die Analysen zeigen suffiziente Erklärungen der Lebensqualität (selbst: p < 0,001, R2 = 0,493; fremd: p < 0,001, R2 = 0,406). Höhere Lebensqualität liegt vor, wenn MmD und die Bezugsperson in einer Wohnung leben sowie bei besseren Alltagsfähigkeiten der MmD. Regionale (städtisch vs. ländlich) Unterschiede konnten nicht festgestellt werden. Schlussfolgerungen: Die Lebensqualität von MmD in der ambulanten Versorgung liegt auf vergleichbarem Niveau wie in anderen Studien zur häuslichen Versorgung. Weitere Untersuchungen dieser neuen Versorgungsstruktur, vor allem hinsichtlich unterschiedlicher Netzwerktypen, sind erforderlich.

Um Menschen mit Demenz (MmD) passgenaue Versorgungsangebote zu ermöglichen und Schnittstellenproblematiken zu überwinden, rücken kooperative, multiprofessionelle Versorgungsstrukturen wie Demenznetzwerke (DNW) in den Fokus der deutschen Versorgungslandschaft.

BACKGROUND:Regional dementia care networks become more and more important in the care for community-dwelling persons with dementia (PwD). However, the quality of life of PwD, served by dementia care networks, has not been investigated yet. It also remains unclear if there are differences between urban and rural dementia care networks. This study therefore aims at investigating the quality of life of PwD using this care model, also regarding possible regional differences. METHODS:Within the DemNet-D-Study, PwD and their primary caregivers were interviewed using typical outcome parameters (quality of life: QoL-AD, depression: GDS, challenging behaviour: CMAI, capacities of daily living: IADL, caregiver burden: BIZA-D). In addition to these parameters, regional differences were analysed using multi-level-analysis. RESULTS:In total, 560 PwD (79.7 years; 57.0 % female) and their caregivers participated in the study. Both self- and proxy-rated quality of life is on a moderate level. The analysis shows a sufficient explanation of the quality of life. (self: p<0.001, R2=0.493; proxy: p<0.001, R2=0.406). Higher quality of life was found for PwD living together with their care givers and for those PwD with higher capacities of daily living. Regional (urban vs. rural) differences could not be found. CONCLUSION:The quality of life of community-dwelling PwD using regional dementia care networks is comparable to those in other studies of outpatient dementia care. Further investigation should be carried out regarding different types of dementia care networks.

Shared-housing arrangements (SHA) are a German type of small-scale living arrangements for people with dementia (PwD). The involvement of family members is one core domain of SHA. But it has not been investigated yet, what are factors associated with family visits and if family involvement within SHA contributes to better residents’ quality of life (QoL).

BACKGROUND:Malnutrition in the elderly is an important nursing challenge. Persons with dementia disease are often affected by malnutrition. During recent years, shared-housing arrangements (SHA) for older care-dependent people, frequently with dementia disease, have evolved in Germany. SHA can be an alternative to traditional residential care in nursing homes. The prevalence of malnutrition in SHA is compared to the prevalence in community dwellings and lower than the prevalence of malnutrition in nursing homes. There are no scientific data about the development of the nutritional status of older care-dependent people in SHA over one year. The aim of this study is to describe the nutritional status of care-dependent people with dementia disease living in SHA and to investigate changes over a period of one year.METHOD:A longitudinal study with a one-year follow-up was performed. Standardised interviews with nurses were conducted concerning nutritional status (Mini Nutritional Assessment--MNA), cognitive capacities (Mini Mental State Examination--MMSE), activities of daily living (Extended Barthel-Index--EBI) and socio-demographic characteristics. Nutritional data were available for 45 residents at baseline and 36 residents at follow-up.RESULTS:At baseline, 45 residents with an average age of 78.4 years living in SHA in the state of Berlin, Germany, were included in the study. Predominantly, residents were female (73.3%) and diagnosed with dementia (88.9%), with a moderate to severe cognitive impairment (MMSE: 10.8) and low daily living abilities (EBI: 33.7). Most residents (80.6%) have a risk of malnutrition regarding the MNA. The average MNA score did decline slightly within one year (t0 = 20.8 vs. t1 = 19.7).CONCLUSION:Regular screenings for malnutrition using validated standardised assessments, which are easy to apply, should be implemented in SHA to avoid nutritional and health-related problems arising from malnutrition. Flexible structures for care, as in SHA, can facilitate coping with nutritional problems.

BACKGROUND:Dementia networks in Germany constitute a specialised setting for integrated dementia care and have shown benefits on relevant outcomes, including those of drug treatment. National guidelines recommend treatment with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) or the N-Methyl-D-Aspartate antagonist (memantine) to reduce cognitive symptoms. However, prescription rates are lower than 30 % in general practises. This study aims to describe antidementia drug treatment and the factors that are associated with the treatment in different dementia networks across Germany.METHODS:We have analysed the socio-demographic, clinical and utilisation data from 560 patients with dementia (PWD), as well as data from their caregivers, in 13 selected dementia networks in Germany. The patients and caregivers were interviewed in their homes or in the network facilities. Multiple logistic regression models were fitted to evaluate the socio-demographic and clinical factors associated with the utilisation of antidementia drug treatment in the various networks.RESULTS:In all of the networks in the study, 52 % of the participants received an antidementia drug treatment. Factors associated with the utilisation of the antidementia drug treatment were: formal diagnosis (OR = 16.81, p < 0.001), association with a physician in the network (OR = 3.69, p < 0.001), higher number of comorbidities (OR = 0.88, p = 0.039), living alone (OR = 0.51, p = 0.032) and higher age (OR = 2.97, p = 0.002).CONCLUSION:Medical treatment of PWD with antidementia drugs in dementia networks in Germany is more frequent than in primary and nursing home care settings. Our findings also suggest that participants with a formal diagnosis and a physician in the network have increased rates of receiving antidementia drug treatments. These findings suggest that dementia networks focusing on medical treatment should support diagnostic procedures and incorporate physician specialists.

EinleitungDie Anzahl der Pflegebedürftigen steigt bei gleichzeitig abnehmendem familiärem Unterstützungspotenzial an. Die Frage nach Versorgungserfordernissen gewinnt an Bedeutung, alternative Wohn- und Betreuungsformen nehmen zahlenmäßig deutlich zu. Gleichzeitig fehlen bundesweit gültige Vorgaben zu Qualitätsvorgaben und Qualitätssicherungskonzepten sowie einheitliche Begriffsdefinitionen zur klaren Abgrenzung zwischen den verschiedenen alternativen Wohnformen. Wünschenswert wären wissenschaftlich abgesicherte Qualitäts(weiter)entwicklungskonzepte für alternative Wohnformen.

Aim: The aim of study was to evaluate setting-specific quality indicators (QIs) for shared-housing arrangements (SHA) regarding effects of a guided quality development process on resident's quality of life (QoL).Background: SHA are a specific German kind of small-scale living facilities for care-dependent persons with dementia. SHA are disconnected from residential facilities and served by community care services.Method: In a longitudinal cluster-randomised design 104 residents of 34 SHA were surveyed for 1 year; the intervention group took part in a quality development process. QIs, physical and psychological health outcomes including QoL were surveyed.Results: During the 1 year follow-up, analyses show a positive trend regarding QI-outcomes in the intervention group, but no statistically significant differences could be proved regarding QoL.Conclusions: Setting-sensitive QIs are absolutely essential to measure quality of care in multi-professional settings like SHA. Further research as well as longer study intervals is essential. (C) 2014 Elsevier Inc. All rights reserved.

OBJECTIVE:Quality of life (QoL) is one major outcome parameter in the care for people with dementia (PwD); however, their assessment is lacking a gold standard. The purpose of this study was to evaluate potential factors associated with nurse-rated quality of life of PwD in nursing homes in Berlin, Germany.METHOD:An explorative cross-sectional study was performed in five nursing homes to evaluate QoL. Nurses rated the QoL for all residents with dementia by completing two different standardised assessments (ADRQL, QUALIDEM). Potential associated factors were evaluated concerning resident and nurse related factors. A fixed-effects models of analysis of co-variance (ANCOVA) was used to analyse effects of assumed associated factors of the major outcome parameters ADRQL and QUALIDEM. Associated factors were severity of dementia (GDS), challenging behaviour (CMAI), and other characteristics. Regarding the nurses, burnout (MBI), satisfaction with life (SWLS), attitude (ADQ) and empathy toward residents (JSPE), as well as circumstances of the ratings and days worked in advance of the ratings were assessed.RESULTS:In total, 133 PwD and 88 nurses were included. Overall, the ratings show moderate to high QoL in every subscale independent of the instrument used. Assumed confounders relevantly influenced 14 out of 17 ratings. Predominantly, residents' challenging behaviour, nurses' burnout and satisfaction with life as well as the circumstances of the ratings are significant and clinically relevant associated factors.CONCLUSION:Assessing QoL of PwD is acknowledged as a central component of health care and health care research. In later stages of dementia, proxy-reported information obtained from quality of life questionnaires is and will continue to be essential in this research. However, methodological issues that underline this research - matters of measurement and instrument validity - must receive more attention. Associated factors in proxy-ratings have to be routinely assessed in order to get more valid and comparable estimates.

Malnutrition and weight loss are special challenges in the care of older people particularly with dementia. In Germany, shared-housing arrangements (SHA) for older care-dependent people evolved in the last years. SHA are an alternative to traditional nursing homes. Despite of the increase of SHA in number it remains unclear if this setting is especially beneficial in terms of (mal-)nutrition. Therefore the nutritional status of older people with and without dementia living in SHA and traditional nursing homes will be compared. From 2010 to 2011 data was collected in various SHA in Berlin and in a nursing home in Schkeuditz/Saxony using standardized face-to-face interviews with nurses. In addition to socio-demographic data the nutritional status using the Mini Nutritional Assessment (MNA) and the cognitive capacities usingthe Mini Mental State Examination (MMSE) were examined. In the secondary data analysis, data from 129 residents (60 residents from 29 SHA and 69 from a nursing home) were included in the analysis. The residents of both settings were mostly female (76.7%) and on average 80.4 years old and with a moderate to severe cognitive decline (MMSE: 13.2). The average MNA score of residents from both settings is 19.7, indicating a risk for malnutrition. Residents of SHA have a significantly higher (and therefore better) MNA score (21.2) on average than residents in the nursing home (18.3; t-Test p<0.001). The present study shows that residents in SHA show a better nutritional status than residents in the nursing home even when taking into account differences concerning age, gender, care dependency, a medical diagnosis of dementia and the MMSE. Further studies should evaluate the concept of food intake in both settings and evaluate differences.

Background: Shared-housing arrangements (SHA) are a specific German kind of small-scale living facilities for care-dependent persons with dementia. SHA are disconnected from residential facilities and served by community care services. Purpose: The aim of the study was to evaluate the long-term progression of physical and psychosocial outcomes of people with dementia living in SHA in Berlin/Germany and to investigate if a setting-specific quality development shows a positive impact.