Knowledge management in dementia care networks: a qualitative analysis of successful information and support strategies for people with dementia living at home and their family caregivers.

OBJECTIVES: Stakeholders involved in community dementia support services often work on their own and without coordination with other services. These circumstances can result in a lack of information and support for people with dementia and their family caregivers at home. To increase the coordination between existing support services, so-called 'Dementia Care Networks' (DCNs) have been established. Most of the tasks that are performed in DCNs are based on communication strategies. Therefore, knowledge management (KM) is a key process in these networks. However, few studies have focused on this topic. This study attempted to evaluate KM strategies in DCNs across Germany as part of the DemNet-D study. STUDY DESIGN: A qualitative interview study design was used. METHODS: Qualitative data were collected during single and group interviews with key persons associated with thirteen DCNs. Interviews were audiotaped and transcribed, and a structured content analysis was conducted. The framework for the analysis was derived from a KM model. RESULTS: Information dissemination strategies for people with dementia and their informal caregivers based on actively established contacts appear to be more successful than passive strategies. General practitioners often play a key role as external gatekeepers in initiating contact between a network and a person affected by dementia. In this context, case managers can help integrate external stakeholders, such as general practitioners or pharmacists, into DCNs using different KM strategies. The systematic development of common objectives under an agency-neutral leadership seems to be an important aspect of successful KM within DCNs. CONCLUSIONS: The findings reported here can help DCNs optimize their KM strategies for generating tailored information and support services for people with dementia living at home and their family caregivers. In particular, the identified potential knowledge distribution barriers and facilitators will be of practical use to DCN stakeholders.

Influence of living situation on vulnerable elderly: focus on nutritional status.

OBJECTIVES: We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements). DESIGN: For this secondary analysis, a cross-sectional study was performed. SETTING: For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study. PARTICIPANTS: The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs. MEASUREMENTS: Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE). RESULTS: Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting. CONCLUSION: Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings.

[Housing Project 'Living Independently with Intensive Support (WmI)': The Scientific Evaluation]. / Modellprojekt "Wohnen mit Intensivbetreuung (WmI)": Die wissenschaftliche Evaluation.

BACKGROUND: In Germany, people with multiple severe disabilities caused by brain injuries, are predominantly cared for in permanent residential living facilities. In 2009 the Fürst Donnersmarck Foundation (FDSt) launched a new housing project - supported living accommodations (SLA) - for this group of people. Residents from a permanent residential living facility (Fürst Donnersmarck House, FDH) are offered the opportunity to move into 2 newly built SLA with a 24/7 individual support of a social pedagogic staffs as well as nursing care. The aim of the study is to compare the changes of residents' social and health related outcomes in the SLA group as compared to the group remaining in stationary care. METHODS: In a prospective longitudinal study (2009-2011) residents of the FDH are surveyed using standardized self- and proxy-rating instruments. Times of measurement are shortly before moving into the SLA (baseline, t1) and at follow-up after 6, 12 and 18 months after relocation (t2-t4). Additionally to residents' socio-demographic data, health outcomes including ADL functioning (EBI), quality of life (WHOQoL-Bref, EQ-5D), need of assistance (HMB-W), social inclusion/perceived disability (WHODAS II), anxiety and depression (HADS) and social contacts were evaluated. RESULTS: 40 residents could be included into the study, 29 of them moved into 2 SLA. The underlying neurological causes of the handicap were mainly sequelae of acuired damage of the central nervous system during adult age. Residents are on average 46.2 years old and predominantly male (65%). During the study the perceived dis-ability (WHODAS II) increased statistically significant but we could not show differences between groups (p > 0.05). Changes in functional and cognitive everyday abilities, fear, depression and quality of life (WHOQoL-Bref, EQ-5D) could not be shown (p > 0.05). The perceived sense of -mastery (Pearlin Mastery Scale) increased statistically significant and showed more positive developments by tendency in SLA. Everyday activities in SLA increased to a large extent. CONCLUSION: Some positive but no overall effects of moving into SLA can be shown. It is remarkable that the serious changes of living conditions do not lead to less QoL or more anxiety in this vulnerable group of people but resulted in increasing external contacts and greater mobility. Social pedagogic support offers the residents the chance to bear a more self-determined life and to participate actively in new social networks.

[Shared-housing arrangements for care-dependent persons. Legal frameworks and numbers in Germany]. / Ambulant betreute Wohngemeinschaften für Menschen mit Pflegebedarf. Versorgungsangebote und gesetzliche Rahmenbedingungen in Deutschland.

BACKGROUND: Since the mid-1990s, supervised shared-housing arrangements (SHA; assisted living facilities) have developed as a specific type of small-scale living facility for elderly care-dependent persons with dementia in Germany, offering services different than those in residential care. Neither a uniform and binding definition of SHA nor reliable estimates concerning numbers currently exist. Since January 2013, SHA have been promoted nationwide in Germany by law. MATERIALS AND METHODS: In a cross-sectional study funded by the National Association of Statutory Health Insurance Funds numbers as well as legal and financial frameworks of SHA in Germany were surveyed. RESULTS: As of February 2013, almost all German "Bundesländer" (federal states) have created special legal regulations for supervised SHA. The results of the present study show at least 1,420 SHA with 10,590 care places for adults in Germany. The regional distribution differs greatly. CONCLUSION: Supervised SHA are increasingly an established care offer among the various long-term care offers in Germany. Different care and support offers help ensure individualized and high quality care for elderly care-dependent persons with dementia.

[Shared-housing arrangements for care-dependent people in Germany. A literature overview of structures, outcomes and quality management]. / Ambulant betreute Wohngemeinschaften für pflegebedürftige Menschen in Deutschland. Eine Literaturübersicht zu Strukturen, Versorgungsoutcomes und Qualitätsmangagement.

A main factor for the development of shared-housing arrangements (SHA) was the wish of more self-determination in old age. Since January 2013 SHA is government-funded through the "Pflege-Neuausrichtungs-Gesetz" (PNG). Yet, an overview of the situation of SHA in Germany is not available. Therefore, a systematic literature search (databases CareLit, CINAHL, GeroLit, PubMed) was conducted in order to identify publications regarding resident- and care-specific characteristics, resident-related health outcomes and setting-specific quality management systems. The currently available knowledge in these fields is not exhaustive and further research is needed. The results indicate that care in SHA is not more efficient regarding residents' quality of life than in institutional care settings. Valid studies regarding the quality of care provision in SHA and conceptual basics concerning quality assessment are widely lacking. Thus, the goal of expanding SHA within the framework of the PNG has to be accompanied by in-depth health services research.

[Schizophrenia in children and adolescents. An investigation of 305 consecutive inpatient treatment cases]. / Schizophrene Erkrankungen im Jugendalter. Eine versorgungsepidemiologische Untersuchung an 305 konsekutiven stationären Behandlungsfällen.

This paper analyses sociodemographic, clinical, and descriptive data and data concerning cooperation in a sample of 305 consecutively treated inpatients with schizophrenia. The data of this group were compared with those from two other diagnostic groups (affective disorders, n=318; conduct disorders, n=982) who were treated as inpatients at the same time. Schizophrenic patients were significantly older at admittance (mean 17.6 years) than patients in the other two diagnostic groups (affective disorders 15.9 years, conduct disorders 13.1 years). On average, the inpatient treatment stay was longer in schizophrenic patients (by approximately 1 month) than in both of the other groups, and dropout was less frequent (5% vs 9% in affective disorders and 11% in conduct disorders). The treatment of the three patient groups was based on a multidimensional program following a model including five components: individual psychotherapy, family-centered measures, functional therapies, sociotherapeutic measures, and medication.

[Cohort study of respiratory tract diseases and lung function in school children in southwest Germany. 2. Regional influences on respiratory tract diseases in Mannheim and the Freiburg area]. / Kohortenstudie zu Atemwegserkrankungen und Lungenfunktion bei Schulkindern in Südwestdeutschland. Teil 2: Regionale Einflüsse auf Atemwegserkrankungen in Mannheim und im Raum Freiburg.

A prospective cohort study on 8124 schoolchildren aged 8 to 16 was conducted during the years 1977, 1979 and 1985 in Mannheim and two regions near Freiburg (Breisgau and the Black Forest). The objective of this part of the analysis was to investigate the regional differences in respiratory symptoms due to air pollution. Results are presented of 5726 children who had been living in those regions for at least five years at the times of interview. We have analysed 11 respiratory symptoms and two scores, measuring the tendency to infectious and asthmatic diseases, by logistic regression. Comparing the children living 1977 in Mannheim or the Breisgau to those living in the Black Forest the Relative Risks (Odds Ratios) of respiratory symptoms are in the range of 1.26-1.85 and 1.21-1.96 respectively. The results for the year 1979 are similar. In 1985 the regional effect has become smaller and no difference can be observed between Breisgau and the Black Forest. The infect score comprises bronchitis, inflamed throat with fever and sinusitis. The Relative Risk of an increased score decreases from 1.67 in 1977 to 1.65 in 1979 and 1.35 in 1985 in Mannheim and from 1.40 to 1.28 and 1.05 respectively in the Breisgau. The results of asthma and asthma symptoms are not homogeneous. In the Breisgau 1977 and 1979 the Relative Risk of an increased asthma score is slightly higher compared to the Black Forest. Allergies of the skin are reported more often in Mannheim than in the other areas. The Relative Risks of infectious respiratory symptoms and diseases agree spatially and temporarily well with the pattern of SO2 concentration. SO2 may be interpreted as an indicator for air pollution by power plants, industry and domestic heating.