Engagement in purposeful activities and social interactions amongst persons with dementia in special care units compared to traditional nursing homes: An observational study.

BACKGROUND: Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household-like design and individualised stimuli is studied. AIM: To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions. METHODS: We conducted an observational study as part of a theory-driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty-three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments. RESULTS: Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening. CONCLUSION: The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.

Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation.

BACKGROUND: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. METHODS: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. RESULTS: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. CONCLUSIONS: The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept. TRIAL REGISTRATION: DRKS00011513 .

[Prevention of malnutrition in institutional long-term care with the DNQP "nutrition management" expert standard]. / Prävention von Mangelernährung in der stationären Pflege am Beispiel des DNQP-Expertenstandards "Ernährungsmanagement".

Malnutrition is a big challenge in long-term care. There are a variety of reasons for developing malnutrition; they can be disease-related as well as psychosocial. However, the consequences can be seriously health threatening. Therefore, effective prevention is necessary and is an important part of nursing.The following article deals with the prevention of malnutrition as a nursing task, particularly in institutional long-term care. This is discussed with the evidence-based expert standard on quality criteria for securing oral nutritional intake by the German Network for Quality Development in Nursing (DNQP). Systematic screening is important and after finding signs of insufficient intake, a detailed search for reasons must follow. This should be initiated by nurses and often ends in a multiprofessional task. Nurses have to detect dysphagia and a resident's ability to chew. People with dementia are at increased risk of malnutrition due to the disease-related declining ability to eat enough. If oral food intake can no longer be secured, artificial nutrition can be recommended based on a clear indication for a limited period of time. In the terminal phase, nutrition can be agonizing. Therefore, the decision about artificial nutrition should be carefully discussed in a case conference.A first health-economic evaluation of the standard in 11 nursing homes shows a positive impact on the residents' health. Securing oral nutrition intake is an important part of person-centered care.

[Development of a program theory as a basis for the evaluation of a dementia special care unit]. / Entwicklung einer Programmtheorie als Grundlage für die Evaluation einer Demenzstation.

Background: An existing dementia special care unit should be evaluated. In order to build a sound foundation of the evaluation a deep theoretical understanding of the implemented intervention is needed, which has not been explicated yet. One possibility to achieve this is the development of a program theory. Aim: The aim is to present a method to develop a program theory for the existing living and care concept of the dementia special care unit, which is used in a larger project to evaluate the concept theory-drivenly. Method: The evaluation is embedded in the framework of van Belle et al. (2010) and an action model and a change model (Chen, 2015) is created. For the specification of the change model the contribution analysis (Mayne, 2011) is applied. Data were collected in workshops with the developers and the nurses of the dementia special care unit and a literature research concerning interventions and outcomes was carried out. The results were synthesized in a consens workshop. Results: The action model describes the interventions of the dementia special care unit, the implementers, the organization and the context. The change model compromises the mechanisms through which interventions achieve outcomes. Conclusions: The results of the program theory can be employed to choose data collection methods and instruments for the evaluation. On the basis of the results of the evaluation the program theory can be refined and adapted.

Development and evaluation of the content validity, practicability and feasibility of the Innovative dementia-oriented Assessment system for challenging behaviour in residents with dementia.

BACKGROUND: One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers' management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes. METHODS: The development process and evaluation of the content validity were based on Lynn's methodology (1998). A literature review (steps 1 + 2) provided the theoretical framework for the instrument and for item formation. Ten experts (step 3) evaluated the first version of the instrument (the Innovative dementia-oriented Assessment (IdA®)) regarding its relevance, clarity, meaningfulness and completeness; content validity indices at the scale-level (S-CVI) and item-level (I-CVI) were calculated. Health care workers (step 4) evaluated the second version in a workshop. Finally, the instrument was introduced to 17 units in 11 nursing homes in a field study (step 5), and 60 care staff members assessed its practicability and feasibility. RESULTS: The IdA® used the need-driven dementia-compromised behaviour (NDB) model as a theoretical framework. The literature review and expert-based panel supported the content validity of the IdA®. At the item level, 77% of the ratings had a CVI greater than or equal to 0.78. The majority of the question-ratings (84%, n = 154) and answer-ratings (69%, n = 122) showed valid results, with none below 0.50. The health care workers confirmed the understandability, completeness and plausibility of the IdA®. Steps 3 and 4 led to further item clarification. The carers in the study considered the instrument helpful for reflecting challenging behaviour and beneficial for the care of residents with dementia. Negative ratings referred to the time required and the lack of effect on residents´ behaviour. CONCLUSIONS: There was strong evidence supporting the content validity of the IdA®. Despite the substantial length and time requirement, the instrument was considered helpful for analysing challenging behaviour. Thus, further research on the psychometric qualities, implementation aspects and effectiveness of the IdA® in understanding challenging behaviour is needed.

Implementing Dementia Care Mapping to develop person-centred care: results of a process evaluation within the Leben-QD II trial.

AIMS AND OBJECTIVES: To evaluate Dementia Care Mapping implementation in nursing homes. BACKGROUND: Dementia Care Mapping, an internationally applied method for supporting and enhancing person-centred care for people with dementia, must be successfully implemented into care practice for its effective use. Various factors influence the implementation of complex interventions such as Dementia Care Mapping; few studies have examined the specific factors influencing Dementia Care Mapping implementation. DESIGN: A convergent parallel mixed-methods design embedded in a quasi-experimental trial was used to assess Dementia Care Mapping implementation success and influential factors. METHODS: From 2011-2013, nine nursing units in nine different nursing homes implemented either Dementia Care Mapping (n = 6) or a periodic quality of life measurement using the dementia-specific instrument QUALIDEM (n = 3). Diverse data (interviews, n = 27; questionnaires, n = 112; resident records, n = 81; and process documents) were collected. Each data set was separately analysed and then merged to comprehensively portray the implementation process. RESULTS: Four nursing units implemented the particular intervention without deviating from the preplanned intervention. Translating Dementia Care Mapping results into practice was challenging. Necessary organisational preconditions for Dementia Care Mapping implementation included well-functioning networks, a dementia-friendly culture and flexible organisational structures. Involved individuals' positive attitudes towards Dementia Care Mapping also facilitated implementation. Precisely planning the intervention and its implementation, recruiting champions who supported Dementia Care Mapping implementation and having well-qualified, experienced project coordinators were essential to the implementation process. CONCLUSIONS: For successful Dementia Care Mapping implementation, it must be embedded in a systematic implementation strategy considering the specific setting. Organisational preconditions may need to be developed before Dementia Care Mapping implementation. Necessary steps may include team building, developing and realising a person-centred care-based mission statement or educating staff regarding general dementia care. The implementation strategy may include attracting and involving individuals on different hierarchical levels in Dementia Care Mapping implementation and supporting staff to translate Dementia Care Mapping results into practice. RELEVANCE TO CLINICAL PRACTICE: The identified facilitating factors can guide Dementia Care Mapping implementation strategy development.

Construct validity and internal consistency of the neuropsychiatric inventory - nursing home (NPI-NH) in German nursing homes.

BACKGROUND: The Neuropsychiatric Inventory (NPI) is one of the most popular and frequently used instruments for assessing so-called challenging behavior in individuals with dementia in research practice. However, no information is available regarding the factor structure of the German version of the Neuropsychiatric Inventory - Nursing Home (NPI-NH). The aim of this study was to evaluate the factor structure (an aspect of construct validity) and internal consistency of the NPI-NH for two different stages of dementia severity in a large German nursing home population. METHODS: A total of 784 residents with dementia from 40 nursing homes in three studies was included in a secondary data analysis. Principal component analysis (PCA) using an orthogonal rotational procedure (with varimax rotation) was used to evaluate the factor structure of the NPI. Cronbach's α was used to assess the stability of the scale. RESULTS: The factors agitation & restless behavior, psychosis, and mood were identified (with factor loading > 0.4 explaining 50% of the variance). The factors showed a moderate internal consistency of 0.55 and 0.68 (Cronbach's α). CONCLUSIONS: The results show the acceptable factor structure of the NPI for a German population in nursing homes and confirm the results of studies from other countries. The three identified factors appear to be robust over the various stages of dementia severity. The results also support the hypothesis that the NPI-NH can be subdivided into multiple domains.

Item distribution, internal consistency and inter-rater reliability of the German version of the QUALIDEM for people with mild to severe and very severe dementia.

BACKGROUND: The QUALIDEM is a dementia-specific Quality of life (Qol) instrument that is recommended for longitudinal studies and advanced stages of dementia. Our study aimed to develop a user guide for the German version of the QUALIDEM and to determine the item distribution, internal consistency and inter-rater reliability (IRR) of the German QUALIDEM. METHODS: A user guide was developed based on cognitive interviews with ten professional caregivers and a focus group with six professional caregivers. The item distribution, internal consistency and IRR were evaluated through a field test including n = 55 (mild to severe dementia) and n = 36 (very severe dementia) residents from nine nursing homes. Individuals with dementia were assessed four times by blinded proxy raters. RESULTS: A user guide with instructions for the application of the QUALIDEM and definitions and examples for each item was created. Based on the single-measure intra-class correlation coefficient (ICC for absolute agreement), we observed strong IRR for nearly all of the QUALIDEM subscales, with ICCs of at least 0.79. A lower ICC (ICC = 0.64) was only obtained for people with very severe dementia on the 'negative affect' subscale. CONCLUSIONS: The IRR improved based on the application of the QUALIDEM user guide developed in this study. We demonstrated a sufficient IRR for all subscales of the German version of the QUALIDEM, with the exception of the 'negative affect' subscale in the subsample of people with very severe dementia. The item distribution and internal consistency results highlight the need to develop new informative items for some subscales.

Dementia care mapping: effects on residents' quality of life and challenging behavior in German nursing homes. A quasi-experimental trial.

BACKGROUND: Person-centered care (PCC) is a widely recognized concept in dementia research and care. Dementia Care Mapping (DCM) is a method for implementing PCC. Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia (PwD). We aimed to investigate the effectiveness of DCM with regard to quality of life (QoL) and challenging behavior in PwD in nursing homes (NHs). METHODS: Leben-QD II is an 18-month, three-armed, pragmatic quasi-experimental trial. The sample of PwD was divided into three groups with three living units per group: (A) DCM applied since 2009, (B) DCM newly introduced during the study, and (C) a control intervention based on a regular and standardized QoL rating. The primary outcome was QoL measured with the Quality of Life-Alzheimer's Disease (QoL-AD) proxy, and the secondary outcomes were QoL (measured with QUALIDEM) and challenging behavior (measured with the Neuropsychiatric Inventory Nursing Home version, NPI-NH). RESULTS: There were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes. At baseline, the estimated least square means of the QoL-AD proxy for groups A, B, and C were 32.54 (confidence interval, hereafter CI: 29.36-35.72), 33.62 (CI: 30.55-36.68), and 30.50 (CI: 27.47-33.52), respectively. The DCM groups A (31.32; CI: 28.15-34.48) and B (27.60; CI: 24.51-30.69) exhibited a reduction in QoL values, whereas group C exhibited an increase (32.54; CI: 29.44-35.64) after T2. CONCLUSIONS: DCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

[Admission and discharge of people with dementia- Communication from the perspective of respite care experts]. / Aufnahme und Entlassung von Menschen mit Demenz - Kommunikation aus Sicht von Experten der Kurzzeitpflege.

BACKGROUND: There is a lack of information regarding the structures and processes of communication between home and respite care at admission and discharge of people with dementia (PwD}. Considering the background,it was aimed to reconstruct information exchange between home and respite care of PwD and to identify factors which affect the quality of communication structure and processes. METHODS: Semi-structured guided telephone interviews with 16 experts out of 15 respite care facilities were conducted. A structured content analysis and a process-mapping were performed. RESULTS: Core procedures of admission and discharge of PwD were identified. There were differences and overlaps between the institutions. The differences were related to the point of time and the frequency of intake inter-"views, the checks of information completeness and the provision of information.The institutions had in common that no further coordinative steps were planned after discharge. Aneed for action was identified regarding the coordination of care and the performance of handover evaluations. CONCLUSION: A timely provision of information for respite care is crucial fo rPwD. The coordination of all stakeholders,the assignment of responsibilities in communication, and easing the burden of informal caregivers is a requirement for care continuation. Across sectorial case-management, a standard of care transition, and the evaluation of hand overs is recommended.

Which characteristics of nursing home residents influence differences in malnutrition prevalence? An international comparison of The Netherlands, Germany and Austria.

Prevalence rates of malnutrition vary considerably internationally, partly due to differences in measurement methodology and instruments. In the present study, the same measurement methodology and instruments were used in The Netherlands, Germany and Austria. The aim of the present study was to investigate whether resident characteristics influence possible differences in malnutrition prevalence between countries. The study followed a cross-sectional, multi-centre design that measured malnutrition in nursing home residents from The Netherlands, Germany and Austria. Resident data were gathered using a standardised questionnaire. Malnutrition was operationalised using BMI, unintentional weight loss and nutritional intake. Data were analysed using an association model. The prevalence rates of malnutrition in The Netherlands, Germany and Austria were 18·3, 20·1 and 22·5 %, respectively. The multivariate generalised estimating equation (GEE) logistic regression analysis showed that sex, age, care dependency, the mean number of diseases and some specific diseases were influencing factors for whether the resident was malnourished or not. The OR of malnutrition in the three countries declined after including the influencing factors resulting from the multivariate GEE analysis. The present study reveals that differences in the prevalence rates of malnutrition in nursing homes in The Netherlands, Germany and Austria are influenced by different resident characteristics. Since other country-related factors could also play an important role in influencing differences in the prevalence rates of malnutrition between the countries (structural and process factors of malnutrition care policy). We recommend the investigation of these factors in future studies.

Measuring the quality of life in mild to very severe dementia: testing the inter-rater and intra-rater reliability of the German version of the QUALIDEM.

BACKGROUND: Quality of life (Qol) is an increasingly used outcome measure in dementia research. The QUALIDEM is a dementia-specific and proxy-rated Qol instrument. We aimed to determine the inter-rater and intra-rater reliability in residents with dementia in German nursing homes. METHODS: The QUALIDEM consists of nine subscales that were applied to a sample of 108 people with mild to severe dementia and six consecutive subscales that were applied to a sample of 53 people with very severe dementia. The proxy raters were 49 registered nurses and nursing assistants. Inter-rater and intra-rater reliability scores were calculated on the subscale and item level. RESULTS: None of the QUALIDEM subscales showed strong inter-rater reliability based on the single-measure Intra-Class Correlation Coefficient (ICC) for absolute agreement ≥ 0.70. Based on the average-measure ICC for four raters, eight subscales for people with mild to severe dementia (care relationship, positive affect, negative affect, restless tense behavior, social relations, social isolation, feeling at home and having something to do) and five subscales for very severe dementia (care relationship, negative affect, restless tense behavior, social relations and social isolation) yielded a strong inter-rater agreement (ICC: 0.72-0.86). All of the QUALIDEM subscales, regardless of dementia severity, showed strong intra-rater agreement. The ICC values ranged between 0.70 and 0.79 for people with mild to severe dementia and between 0.75 and 0.87 for people with very severe dementia. CONCLUSIONS: This study demonstrated insufficient inter-rater reliability and sufficient intra-rater reliability for all subscales of both versions of the German QUALIDEM. The degree of inter-rater reliability can be improved by collaborative Qol rating by more than one nurse. The development of a measurement manual with accurate item definitions and a standardized education program for proxy raters is recommended.

The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes.

BACKGROUND: The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability. METHOD: Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs. RESULTS: 58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability. DISCUSSION: The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.

[Variability in nursing workload within Swiss Diagnosis Related Groups]. / Variabilität des Pflegeaufwands in SwissDRG-Fallgruppen.

Nursing care inputs represent one of the major cost components in the Swiss Diagnosis Related Group (DRG) structure. High and low nursing workloads in individual cases are supposed to balance out via the DRG group. Research results indicating possible problems in this area cannot be reliably extrapolated to SwissDRG. An analysis of nursing workload figures with DRG indicators was carried out in order to decide whether there is a need to develop SwissDRG classification criteria that are specific to nursing care. The case groups were determined with SwissDRG 0.1, and nursing workload with LEP Nursing 2. Robust statistical methods were used. The evaluation of classification accuracy was carried out with R2 as the measurement of variance reduction and the coefficient of homogeneity (CH). To ensure reliable conclusions, statistical tests with bootstrapping methods were performed. The sample included 213 groups with a total of 73930 cases from ten hospitals. The DRG classification was seen to have limited explanatory power for variability in nursing workload inputs, both for all cases (R2 = 0.16) and for inliers (R2 = 0.32). Nursing workload homogeneity was statistically significant unsatisfactory (CH < 0.67) in 123 groups, including 24 groups in which it was significant defective (CH < 0.60). Therefore, there is a high risk of high and low nursing workloads not balancing out in these groups, and, as a result, of financial resources being wrongly allocated. The development of nursing-care-specific SwissDRG classification criteria for improved homogeneity and variance reduction is therefore indicated.

[ Low-threshold support services for people with dementia from the family carers' viewpoint]. / Niedrigschwellige Betreuungsangebote für Menschen mit Demenz aus Sicht pflegender Angehöriger.

Low-threshold support services are one possibility to relieve family carers with an hourly care for people with dementia. The aim of the study is to invest aspects of low-thresholdness (accessibility, flexibility, reachability, cheapness) with regards to content and to organisation. In an explorative cross-sectional study we collected the estimation according to low-threshold support services of family carers of people with dementia using those services in two regions of North-Rhine-Westphalia (Germany). The analysis was descriptive. The results show, that the 53 family carers estimate the aspects with regards to content mainly with focus on the well-being of the people with dementia as crucial, meanwhile the organisational aspects and the low-thresholdness were less important. Carers' burden was no object. For the family carers and the decision to utilise a low-threshold support service it seems to be import to have a transparent description of the care with a focus on the needs and well-being of the person with dementia.

[Satisfaction with the quality of care in nursing homes--the nurses' perspective]. / Zufriedenheit mit der Qualität der Pflege in stationären Altenpflegeeinrichtungen aus Sicht der Pflegenden.

BACKGROUND: In Germany, the number of residents in Nursing Homes (NH) has increased in recent years, residents become older, increasingly multimorbid and suffer more from dementia. In parallel demands concerning the quality of care in NH have increased. The vivid poltical and public debate about quality of care, however, widely disregards the perception of nurses. The aim of this study is to investigate the nurses' satisfaction with the quality of care in their NH and potential psychological consequences. METHODS: Secondary questionnaire data from 1489 nurses in 88 NH of the German 3Q-study (www.3q-studie.de) were used from the 2011 investigation. Questions regarding satisfaction enquire satsifaction in five nursing work domains. Descriptive analyses as well Chi2-tests were performed. RESULTS: The majority of nurses were satisfied in the subdomain "overall quality of care" and "physical care" (80% each). 67% were satisfied with "the quality of care for residents with dementia" and 64% with "end-of-life care". Only 56% of the nurses were satisfied with "mental care". If nurses were unsatisfied with the quality of care, this was mostly perceived as a psychological stressor. Subgroup analysis showed a pattern for four of the five domains: dissatisfied nurses were older, better qualified, worked more than 25 hours per week and worked in larger NH. No such pattern was found for "quality of care for residents with dementia". CONCLUSIONS: Nurses' satisfaction with the quality of care has shown to be a relevant work factor and potential stressor deserving more scientific and clinical attention. For NH it could constitute a core indicator for internal quality management as well as for human resource management. Research in work, health and economy in NH should also consider this factor.

Scalability and internal consistency of the German version of the dementia-specific quality of life instrument QUALIDEM in nursing homes - a secondary data analysis.

BACKGROUND: Quality of life (Qol) is a widely selected outcome in intervention studies. The QUALIDEM is a dementia-specific Qol-instrument from The Netherlands. The aim of this study is to evaluate the scalability and internal consistency of the German version of the QUALIDEM. METHODS: This secondary data analysis is based on a total sample of 634 residents with dementia from 43 nursing homes. The QUALIDEM consists of nine subscales that were applied to a subsample of 378 people with mild to severe dementia and six consecutive subscales that were applied to a subsample of 256 people with very severe dementia. Scalability, internal consistency and distribution scores were calculated for each predefined subscale using the Mokken scale analysis. RESULTS: In people with mild to severe dementia, seven subscales, care relationship, positive affect, negative affect, restless tense behavior, positive self-image, social relations and feeling at home, were scalable (0.31 ≤ H ≤ 0.65) and internally consistent (Rho ≥ 0.62). The subscales social isolation (H = 0.28) and having something to do (H = 0.18) were not scalable and exhibited insufficient reliability scores (Rho ≤ 0.53). For people with very severe dementia, five subscales, care relationship, positive affect, restless tense behavior, negative affect and social relations, were scalable (0.33 ≤ H ≤ 0.65), but only the first three of these subscales showed acceptable internal consistency (Rho 0.59 - 0.86). The subscale social isolation was not scalable (H = 0.20) and exhibited poor internal consistency (Rho = 0.42). CONCLUSIONS: The results show an acceptable scalability and internal consistency for seven QUALIDEM subscales for people with mild to severe dementia and three subscales for people with very severe dementia. The subscales having something to do (mild to severe dementia), negative affect (very severe dementia), social relations (very severe dementia) and social isolation (both versions) produced unsatisfactory results and require revision.

The effects of dementia care mapping on nursing home residents' quality of life and staff attitudes: design of the quasi-experimental study Leben-QD II.

BACKGROUND: The main objective of care for people with dementia is the maintenance and promotion of quality of life (Qol). Most of the residents in nursing homes have challenging behaviors that strongly affect their Qol. Person-centered care (PCC) is an approach that aims to achieve the best possible Qol and to reduce challenging behaviors. Dementia Care Mapping (DCM) is a method of implementing PCC that has been used in Germany for several years. However, there are no data on the effectiveness of DCM or the challenges of implementation of DCM in German nursing homes. METHODS/DESIGN: In this quasi-experimental non-randomized cluster-controlled study, the effects of DCM will be compared to 2 comparison groups. 9 nursing homes will take part: 3 will implement DCM, 3 will implement a comparison intervention using an alternative Qol assessment, and 3 have already implemented DCM. The main effect outcomes are Qol, challenging behaviors, staff attitudes toward dementia, job satisfaction and burnout of caregivers. These outcomes will be measured on 3 data points. Different quantitative and qualitative data sources will be collected through the course of the study to investigate the degree of implementation as well as facilitators of and barriers to the implementation process. DISCUSSION: This study will provide new information about the effectiveness of DCM and the implementation process of DCM in German nursing homes. The study results will provide important information to guide the national discussion about the improvement of dementia-specific Qol, quality of care in nursing homes and allocation of resources. In addition, the study results will provide information for decision-making and implementation of complex psychosocial interventions such as DCM. The findings will also be important for the design of a subsequent randomized controlled trial (e.g. appropriateness of outcomes and measurements, inclusion criteria for participating nursing homes) and the development of a successful implementation strategy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN43916381.

Longitudinal evaluation of dementia care in German nursing homes: the "DemenzMonitor" study protocol.

BACKGROUND: In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents' behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. METHODS/DESIGN: The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. DISCUSSION: The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents' outcome measurements, making it possible to evaluate different aspects and concepts of care.