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educating junior doctors on the importance of identifying memory
impairment and delirium, as well as providing a confusion bundle,
improved identification and management of high risk patients.
Conclusions:
Clinicians assessment and management of cognitive
impairment can be significantly improved by education, an admission
proforma and confusion bundle.
P-123
The influence of the environment on behavioural symptoms
among nursing home residents with dementia: a systematic review
M.J. Krijger, R. Wetzels.
VOSON Radboud UMC Nijmegen
Background:
Behavioural symptoms of dementia (BSD), including
physical and verbal aggression, psychomotor and verbal agitation,
negativism, sleep wake disorders, irritable mood, sexual inappropriate
behaviour, obsessive behaviour, apathy are very common in nursing
home residents with dementia. Understanding the influence of the
environment on these behavioural symptoms might be the key to
reduce these symptoms by adequate interventions done by the
professional caregivers. Research question:
“
What is the influence of
the environment on clinically relevant behavioural symptoms among
nursing home residents with dementia?
Methods:
A systematic review was achieved in accordance with
the Preferred Reporting Items for Systematic Review and Meta-
Analysis Protocols 2015 (PRISMA-P). A literature search was performed
in five electronic databases (Pubmed, Embase, Cochrane, PsycINFO and
CINAHL), using the synonyms for Dementia, Nursing Home Residents
and Behavioural Symptoms. The articles were screened individually
by two independent reviewers on title and abstract using predeter-
mined inclusion and exclusion criteria. Critical appraisal and data-
extraction were accomplished by two independent reviewers.
Results:
Our search yielded 4546 articles after excluding the dupli-
cates. Using the methods described, we critically appraised remaining
articles. The most relevant and valid articles were qualified for further
assessment and data-extraction was performed. Preliminary results
will be presented at the EUGMS congress.
Conclusion:
We expect that the results will show that the environ-
ment appears to be a major influence on behavioural symptoms
among nursing home residents with dementia. And possibly that
interventions should be aimed primarily on changing the
environment.
P-124
Dementia care mapping: a tool to improve non-verbal
communication for people with dementia
J.C. Leners.
LTCF Ala and Pontalize, Luxembourg
Objectives:
Dementia care mapping (DCM) is a tool (T. Kitwood) to
evaluate the model of person centred care (PCC). It consist in assessing
patients with dementia in order to find out about wellbeing and stress
during day-times.
Method:
The mapping consist of an observation of patients in their
normal surroundings with a specific encoding system for different
types of activities.(feeding, leisure, etc). It allows to understand some
behaviors. We wanted to find out, if the non-verbal communication
was better after a 6 months implementation of PCC.
Results:
The population examined: 30 persons having lost oral
expression. By a standardized classification for non-verbal communi-
cation, the results for patients were: (a) acceptance of proposed
actions: 71%; (b) acquiescence: 17%; (c) expressed wishes: 6%; (d)
apathy: 4% and (e) opposition: 2%. The results from the nurse
’
s attitude
were: (b) guidance of activities: 31%; (b) recognition of participation:
25%; (c) negotiation: 21% (d) explanation: 12%; (e) basic stimulation:
11%.
Conclusions:
Dementia care mapping is a useful tool for geriatricians
to understand the unusual behavior of persons in advanced stages of
dementia. Through this positive attitude, the physician is less often
confronted to negative attitudes of his patient and will prescribe less.
(reduction: 9% for psychotropics)
P-125
Dysphoric symptoms in relation to other behavioral and
psychological symptoms of dementia, among elderly in nursing
homes
A. Lindbo, M. Gustafsson, U. Isaksson, P.O. Sandman, H. Lövheim.
1
Department of Geriatric Medicine, Umeå University,
2
Department of
Pharmacology and Clinical Neurosciences, Umeå University,
3
Department
of Nursing, Umeå University,
4
Division of Nursing, Karolinska Institutet,
Stockholm, Sweden
Background:
Behavioral and psychological symptoms of dementia
(BPSD) are common and varies throughout the disease. The aim of this
study was to explore associations between BPSD and dysphoria at
different levels of cognitive impairment.
Method:
Survey assessments of 4,397 individuals in Swedish nursing
homes were analyzed. Data of cognitive function and BPSD were
collected using the Multi-Dimensional Dementia Assessment Scale
(MDDAS). Eight BPSD factors were plotted in relation to cognitive
function and level of dysphoria to investigate their relation with
concurrent dysphoria.
Results:
Dysphoric symptoms was most frequent in moderate cogni-
tive impairment, however, moderate to severe dysphoric symptoms
showed no clear variation with cognitive impairment. Further,
aggressive behavior, verbally disruptive/attention-seeking behavior,
hallucinatory symptoms and wandering behavior were more common
with concurrent dysphoria regardless of cognitive function. In
contrast, passiveness was more common with concurrent dysphoria
in mild cognitive impairment but not in moderate to severe cognitive
impairment.
Conclusion:
Several BPSD including aggressive behavior and halluci-
nations were more common with concurrent dysphoric symptoms,
providing further insight to behavioral and psychological symptoms
among individuals with cognitive impairment. Apathy was more
common with concurrent dysphoria in early stages of cognitive
decline but not in later stages, supporting the notion that apathy and
dysphoric symptoms represent separate concepts among people with
moderate to severe cognitive impairment.
P-126
Dementia
–
an umbrella term misused as a diagnosis?
A. Mackett
1
, T. Lockington
2
.
1
Cambridge University Hospitals Trust,
2
Ipswich Hospital Trust
Introduction:
A patient, treated as Alzheimer
’
s dementia, presented
to us in crisis awaiting an end of life placement. Following re-diagnosis
and application of dementia with Lewy bodies (DLB) therapeutics he
subsequently spent two years at home, with a stable mini-mental state
examination of 27/30 [1]. A national dementia Commissioning for
Quality and Innovation was developed to increase the dementia
diagnosis rate. A single screening question is used but many have
questioned the evidence base [2]. It is vital that dementia does not
become a diagnosis in itself but the underlying pathology must be
rigorously pursued as clinical course/management vary significantly.
Methods:
14 patients with DLB who had been misdiagnosed were
identified in a movement disorder clinic in a large district general
hospital over a 6 month period. Symptoms at time of diagnosis were
reported.
Results:
Initial dementia diagnosis: 71% Alzheimer
’
s, 14% vascular, 7%
frontal lobe or mixed type. Motor symptoms: 92% bradykinesia, 78%
rigidity and 64% resting tremor. Non motor symptoms: 71% REM sleep
disorder, 57% anosmia and constipation, 57% diurnal variation and 43%
visual hallucinations.
Conclusions:
Patients were commenced on appropriate pharmaco-
logical interventions including Rivastigmine. There is clear efficacy
in the use of Rivastigmine in DLB including amelioration of hallu-
cinations, improvement in agitation, apathy and delusions and
improvement in the sleep/wake cycle [3]. Furthermore improvement
in cognition appears to be preserved over a significant period [4].
Outside specialist centres, potentially too much emphasis is placed on
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
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S61