Analysis of cybersickness in virtual nursing simulation: a German longitudinal study.

BACKGROUND: Innovative educational approaches such as simulation-based nursing education using virtual reality (VR) technologies provide new opportunities for nursing education. However, there is a lack of information on side effects, especially health-related side effects, of head-mounted displays (HMDs) on the human body when using VR devices for nursing simulation. This study aims to validate the German version of the Virtual Reality Sickness Questionnaire (VRSQ) and to evaluate its associations with sex and age, as reflected in the VRSQG scores (total score, oculomotor, and disorientation) over time. METHODS: A longitudinal-sectional study was conducted. In addition to the VRSQG (pre-, post-, and 20 min post-intervention), participants (all nursing students) completed data on personal characteristics. Participants completed a VR simulation of a blood draw. Confirmatory factor analysis (CFA) was used to evaluate whether the measured construct was consistent with the original. In addition to the validity, internal consistency was analyzed and generalized linear models (GLMs) were used for data analysis. RESULTS: A total of 38 nursing students (mean age 26.8 years; SD = 7.1, 79.0% female) participated. The mean time spent in the VR simulation was 21 min. All participants completed the entire simulation. The CFA indicates (CFI = 0.981, SRMR = 0.040) VRSQG structure is given. Internal consistency showed low values for the subdomain Oculomotor (Cronbach alpha 0.670). For Disorientation and the Total score values showed a sufficient internal consistency. GLMs showed significant between subject associations with age over time with VRSQG total score, oculomotor, and disorientation. Older nursing students start with higher VRSQG-Scores. Over time, an approximation occurs, so that all participants reach a similar level by the final measurement point. No associations were found between sex (male/female) and VRSQG scores. CONCLUSIONS: The VRSQG is a reliable and valid self-assessment for measuring cybersickness in VR based nursing simulations, with cybersickness symptoms positively associated with age. However, in depth-evaluation regarding age-associations with cybersickness should be done. As well as studies to explore additional associations and emphasizes the importance of establishing cut-off values to assess the clinical relevance of the scores.

[Status of the implementation of simulation-based education in Germany: A cross-sectional study]. / Stand der Umsetzung des simulationsbasierten Lehrens in Deutschland.

Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.

Facilitator competency rubric in nursing simulations: transcultural adaptation and validation of the German version.

BACKGROUND: Simulations are part of nursing education. To obtain good results, simulation facilitators need to be competent in simulation pedagogy. Part of this study was the transcultural adaptation and validation of the Facilitator Competency Rubric into German (FCRG) and the evaluation of the factors associated with higher competencies. METHOD: A written-standardized cross-sectional survey was conducted. N = 100 facilitators (mean age: 41.0 (9.8), female: 75.3%) participated. Test-re-test, confirmatory factor analysis (CFA), and ANOVAs were conducted to evaluate the reliability and validity of, and the factors associated with, FCRG. Intraclass correlation coefficient (ICC) values > .9 indicate excellent reliability. RESULTS: The FCRG achieved good intra-rater reliability (all ICC > .934). A moderate correlation (Spearman-rho .335, p < .001) with motivation indicates convergent validity. The CFA showed sufficient to good model fits (CFI = .983 and SRMR = .016). Basic simulation pedagogy training is associated with higher competencies (p = .036, b = 17.766). CONCLUSION: The FCRG is a suitable self-assessment tool for evaluating a facilitator's competence in nursing simulation.

Associations Between Older Adults' Loneliness and Acceptance of Socially Assistive Robots: A Cross-Sectional Study.

The use of socially assistive robots (SARs) to enable older adults (aged ≥65 years) to live independently for as long as possible has been researched for several years. Of particular interest is the way SARs can combat loneliness. A quantitative cross-sectional study was conducted with 61 older adults in living facilities in Berlin, Germany. Paper-based questionnaires were used to elicit experiences of loneliness and determine the level of acceptance of SARs. Mean score (39.3) of the loneliness scale was in the average range for this population. Mean score (56.1) of acceptance of SARs was on a moderate level. Regression analyses showed that loneliness did not influence the acceptance of SARs by older adults in the sample, which was contrary to findings in the literature. Further studies might generate more accurate data and accelerate the development of robots to make them more attractive for social purposes. [Journal of Gerontological Nursing, 49(4), 21-26.].

[Effort-Reward Imbalance, Ability to Work and the Desire for Career Exits: a Cross-sectional Study of Nurses]. / Gratifikationskrisen, Arbeitsfähigkeit und Wunsch nach beruflichen Veränderungen ­ eine Querschnittsstudie bei Pflegepersonen.

INTRODUCTION: Since the Sars-Cov-2 pandemic, the working conditions of professional caregivers have tougher. This has lead to an increased desire to leave the profession. Since thoughts of leaving are influenced by factors such as ability to work and the relationship between effort and reward, both should be recorded and examined in relation to the desire to leave the profession. METHODOLOGY: In a standardized, online-based cross-sectional study, nurses from all areas were asked about their ability to work (Work Ability Index: WAI), the ratio of effort and reward (Effort-Reward-Imbalance: ERI-Ratio) as well as their desire to either leave the job or to change employers. RESULTS: A total of 2,689 questionnaires returned by nurses (average 41.3 years old, 75.1% female) were evaluated. The WAI indicates an average working ability (37.9 (6.7)). Nurses put in more effort than they get rewarded for (ERI ratio 1.7 (0.5)). 38.3% of the nurses considered leaving their job several times a month or more frequently, 30.6% to change their employers. Predicting factors were WAI (OR 0.881, 95%-CI 0.866; 0.897 and 0.923, 95%-CI 0.908; 0.938) and ERI ratio (OR 4.076, 95%-CI 3.224; 5.149 and 4.203, 95%-CI 3.312; 5.334). CONCLUSION: The ability to work and, in particular, the perception of professional effort and the reward received becomes apparent as having an influence on the idea of leaving the profession. The present results show that the ERI is of particular importance. Accordingly, it is important to find out which reward factors have a positive effect on remaining in the profession. The proportion of nurses with an academic degree is higher than expected which might have influenced the results.

[Initial results of the evaluation of a digital rollator]. / Erste Ergebnisse der Evaluation eines digitalen Rollators.

BACKGROUND: Rollators are preferred to compensate physiological limitations and to maintain mobility in old age; however, environmental obstacles or limited perception of fall hazards can lead to fall events. OBJECTIVE: The present study evaluates an electronic box that is used to supplement conventional rollators with various technical assistance systems (e.g. call for help to contact persons, fall detection). The rollator equiped with the electronic box (DigiRoll) was tested for its suitability for everyday use during the pilot phase of the study, with the aim of further development. METHODS: In a qualitative design, the DigiRoll was tested in a pilot phase with 10 participants. Individuals were interviewed in focus groups and individual interviews. In addition, ethnographic observations were made. The data evaluation was carried out using qualitative content analysis. RESULTS: The test persons showed great interest in the development of the assistance systems to increase the feeling of safety. At the same time, the necessity of adapting the DigiRoll to individual needs became clear, depending on the living situation, the type of impairment and personal habits. CONCLUSION: The DigiRoll has the potential to provide sustainable support for people with reduced mobility by increasing the users' sense of safety. Other contextual factors such as access to suitable rollators and safe walkways cannot be influenced by the DigiRoll.

Services for homeless people in Germany during the COVID-19-pandemic: A descriptive study.

DESIGN: A cross-sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. SAMPLE: 135 of 244 identified service institutions took part in the evaluation. MEASUREMENTS: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. RESULTS: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. CONCLUSIONS: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in-depth investigation to improve this is necessary.

COVID-19-Pandemie in Berlin und Brandenburg - Eine Ist-Analyse in Krankenhäusern aus Sicht des Pflegemanagements.

COVID-19 pandemic in Berlin and Brandenburg - A hospital survey from nursing management perspective Abstract. Background: During the COVID-19 pandemic, it is unclear how hospitals in the federal states of Berlin and Brandenburg are structured with regard to structural adaptions, personnel situations, protective equipment and trainings. Therefore, the aim of the present study is to evaluate and compare the current status of all hospitals in both states. Methods: In April 2020, an online survey of all hospitals in Berlin and Brandenburg (n = 99) was carried out. Structural capacities, the personnel situation, protective equipment and training were investigated. Results: The hospitals (response rate: 31.3 %) have made all structural changes except for n = 1 facility. The majority of the failure rate is critically stated as 5 - 10 % before (58.6 %) and during the pandemic (51.5 %). The proportion with > 10 % default rate increases from 20.7 % to 31.0 %. 45.2 % of hospitals report that they rarely have shortage in protective clothing. Nurses at peripheral wards are often trained in handling with respiratory patients. The duration is in median 2 - 8 hours. No significant differences between Berlin and Brandenburg were found. Conclusions: At the time of the survey, the hospitals in Berlin and Brandenburg were well prepared for the challenges posed by the COVID-19 pandemic. In April 2020, the results indicate that hospitals are well prepared to ensure the health care provision.

Acceptability and Validity of the EQ-5D in Patients Living With Dementia.

OBJECTIVES: To assess the acceptability and validity of the 3 levels of the EQ-5D (EQ-5D-3L) compared with the Quality of Life in Alzheimer's Diseases (QoL-AD) in patients living with dementia. METHODS: The analysis was based on 560 dyads of persons with dementia and their caregivers of the multicenter observational study of dementia care networks in Germany (DemNet-D). Health-related quality of life was assessed by face-to-face interviews using the EQ-5D-3L (self-rating) and the QoL-AD (self- and proxy-rating). The number of missing values, the score ranges (observed vs possible range) and the floor and ceiling effects were used to assess the acceptability. We used one-way analyses of variance and multivariate linear regression models to evaluate the discriminative ability. The convergent validity was assessed using Spearman's correlation coefficient (rs) and multivariate regression models. RESULTS: The EQ-5D index had a higher response rate (89% vs 84%) and a comparable floor (>1%) but a higher ceiling effect (18% vs >1%) compared with the QoL-AD. Both measures can significantly differentiate between different stages of general health, instrumental activities of daily living, and depression. The EQ-5D index and the visual analog scale self-rating scores strongly correlated with the QoL-AD self-rating (rs = 0.644 and 0.553, respectively) but not with the proxy-rating score (rs = 0.314 and rs = 0.170, respectively), which was confirmed by multivariate regression analyses. CONCLUSION: The results satisfy acceptability, discriminative ability, and convergent validity for moderately cognitively and functionally impaired patients living with dementia. The EQ-5D-3L performed comparably with the QoL-AD, and could, therefore, be used in economic evaluations in dementia. The differences between self- and proxy-ratings should be evaluated and considered in the interpretation of health-related quality of life scores.

More staff = better quality of life for people with dementia? results of a secondary data analysis in German shared-housing arrangements.

BACKGROUND: Shared-housing arrangements (SHAs) in Germany are an alternative care arrangement for people with dementia. They are disconnected from traditional nursing homes and are often situated in ordinary apartment buildings. Community health care providers serve persons with dementia in SHAs, and there is no official regulation regarding the staff-resident ratio. The association between the staff-resident ratio and the quality of life (QoL) of persons with dementia has not yet been investigated in SHAs. METHOD: A cross-sectional study was performed in SHAs in Berlin, Germany, using ANCOVA models to analyse whether residents' QoL (QUALIDEM), as assessed by staff in SHAs, can be explained by the staff-resident ratio, adjusted for residents' sex, age, length of stay, challenging behaviour (CMAI), cognitive impairment (GDS) and level of care dependency according to the German statutory health care insurance. RESULTS: In this study, 58 SHAs with 396 residents (mean age 78.4 years, 69.4% female) participated. The staff-resident ratio was 0.2 and 0.6 for registered nurses and certified nursing assistants, respectively. Associations with QoL were found predominantly for challenging behaviour and cognitive impairment. The analysis showed that there was no significant effect of the total staff-resident ratio (p > 0.05) in explaining the variation in residents' QoL (total and subdomains). In general, the proportion of explained variance was weak (R2 <  0.216). CONCLUSIONS: The present study did not show a significant association between staffing and residents' QoL in SHAs. However, further investigation is required regarding the direct interaction between staff and residents. A main focus should be to educate users about the benefits and disadvantages of shared-housing arrangements.

How Does Utilization of Health Care Services Change in People with Dementia Served by Dementia Care Networks? Results of the Longitudinal, Observational DemNet-D-Study.

BACKGROUND: There is no common definition for the Dementia Care Network (DCN). They are heterogeneous and there is no general, longitudinal evidence for the effects of DCN. OBJECTIVE: We describe changes in utilization of health services by people served by dementia care networks in Germany and factors associated with those changes over time. METHODS: Primary data was assessed in 560 people with dementia (PwD) and their caregivers supported by DCN in Germany; sociodemographic and clinical variables, utilization of services; DCN were characterized according to governance. The design: observational study with face-to-face interviews at two time points over a period of one year. Data was assessed via semi-structured interviews at the participants' homes. RESULTS: Utilization of health services in this study is consistently higher than reported for the general population and does not significantly change over time. The strongest predictor of utilization of any service after one year was the use of this service at baseline (OR from 3.23 to 44.16). Higher activities of daily functioning increased the chances to utilize specialist physicians (OR = 1.32; 95% -CI: 1.08-1.63) or occupational therapy (OR = 1.24; 95% -CI: 1.02-1.50) significantly. Being a female decreased chances to utilize specialist physicians (OR = 0.57; 95% -CI: 0.37-0.87) and increased the chances to utilize no services (OR = 2.08; 95% -CI: 1.29-3.33). CONCLUSION: While health care acknowledges the importance and benefits of dementia care networks (i.e., in Germany, the results were considered in new German legislation (SGB XI)), further research is needed to define this kind of service delivery to facilitate comparison as well as promote evidence-based implementation.

Quality of life in persons with dementia using regional dementia care network services in Germany: a one-year follow-up study.

BACKGROUND: The majority of individuals with dementia live in the community; thus, regional dementia care networks are becoming increasingly more important for the provision of care. To date, four different types of dementia care networks have been identified in Germany (stakeholder, organisation, hybrid, mission); however, the effect on the quality of life of persons with dementia using such network services has not yet been examined. Moreover, the possible differences in the effect on the quality of life among the four types of dementia care networks have not been investigated. Therefore, the aim of the present study was to describe the changes over time in the quality of life of persons with dementia, assessing the association with the different types of dementia care networks. METHODS: Within the DemNet-D study, face-to-face interviews with persons with dementia and their primary caregivers were conducted to collect data of typical outcome parameters, such as quality of life (Quality of Life Alzheimers Disease: QoL-AD), sociodemographic data, social index (Scheuch-Winkler), depression (Geriatric Depression Scale: GDS), challenging behaviour (Cohen-Mansfield Agitation Inventory: CMAI), capacities of daily living (Instrumental Activity of Daily Living: IADL), impairment due to dementia (FAST), and caregiver burden. In addition to these parameters, the differences in quality of life scores among the four types of dementia care networks were analysed using multi-level analysis. RESULTS: In total, 407 persons with dementia (79.1 years; 60.1% female) and their caregivers were included in the analysis. Over 75% of the persons with dementia showed moderate to (very) severe impairments of dementia and at least one challenging behaviour. At baseline, 60.6% had a low social index. Quality of life was stable over one-year on a level slightly above average (baseline 29.1; follow-up 28.7). Multi-level analyses (p <  0.001; R2 = 0.183) show that persons with dementia with higher QoL-AD scores at baseline were associated with a decline at follow-up. No significant differences among the types of dementia care networks were found. CONCLUSION: Users of dementia care network services showed a stable QoL-AD score over time at a level slightly above average, indicating no decrease or worsening over time as expected. Therefore, dementia care network services can be considered as a beneficial model of care in terms of the quality of life of persons with dementia, regardless of their special organisational type.

Regional dementia care networks in Germany: changes in caregiver burden at one-year follow-up and associated factors.

BACKGROUND: Recently, regional dementia care networks (DCNs) have been established in Germany to provide timely support for persons with dementia (PwDs) and their families. There is a lack of research in this setting. This study was conducted to describe the burden experienced by informal caregivers over the course of one year when utilizing a DCN and the factors affecting potential changes in caregiver burden during that time. METHODS: The study was part of the DemNet-D project, a multi-center observational study of DCNs in Germany. Standardized questionnaires were administered during face-to-face interviews at baseline and at a one-year follow-up with PwDs and their informal caregivers who used a DCN. Based on qualitative data, four DCN governance types were identified and used in a multivariate analysis of burden categories. RESULTS: A total of 389 PwD-informal caregiver dyads completed the follow-up assessment. At follow-up, the dyads reported significantly lower scores for burden in relation to practical care tasks, conflicts of need, and role conflicts. This change was associated with the PwD-caregiver relationship, the caregiver's gender and health status, and the PwD's socio-economic status. The governance structure of the DCNs was associated with change in one of the four burden categories. CONCLUSIONS: Our data provide the first indications that different governance structures of DCNs seem to be similarly well suited to support network users and might contribute to reducing caregiver burden. However, further studies set in DCNs examining factors that mediate changes in burden are needed to draw strong conclusions regarding the effectiveness of DCNs. Gender differences and the PwD-caregiver relationship should be considered by DCN stakeholders when developing support structures.

[Users of regional dementia care networks in Germany : First results of the evaluation study DemNet-D]. / Nutzer und Nutzerinnen regionaler Demenznetzwerke in Deutschland : Erste Ergebnisse der Evaluationsstudie DemNet-D.

BACKGROUND: In Germany a growing number of community-based support services for people with dementia (PwD) and their caregivers are organized in dementia care networks (DCN), which provide a single point of entry to social facilities and offer personal care and support. OBJECTIVE: The aim of this study was to describe the health, functional and social characteristics of PwDs enrolled in DCNs throughout Germany because no data are currently available on this aspect. MATERIAL AND METHODS: As part of the multi-center, multi-professional 12-month follow-up study DemNet-D, data on functional and psychological health, sociodemographic and dementia-specific factors and social inclusion were collected in standardized interviews with PwDs living at home. RESULTS: A total of 560 PwDs with an average age of 80 years were enrolled in the study. Of the participants approximately 50 % had Alzheimer's dementia and more than 75 % demonstrated at least a challenging form of behavior. More than half of the participants lived together with a partner or relative. Instrumental activities of daily living (IADLs) were very limited; nevertheless, one in five PwDs showed no long-term care-dependency level. The participants reported having a relatively low feeling of loneliness and a high feeling of social inclusion, depending on the severity of dementia. CONCLUSION: This is one of the very first studies generating data on PwDs who receive domiciliary care within DCNs in Germany. The results suggest that the regional DCNs make a successful contribution to overcoming the interface problem and can, therefore, contribute to a more stable care situation and better social integration of PwDs.

How do people with dementia utilise primary care physicians and specialists within dementia networks? Results of the Dementia Networks in Germany (DemNet-D) study.

Outpatient dementia healthcare is predominantly fragmented, and dementia networks (DNs) represent an integrated care concept to overcome this problem. Little is known about the patients of these networks with regard to utilisation of physicians and associated factors. We interviewed 560 caregivers of people with dementia in 13 different DNs in Germany in 2013 and assessed socio-demographics, clinical data and physician utilisation. Networks were categorised in predominantly medical DNs and community-oriented DNs. Descriptive and multivariate statistical models were used to identify associated factors between DNs and users' data. Overall, the users of networks received high rates of physician care; 93% of the sample stated at least one contact with a primary care physician within the last 6 months, and 74% had been treated by a specialist (neurology/psychiatry physician). Only 5% of the sample had no contact with a physician in the 6 months preceding the interview. Females showed a lower odds for physician specialist consultations (OR = 0.641). Users of medical DNs receive greater specialist consultations overall (OR = 8.370). Compared to the German general population and people with dementia in other settings, users of DNs receive physician care more regularly, especially with regard to the consultations of neurologist/psychiatrists. Therefore, DNs seem to perform a supportive role within the integration of physician healthcare. More research is needed on the appropriate relationship between the needs of the people with dementia and utilisation behaviour.

[Regional Dementia Care Networks in Germany--results from the DemNet-D-Study regarding the quality of life of their users]. / Regionale Demenznetzwerke in Deutschland. Ergebnisse der DemNet-D-Studie zur Lebensqualität der Nutzer(innen).

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.

Family visits in shared-housing arrangements for residents with dementia--a cross-sectional study on the impact on residents' quality of life.

BACKGROUND: 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). METHOD: A cross-sectional study including all SHA in Berlin/Germany was performed. Main parameters of interest were residents' QoL (QUALIDEM) and frequencies of family visits within the SHA. Besides descriptive analyses we used logistic regression and ANCOVA to analyze the data. RESULTS: 58 SHA with 396 residents (78.4 years, 69.4% female) participated in the study. Older (OR: 1.034; 95% CI: 1.005; 1.064) and female residents (OR: 2.006; 95% CI: 1.018; 3.950) got more often visited by family members. An active participation of family members in SHA contributes on average to a better QoL in terms of social relationship and social isolation (all ANCOVA p < 0.005). A decreased QoL was found for people without family visits compared to those without family members. CONCLUSIONS: The involvement of family members in SHA is common but on a similar level compared to other care arrangements. Staff should convince available family members to visit PwD, in order to improve residents QoL. However, the response rate in the present study was about 13%, which may limit the results.

Nutritional status of care-dependent people with dementia in shared-housing arrangements--a one-year follow-up.

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.

Quality of life ratings in dementia care--a cross-sectional study to identify factors associated with proxy-ratings.

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.