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ALOIS / Cochrane Dementia and Cognitive Improvement Group / Oxford [UK] : Medical Sciences Office, University of Oxford (2010)
€ 0,00
Languages : English (eng)
Descriptors: Indexation
Databases, Bibliographic ; Databases, Clinical Trials ; Dementia ; Intervention Studies ; Randomized Controlled Trials
Classification
W20.55.C5 - Clinical trialsKeywords: Cochrane Abstract: ALOIS was created and is maintained by the Cochrane Dementia and Cognitive Improvement Group. Uniquely, ALOIS is study-based: multiple references to the same trial are grouped together. ALOIS covers all randomised controlled trials of interventions:
* for people with dementia
* for people with cognitive impairment
* for the improvement of, or prevention of decline in, cognitive function in healthy people.
It was created in 2008 thanks to a grant from the Alzheimer's Association. It is a free open-access resource, available to anyone with an internet connection.Contents note: There are currently around 4000 studies on ALOIS (April 2010).
At present (April 2010) there are around 800 records on ALOIS that have a "record in process" status.Link for e-copy: http://www.medicine.ox.ac.uk/alois/ Format of e-copy: Dynamic Webpage Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=1951 Assessment and support of decisional capacity in persons with dementia or mental health problems / Imgard Vinck / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2022)
ISSN : D/2021/10.273/55 : € 0,00
Languages : English (eng)
Descriptors: Classification
W 85 Patients. Attitude and compliance. Satisfaction
Indexation
2018-11 ; Decision Making ; Decision Making, Shared ; Dementia ; Mental Competency ; Patient Rights ; R349Contents note: 1 INTRODUCTION 13 -- 2 SCOPE OF THE STUDY 15 -- 3 RESEARCH QUESTIONS 17 -- 3.1 RESEARCH QUESTION 1: WHAT ARE THE DIFFERENT APPROACHES TOWARDS DECISIONAL CAPACITY, ITS ASSESSMENT AND SUPPORT? 17 -- 3.2 RESEARCH QUESTION 2: HOW DOES BELGIAN LEGISLATION DEAL WITH DECISIONAL CAPACITY AND ITS ASSESSMENT AND SUPPORT? 17 -- 3.3 RESEARCH QUESTION 3: WHAT ARE THE NEEDS OF (HEALTH)CARE PROFESSIONALS (IN THE DOMAIN OF DEMENTIA OR MENTAL HEALTH PROBLEMS) IN THE ASSESSMENT AND SUPPORT OF DECISIONAL CAPACITY? 18 -- 3.4 RESEARCH QUESTION 4: WHAT ARE THE NEEDS OF THE PERSONS WITH MENTAL HEALTH PROBLEMS OR DEMENTIA IN THE ASSESSMENT AND SUPPORT OF DECISIONAL CAPACITY? 18 -- 4 METHODOLOGY 18 -- 5 DECISIONAL CAPACITY IN SCIENTIFIC LITERATURE 19 -- 5.1 OBJECTIVE 19 -- 5.2 METHODOLOGY 19 -- 5.2.1 Search strategy 19 -- 5.2.2 Selection criteria for in- or exclusion 19 -- 5.2.3 Data to retrieve / analysis 21 -- 5.3 RESULTS 22 -- 5.3.1 Description of the included articles. 22 -- 5.3.2 Presentation of the findings 22 -- 5.4 PART 1 - TERMINOLOGY 22 -- 5.4.1 Decision-making : a complex phenomenon 22 -- 5.4.2 Decision-making in the medical context 23 -- 5.4.3 Different wordings and four elements 23 -- 5.4.4 Decisional capacity: decision and time specific 30 -- 5.5 PART 2 - PATHOLOGIES AS SOURCE OF DECISIONAL CAPACITY IMPAIRMENT 32 -- 5.5.1 Dementia 33 -- 5.5.2 Brain tumors and other neurological cancers 33 -- 5.5.3 Schizophrenia spectrum and other psychotic disorders 34 -- 5.5.4 Bipolar and related disorders 35 -- 5.5.5 Depression 35 -- 5.5.6 Autism spectrum disorders 36 -- 5.6 PART 3 - ASSESSING DECISIONAL CAPACITY 37 -- 5.6.1 When is a formal assessment needed? 37 -- 5.6.2 How can an assessment be performed? 41 -- 5.6.3 Who should be designed to be assessor? 51 -- 5.6.4 Which barriers are linked to this assessment? 52 -- 5.6.5 Which facilitators are linked to this assessment? 57 -- 5.6.6 Which recommendations have already been formulated regarding decisional capacity assessment? 65 -- 5.7 PART 4 – IMPACT OF DECISIONAL INCAPACITY: AN ETHICAL QUESTION 69 -- 5.7.1 Discrimination and preconceptions 70 -- 5.7.2 Autonomy versus Paternalism 71 -- 5.7.3 Strategies for improving or maintaining the “decisional capacity” 72 -- 5.8 PART 5 – SUPPORTED DECISION-MAKING PATHWAY 73 -- 5.8.1 Concept 74 -- 5.8.2 When has a supported decision-making pathway to be proposed ? 74 -- 5.8.3 How can a supported decision-making pathway be organized? 75 -- 5.8.4 Who has to be involved in a supported decision-making pathway? 78 -- 5.8.5 Which benefits are described with a supported decision-making pathway? 79 -- 5.8.6 Which barriers are linked to the supported decision-making pathway? 79 -- 5.8.7 Which facilitators are linked to the supported decision-making pathway 82 -- 5.8.8 Which recommendations have already been formulated regarding supported decisionmaking pathway? 84 -- 5.9 PART 6 – ADVANCE DECISION 89 -- 5.9.1 Concepts 89 -- 5.9.2 When should advance decision be proposed? 90 -- 5.9.3 How is advance decision elaborated? 92 -- 5.9.4 Who has to be involved in advance decision pathway? 93 -- 5.9.5 Which benefits are described with advance decision? 95 -- 5.9.6 Which barriers are linked to the advance decision pathway? 97 -- 5.9.7 Which facilitators are linked to the advance decision pathway? 103 -- 5.9.8 Which recommendations have already been formulated regarding advance decision? 107 -- 5.10 PART 7 – SURROGATE DECISION-MAKING PATHWAY: SUBSTITUTED JUDGEMENT AND BEST-INTEREST APPROACH 111 -- 5.10.1 Concepts 111 -- 5.10.2 When a surrogate decision-making pathway should be proposed? 112 -- 5.10.3 How is a surrogate decision-making pathway organized? 113 -- 5.10.4 Who has to be involved in the surrogate decision-making pathway? 116 -- 5.10.5 Which barriers are linked to the surrogate decision-making pathway?. 117 -- 5.10.6 Which facilitators are linked to the surrogate decision-making pathway? 122 -- 5.10.7 Which recommendations have already been formulated regarding surrogate decisionmaking pathway. 125 -- 5.11 LIMITATIONS OF THIS LITERATURE REVIEW 129 -- 5.12 FUTURE RESEARCH 130 -- 5.12.1 Assessment 130 -- 5.12.2 Supported decision-making 131 -- 5.12.3 Advance decision 131 -- 5.12.4 Surrogate decision-making 131 -- 5.12.5 HCPs Training and support 131 -- 6 DECISIONAL CAPACITY AND THE LAW 132 -- 6.1 OBJECTIVE 132 -- 6.2 METHODOLOGY 132 -- 6.3 PART 1 - DECISIONAL CAPACITY: TERMINOLOGY, INTERPRETATION AND ASSESSMENT 133 -- 6.3.1 Terminology 133 -- 6.3.2 The capabilities required to have decisional capacity 134 -- 6.3.3 The assessment of decisional capacity 138 -- 6.4 PART 2 - CONSEQUENCES OF DECISIONAL INCAPACITY: SUBSTITUTE DECISIONMAKING IN THE EXERCISE OF PATIENT’S RIGHTS 149 -- 6.4.1 Who is the substitute decision-maker in charge of exercising patient’s rights? 150 -- 6.4.2 How should a substitute decision-maker decide when exercising patient’s rights? 155 -- 6.4.3 The value of action through which an incapacitated patient appears to oppose treatment. 156 -- 6.4.4 Support in case of reduced decisional capacity? 157 -- 6.5 PART 3 –DECISIONAL CAPACITY IN SPECIFIC LEGISLATION: THE EXAMPLES OF EUTHANASIA, ORGAN DONATION AND MEDICAL EXPERIMENTS 160 -- 6.5.1 Decisional capacity and euthanasia 161 -- 6.5.2 Decisional capacity and experiments on human beings 166 -- 6.5.3 Decisional capacity and organ donation 168 -- 6.6 PART 4 - ADVANCE CARE PLANNING 171 -- 6.6.1 Types of written advance directives 172 -- 6.6.2 Crisis planning for patients with a psychiatric disorder 176 -- 6.7 PART 5 - ADMISSION OF A CARE USER IN A RESIDENTIAL CARE SETTING 178 -- 6.7.1 Admission to a residential care centre (or home replacement environment) 178 -- 6.7.2 Admission in a psychiatric facility 179 -- 6.7.3 Decisional incapacity and day-to-day decisions in a residential care context 183 -- 6.8 PART 6 - THE ROLE OF THE UNITED NATIONS CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES 185 -- 6.9 LIMITATIONS 194 -- 7 PROFESSIONALS’ PERCEPTIONS RELATED TO DECISIONAL CAPACITY 195 -- 7.1 OBJECTIVE 195 -- 7.2 METHODOLOGY 195 -- 7.2.1 Participants 195 -- 7.2.2 Data collection 196 -- 7.2.3 Data analysis 198 -- 7.3 PART 1 -TERMINOLOGY USED BY PROFESSIONALS AROUND DECISIONAL CAPACITY 199 -- 7.3.1 Many synonyms/terms are used 199 -- 7.4 PART 2 - CONTENT AND CHARACTERISTICS OF DECISIONAL CAPACITY 201 -- 7.4.1 Composing elements of decisional capacity 201 -- 7.4.2 Decisional capacity, a ‘relative’ concept 202 -- 7.4.3 Decisional capacity is task/context-specific 202 -- 7.5 PART 3 - ASSESSMENT OF DECISIONAL CAPACITY: CHARACTERISTICS, BARRIERS AND FACILITATORS, METHODS AND CONTEXT 203 -- 7.5.1 Focus on the decision-making process, not on the ultimate decision 203 -- 7.5.2 Standards and modalities for assessment depend on the severity of the pathology and the consequences of the decision for the patient’s health 207 -- 7.5.3 Methods for assessing the decisional capacity 207 -- 7.5.4 When (explicitly) evaluating decisional capacity? 210 -- 7.5.5 Particularities to certain types of mental health problems 210 -- 7.5.6 The impact of the personality and the social context of the patient 211 -- 7.5.7 The (possible) balance of power between the patient and physicians 212 -- 7.5.8 Place of the changing identity/values/preferences 212 -- 7.6 PART 4 - SUPPORTING THE PATIENTS IN THEIR DECISIONAL CAPACITY 214 -- 7.7 PART 5 - NEED FOR GUIDANCE FOR PROFESSIONALS 215 -- 7.8 PART 6 - NEED FOR FEEDBACK TO THE PATIENT 216 -- 7.9 PART 7 - ADVANCE CARE PLANNING 217 -- 7.9.1 Opportunities and limits of advance care planning 217 -- 7.9.2 When initiating advance care planning? 218 -- 7.9.3 Who should initiate/be involved in the process? 219 -- 7.10 PART 8 - CRISIS PLANNING FOR PERSONS WITH PSYCHIATRIC PROBLEMS 221 -- 7.11 LIMITATIONS 221 -- 8 PATIENTS’ PERSPECTIVES ON DECISIONAL CAPACITY 222 -- 8.1 OBJECTIVE 222 -- 8.2 METHODOLOGY 222 -- 8.2.2 Data analysis 225 -- 8.2.3 Ethical aspects 225 -- 8.3 RESULTS 226 -- 8.3.1 Presentation of the participants 226 -- 8.3.2 Presentation of the findings 227 -- 8.4 PART 1 - DECISIONAL CAPACITY AND DECISIONS ABOUT HEALTH CARE 228 -- 8.4.1 Definition/characteristics of the decisional capacity 228 -- 8.4.2 Factors influencing decisional capacity related to health care 229 -- 8.4.3 Patient reported experiences of exerting their decisional capacity 239 -- 8.5 PART 2 - EVALUATION OF THE (IN)CAPACITY 245 -- 8.5.1 Methods to assess the capacity of the patients 245 -- 8.5.2 When should the decisional capacity be assessed? 246 -- 8.5.3 Actors of the evaluation 248 -- 8.5.4 Communication of the results of the evaluation 249 -- 8.5.5 Consequences of the evaluation 249 -- 8.6 PART 3 - SOLUTIONS TO RESTORE AND MAINTAIN DECISIONAL CAPACITY 250 -- 8.6.1 At patient level 250 -- 8.6.2 At institutional level 255 -- 8.6.3 At political level 256 -- 8.7 LIMITATIONS OF THE ANALYSIS AND POTENTIAL BIAS 258 -- 9 DISCUSSION AND CONCLUSIONS 260 -- 9.1 NO CLARITY IN TERMINOLOGY AND DEFINITION OF DECISIONAL CAPACITY 260 -- 9.2 SHIFT FROM SUBSTITUTED-DECISION MAKING TO SUPPORTED-DECISION MAKING? 262 -- 9.3 TOWARDS A MORE PROMINENT ROLE FOR SUPPORTED DECISION-MAKING IN BELGIUM? 264 -- 9.4 ELEMENTS TO STRENGTHEN SUPPORTED DECISION – MAKING 265 -- 9.4.1 Foresee more (types of) support 265 -- 9.4.2 Provide training for patients and support persons 267 -- 9.4.3 Provide training for professionals 268 -- 9.4.4 Manage medical barriers for decisional capacity 268 -- 9.4.5 Facilitate advance care planning 269 -- 9.5 ELEMENTS TO FACILITATE DECISIONAL CAPACITY ASSESSMENTS 272 -- 9.5.1 Guidance on how to deal with decisional capacity (assessments) for healthcare professionals 273 -- 9.5.2 Provide support in the assessment process 275 -- 9.5.3 Provide training, intervision and supervision for professionals 275 -- 9.6 ORGANISING SUBSTITUTE DECISION-MAKING OF PATIENTS IN A COHERENT WAY 276 -- 9.7 FORESEE GUARANTEES RELATED TO COERCION AND OPPOSITION OF PATIENTS 277 -- 9.8 OVERALL NEED FOR SUPPORT MEASURES EMBEDDED IN AN ORGANIZATIONAL AND LEGAL FRAMEWORK TO OPTIMIZE THE PROCESS OF ASSESSING, SUPPORTING AND RESTORING DECISIONAL CAPACITY 278 -- APPENDICES 279 -- APPENDIX 1. LITERATURE SEARCH STRATEGIES 279 -- APPENDIX 1.1. SEARCH STRATEGY 279 -- APPENDIX 1.2. REASONS OF EXCLUSION OF 13 ARTICLES 281 -- APPENDIX 1.3. SUCCINCT DESCRIPTION OF THE 76 INCLUDED ARTICLES 283 -- APPENDIX 1.4. INSTRUMENTS FOR DECISION-MAKING ASSESSMENT. 294 -- APPENDIX 2. STATEMENTS AND CASES OF THE PROFESSIONAL FORUM 300 -- APPENDIX 3. INTERVIEW GUIDE 308 -- APPENDIX 3.1. INTRODUCTION 308 -- APPENDIX 3.2. QUESTIONNAIRE IN FRENCH 309 -- APPENDIX 3.3. TOPIC GUIDE IN DUTCH 315 -- REFERENCES 324 Link for e-copy: https://doi.org/10.57598/R349C Format of e-copy: PDF (4,04 MB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=4811
ISSN : D/2011/10.273/36 : € 0,00
Etude n° 2010-07
Languages : English (eng) French (fre)
Descriptors: Indexation
2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics
Classification
WT 155 Senile dementia. Alzheimer's diseaseAbstract: Les médicaments ne sont pas d’une grande utilité pour la prise en charge de la démence mais y a-t-il des solutions alternatives ? Le Centre fédéral d’expertise des soins de santé (KCE) a analysé trente formes de prise en charge non médicamenteuses. Des données scientifiques montrent l’efficacité de quatre d’entre elles. Le soutien psychologique, social et la formation de l’entourage sont à privilégier à domicile. En institution, la formation du personnel soignant diminue l’usage des moyens de contention. Enfin, l’activité physique et la stimulation des fonctions cognitives exercent un effet positif sur la personne souffrant de démence. Deux conditions pour le succès des ces interventions : un suivi professionnel régulier et un ajustement de l’intervention au patient et à son entourage. Force est de constater que les données scientifiques manquent pour tirer des conclusions relatives aux autres interventions. Contents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160B Format of e-copy: PDF [Open Access] (780 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2625 Copies(0)
Status No copy
ISSN : D/2011/10.273/37 : € 0,00
Study nr 2010-07
Languages : English (eng)
Descriptors: Indexation
2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics
Classification
WT 155 Senile dementia. Alzheimer's diseaseContents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160C Format of e-copy: PDF [Open Access] (767 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2627 Copies(0)
Status No copy
ISSN : D/2011/10.273/35 : € 0,00
Studie nr 2010-07
Languages : English (eng) Dutch (nla)
Descriptors: Indexation
2010-07 ; Caregivers ; Dementia ; Nonpharmacological Treatment ; Pharmacology ; R160 ; Therapeutics
Classification
WT 155 Senile dementia. Alzheimer's diseaseAbstract: Bij de behandeling van mensen met dementie zijn geneesmiddelen niet echt van groot nut, maar zijn er alternatieve oplossingen? Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) onderzocht dertig vormen van aanpak zonder geneesmiddelen. Voor vier van hen vonden de onderzoekers voldoende betrouwbare studies die wijzen op werkzaamheid. Vooral het opleiden en psychosociaal ondersteunen van de mantelzorger blijkt doeltreffend te zijn. Aangepaste opleidingen aan zorgverleners verminderen het gebruik van dwangmaatregelen in instellingen. Lichaamsbeweging en stimulering van de cognitieve functies hebben een positief effect op de demente persoon zelf. Voorwaarde is dat deze behandelingen aangepast zijn aan de demente persoon en zijn omgeving en dat ze regelmatig opgevolgd worden door professionele zorgverleners. Voor de andere interventies waren er onvoldoende wetenschappelijke gegevens om conclusies te kunnen trekken. Contents note: 1 INTRODUCTION 3 -- 1.1 BACKGROUND OF THE STUDY 3 -- 1.2 DEMENTIA 3 -- 1.2.1 A disease with consequences 3 -- 1.2.2 Diagnostic process 3 -- 1.2.3 Prevalence of dementia 4 -- 1.2.4 Types of dementia in Europe 4 -- 1.3 RESEARCH QUESTION 5 -- 2 METHODS 6 -- 2.1 INCLUSION CRITERIA 6 -- 2.2 LITERATURE SEARCH STRATEGY 8 -- 2.2.1 Phase I : systematic reviews 8 -- 2.2.2 Phase II : randomised controlled trials 9 -- 2.3 ASSESSING METHODOLOGICAL QUALITY AND RISK OF BIAS 9 -- 2.3.1 Systematic reviews 9 -- 2.3.2 Randomised controlled trials 10 -- 2.4 DATA EXTRACTION 10 -- 3 RESULTS 11 -- 3.1 METHODOLOGICAL CONSIDERATIONS 11 -- 3.1.1 Systematic reviews 11 -- 3.1.2 Randomised controlled trials 13 -- 3.2 RESULTS BY INTERVENTION 16 -- 3.2.1 Cognition 16 -- 3.2.2 Emotion 19 -- 3.2.3 Sensory enhancement 20 -- 3.2.4 Daily activities 23 -- 3.2.5 Physical activity 23 -- 3.2.6 Communication/interaction/relationship interventions 24 -- 3.2.7 Environmental changes 25 -- 3.2.8 Nutrition 26 -- 3.2.9 Interventions primarily focused on caregivers 26 -- 3.2.10 Interventions for the informal caregivers and patients at home 27 -- 4 SUMMARY OF THE MAIN FINDINGS 31 -- 4.1 QUALITY OF EVIDENCE: SUMMARY TABLE 31 -- 4.2 MODERATE QUALITY OF EVIDENCE FOR SIX GROUPS OF INTERVENTIONS 33 -- 4.2.1 Multicomponent psychoeducation/psychosocial interventions : impact on caregivers -- outcomes and on institutionalisation 33 -- 4.2.2 Physical activity 33 -- 4.2.3 Staff education 33 -- 4.2.4 Cognitive stimulation / training 34 -- 4.3 LOW QUALITY OF EVIDENCE FOR SIXTEEN INTERVENTIONS 34 -- 4.4 NO RCT FOR SIX INTERVENTIONS 34 -- 5 DISCUSSION 35 -- 5.1 STRENGTHS OF THE SYSTEMATIC REVIEW 35 -- 5.2 LIMITATIONS IN THE INTERPRETATION OF RESULTS 35 -- 5.3 LACK OF EVIDENCE: SOME HYPOTHESES 35 -- 5.4 RESULTS: APPLICABLE TO ALL PATIENT SUBGROUPS ? 36 -- 5.5 RESULTS APPLICABLE TO ALL SETTINGS ? 36 -- 5.6 INTERVENTIONS TAILORED TO THE PATIENT AND INFORMAL CAREGIVER ARE MORE -- SUCCESSFUL 36 -- 5.7 ADAPTATION TO THE CULTURAL AND HEALTH CARE CONTEXT 37 -- 5.8 PERSPECTIVES 37 -- 5.9 SUGGESTIONS FOR FURTHER RESEARCH 37 -- 6 APPENDICES 38 -- 6.1 APPENDIX 1 MESH TERM : DEMENTIA 38 -- 6.2 APPENDIX 2 SEARCH STRATEGIES SYSTEMATIC REVIEWS 38 -- 6.3 APPENDIX 3. WEBSITES ADDITIONAL HANDSEARCHING 50 -- 6.4 APPENDIX 4 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS 52 -- 6.5 APPENDIX 5 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS -- (WITH A LOW RISK OF BIAS) 55 -- 6.6 APPENDIX 6 SYSTEMATIC REVIEWS EXCLUDED (HIGH RISK OF BIAS) 65 -- 6.7 APPENDIX 7 RCT SEARCH STRATEGIES 69 -- 6.8 APPENDIX 8 QUALITY APPRAISAL FOR RCTS 77 -- 6.9 APPENDIX 9. DATA EVIDENCE TABLES FOR THE 30 INCLUDED RCTS 95 -- 7 REFERENCES 114 Link for e-copy: https://doi.org/10.57598/R160A Format of e-copy: PDF [Open Access] (785 KB) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2626 Copies(0)
Status No copy
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PermalinkPermalinkThe effectiveness of interventions in supporting self-management of informal caregivers of people with dementia / J.G. Huis In Het Veld in BMC geriatrics, 15(2015)147 ([11/11/2015])
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