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Objective:Individualized formulation-led interventions offer a promising approach for analyzing and managing challenging behaviors in people with dementia. Little is known about which individualized formulation-led interventions exist and what effects these interventions have on people with dementia and their caregivers. Therefore, the review aims to describe and examine existing interventions and to review their evidence. Methods:An integrative review of individualized formulation-led interventions for managing challenging behavior in people with dementia was conducted. PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behavior and individualized formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review. Results:The literature review provided 14 different individualized formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviors compared with the control group. Family caregivers felt less upset about the challenging behavior and more confident in their ability to manage the behavior. Conclusion:There is a clear need for further research on individualized formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualized formulation-led interventions on patient and caregiver outcomes. [ABSTRACT FROM AUTHOR]

Behavioural variant frontotemporal dementia (bv FTD) is an early-onset and progressive neurodegenerative disease associated with strong changes in judgement, behaviour, personality and emotions. These changes can cause significant problems in everyday life for people with bvFTD and their families, and have implications for health and society. Currently, there are no suitable evidence-based specific interventions for people with bv FTD. This scoping review aims to identify the self-expressed needs, demands and coping strategies of people with bv FTD. Identifying these issues is the first step towards the development of need-based psycho-social interventions for people with bv FTD. A comprehensive literature research was conducted of German and English scientific articles published between January 2000 and October 2014 using the databases MEDLINE, CINAHL, Psyc INFO, PSYNDEX, Soc INDEX, GeroLit, the Cochrane Library, ProQuest, the German National Library and additional search strategies in terms of a scoping review. Articles were identified by combining search terms related to 'frontotemporal dementia' with terms related to 'self-expressions', 'needs/demands' and 'coping'. After excluding duplicates, two independent reviewers screened the titles and abstracts of 2317 records for eligibility. Because eligibility could not be assessed from the titles or abstracts of 28 articles, those articles were assessed using the full text. One poster abstract met our research question and a few articles were related, but no article met all of the inclusion criteria. This lack of scientifically based knowledge concerning the perspective of people with bv FTD is discussed with reference to the search strategy and the research questions, disease-related aspects such as changes in behaviour or language and emotions and the difficulties in researching this topic. Recommendations are formulated for future research considering the perspective of people with bv FTD and that will involve the development of appropriate data collection methods. Subsequently, specialised interventions must be developed. [ABSTRACT FROM AUTHOR]

The article presents a study aimed to evaluate and analyze the experiences of nursing staff in the analysis and management of challenging behavior among dementia patients. The study is conducted through qualitative reviews of 18 nursing teams from 12 nursing homes with quasi-experimental study. The results of the study show that Dementia specific-case conferences with the Innovative dementia oriented assessment tool (CC-IdA) is an important tool in the management of the said behavior.

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. [ABSTRACT FROM AUTHOR]

Background Fidelity can act as a potential mediator of the relationship between interventions and their intended outcome. Within the FallDem-study the fidelity of dementia-specific case conferences (DSCC) was assessed as part of a process evaluation to explain the effects of DSCC on residents' challenging behavior (primary outcome). Fidelity was assessed both in relation to the core elements of the DSCC (duration, frequency, process- and role structure, location) and potential adaptations, as well as the reach of the target populations (residents and nursing staff). Materials and methods Fidelity of DSCC was evaluated during the entire trial period using quantitative and qualitative methods. Standardized protocols of DSCC, attendance lists and written documentations of interventionists (trainers) as well as semi-structured interviews with participants of DSCC were conducted. Quantitative data were analysed using descriptive statistics, qualitative data were analysed using documentary analysis and content analysis. The concept of DSCC as well as the curriculum of delivering DSCC provided the basis for a systematic coding scheme for qualitative analysis. Results Results indicate a moderate fidelity of the core elements of DSCC. While the duration, role structure and location of DSCC was mostly followed, the frequency of DSCC was reduced by more than one third and adaptations were made regarding the process structure of DSCC. The reach of the target population indicates that 57% of expected residents (112/192) directly received the intervention, whereas the reach of the nursing staff was good, but characterized by a high turnover and limited continuity during the 7 months of intervention phase. Conclusion The moderate fidelity of DSCC as well as the high turnover and limited continuity of nursing staff might be influencing factors on the effects of DSCC on residents' challenging behavior and should be carefully considered in the overall interpretation of the FallDem study results. A detailed analysis of the reasons for the moderate fidelity and the adaptations will be the next step of analysis. Trial registration Current Controlled Trials identifier: ISRCTN20203855, registered on 10th July 2013. [ABSTRACT FROM AUTHOR]

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

Health services for nursing home residents with dementia require the expertise of highly trained nursing staff. In addition, dealing with challenging behaviour of people with dementia is often stressful for nurses and causes major difficulties for them. Being a part of the general nursing guidelines, «understanding diagnostics» enables nursing staff to deal with challenging behaviour of persons with dementia. The primary focus of the concept is to understand the behaviour. The aim of the study was to implement and evaluate «understanding diagnostics» through structured case conferences and the application of the 'Innovative dementia-oriented Assessment system' (IdA) in nursing homes for the first time. Nursing staff of 15 nursing homes in North- Rhine Westphalia were trained about the content and implementation of «understanding diagnostics». Nurses' perceived level of stress was measured before (n = 106) and after (n = 71) the intervention (9 months). The study results show positive effects on the nurses' perceived level of stress. They support the use of structured case conferences and the IdA assessment in order to understand the behaviour of nursing residents with dementia. The implementation of «understanding diagnostics» allows nursing staff to deal with challenging behaviour of nursing home residents with dementia.