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BackgroundDay care services aim to offer meaningful activities and a safe environment for the attendees and a respite for family caregivers while being cost effective. This study compares the use of formal and informal care in users and non-users of day care centres designed for persons with dementia.MethodUsers of day care designed for dementia (DC group) and non-users (NDC group) were followed over a period of 24 months or until nursing home admission (NHA) respectively death. Demographic and clinical characteristics were collected at baseline and after 12 and 24 months. The use of care was recorded by Resource Utilization in Dementia (RUD).ResultsA total of 257 persons with dementia participated in the study, 181 in the DC group and 76 in the NDC group. Users of day care centres cause higher costs due to the expenses for day care, while neither the use of home nursing, secondary care, informal care nor the time until NHA did show any differences between users and non-users. The overall costs were higher in the DC group at baseline and after 12 months, but this difference was no longer present at the end of the two-year study period.ConclusionOur results indicate no potential cost-saving effect of day care designed for people with dementia, as the use of day care did neither result in a reduced use of care nor in a delay of NHA. Future research should balance the non-monetary benefits of day care against its costs for a full cost-effectiveness analysis, most favourable in a RCT-design.

Abstract Background Farm-based day care services (FDCs) for people with dementia are intending to provide social relationships and meaningful activities in an agricultural landscape and offer respite for next of kin. As this requires a certain cognitive and physical functioning, it is of interest to investigate how this service contribute during the course of dementia. In this study we aim to explore the individual characteristics predicting dropout from FDC. Furthermore, we investigate whether the participants who drop out of the service continue to live at home with another day care service or if they move to a residential care facility. Methods The study includes 92 people with dementia attending FDCs in Norway, assessed with standardized instruments at baseline between January 2017 and January 2018. They were followed for 1 year, and dropouts from FDC during this period were mapped. The association between individual characteristics and dropout was assessed using a Cox proportional hazards regression analysis. Results Thirty-eight people stopped attending FDCs during the study. Twenty-six moved to residential care. Among the 12 who continued to live in their own homes, 9 people started in a regular day care service. Higher score on educational level and more severe dementia, as well as lower scores on social support, increased the probability of stopping FDC. Conclusion FDCs appeared as a service that is stable over time for most participants, as more than two-third could use the care facility until the need of residential care. The transfers within care services and levels of care seemed to be characterized by continuity. More research on the growing population of educated older adults with dementia are warranted, to facilitate for their course of care needs. Finally, extended knowledge is needed to improve the collaboration between private and public networks, such as day care services, to improve the experience of social support for people with dementia.

Background: Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services., Methods: A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data., Results: Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication-a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant's experience of insufficient communication and the lack of a holistic approach from the service, but also in the user's sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis., Conclusions: Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach., (© 2024. The Author(s).)

Purpose: Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls., Methods: A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models., Results: The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls., Conclusions: Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls., Implications for Cancer Survivors: This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate., (© 2024. The Author(s).)

Background: Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting., Methods: In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients' care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137., Results: We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0-17], scores 0-3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period., Conclusions: In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings., (© 2024. The Author(s).)

Background: Demographic changes, with an increasing number and proportion of older people with multimorbidity and frailty, will put more pressure on home care services in municipalities. Frail multimorbid people receiving home care services are at high risk of developing crises, defined as critical challenges and symptoms, which demand immediate and new actions. The crises often result in adverse events, coercive measures, and acute institutionalisation. There is a lack of evidence-based interventions to prevent and resolve crises in community settings., Methods: This is a participatory action research design (PAR) in a 6-month cluster randomised controlled trial (RCT). The trial will be conducted in 30 municipalities, including 150 frail community-dwelling participants receiving home care services judged by the services to be at risk of developing crisis. Each municipality (cluster) will be randomised to receive either the locally adapted TIME intervention (the intervention group) or care as usual (the control group). The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is a manual-based, multicomponent programme that includes a rigorous assessment of the crisis, one or more interdisciplinary case conferences, and the testing and evaluation of customised treatment measures. PAR in combination with an RCT will enhance adaptations of the intervention to the local context and needs. The primary outcome is as follows: difference in change between the intervention and control groups in individual goal achievement to resolve or reduce the challenges of the crises between baseline and 3 months using the PRACTIC Goal Setting Interview (PGSI). Among the secondary outcomes are the difference in change in the PGSI scale at 6 months and in neuropsychiatric symptoms (NPSs), quality of life, distress perceived by professional carers and next of kin, and institutionalisation at 3 and 6 months., Discussion: Through customised interventions that involve patients, the next of kin, the social context, and health care services, crises may be prevented and resolved. The PReventing and Approaching Crises for frail community-dwelling patients Through Innovative Care (PRACTIC) study will enhance innovation for health professionals, management, and users in the development of new knowledge and a new adapted approach towards crises., Trial Registration: ClinicalTrials.gov identifier: NCT05651659. Registered 15.12.22., (© 2024. The Author(s).)

Introduction: Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences., Objectives: The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation., Methods: An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated., Results: The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not., Conclusion: Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects., Material and Methods: This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014-2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment., Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min-max 44-84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] -0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance., Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Purpose: The aim of the present study was to explore the next of kin's experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality., Methods: The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis., Results: Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives' dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network., Conclusions: The study contributes important insights into the next of kin's experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.

Introduction: Half of the patients with limited-stage SCLC (LS SCLC) are above or equal to 70 years old, but they account for less than 20% of participants in most trials. Comorbidities and reduced organ and physical function might lead to more treatment toxicity, and population-based studies indicate that fewer older than younger patients with LS SCLC receive standard chemoradiotherapy, although there is limited evidence for such a policy., Methods: We compared baseline characteristics, comorbidity, survival, treatment completion, toxicity, health-related quality of life, and treatment outcomes between patients above or equal to 70 years old and those younger than 70 years old in an open-label, randomized phase II trial comparing twice-daily thoracic radiotherapy of 45 Gy in 30 fractions with 60 Gy in 40 fractions in LS SCLC. All patients received concurrent i.v. cisplatin (75mg/m 2 ) or carboplatin (AUC 5-6 mg/ml x min) day 1 and i.v. etoposide (100 mg/m 2 ) day 1-3 chemotherapy. This trial is registered at ClinicalTrials.gov (NCT02041845)., Results: A total of 170 patients who were above or equal to 18 years old and had performance status of 0 to 2 were randomized. Of these, 53 patients (60 Gy: 25, 45 Gy: 28) were above or equal to 70 years old and 117 (60 Gy: 64, 45 Gy: 53) were younger. There were no differences in baseline characteristics, treatment completion rates, toxicity, or response rates across the age groups. Health-related quality of life mean scores were similar during year one, but older patients reported more decline on functional scales than younger patients during year two. Overall survival was shorter for older patients, whereas there was no difference in progression-free survival or time to progression., Conclusions: Patients above or equal to 70 years old tolerated concurrent twice-daily chemoradiotherapy and achieved similar disease control as younger patients, indicating older patients should receive the same treatment as younger patients., (Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Background: Several screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA)., Methods: Prospective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed., Results: Patients' (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10-1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments., Conclusion: EFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Røyset et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments., Materials and Methods: A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models., Results: 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes., Discussion: Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640)., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The number of older adults with cancer is increasing. Radiotherapy is an important treatment modality for cancer and may cause side effects and distress. Patient-reported experience measures aim to measure patients' experiences with health care. This can help healthcare services to improve in line with patients' needs. To assess how Norwegian patients receiving radiotherapy experience their care, a valid and reliable tool is required. We selected the person-centred coordinated care experience questionnaire as a tool., Objective: The aim of the study is to validate the Norwegian version of the person-centred coordinated care experience questionnaire in a radiotherapy setting., Methods: A feasibility study of the person-centred coordinated care experience questionnaire and a cross-sectional study-testing psychometric properties of the questionnaire in a Norwegian radiotherapy setting-were conducted. Participants were recruited from two different hospitals in Norway. Patient characteristics and item scores are described using descriptive statistics. We performed an exploratory factor analysis and applied principal component analysis with a varimax rotation. Cronbach's α was used to assess internal consistency., Results: In total, 24 patients participated in the feasibility test, and 176 were included in the cross-sectional study where we explored the psychometric properties of the person-centred coordinated care experience questionnaire. Three factors were identified. Internal consistency was established for the 10-item scale, with Cronbach's α = 0.698., Conclusions: Conclusions must consider the Norwegian setting and healthcare context. We found that the Norwegian version of the person-centred coordinated care experience questionnaire is a relevant, valid and reliable tool to provide insight into different areas of patients' experiences upon receiving radiotherapy. However, further testing on a larger sample is necessitated., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)

Cognitive function can be affected by cancer and/or its treatment, and older patients are at a particular risk. In a prospective observational study including patients ≥65 years referred for radiotherapy (RT), we aimed to investigate the association between patient- and cancer-related factors and cognitive function, as evaluated by the Montreal Cognitive Assessment (MoCA), and sought to identify groups with distinct MoCA trajectories. The MoCA was performed at baseline (T0), RT completion (T1), and 8 (T2) and 16 (T3) weeks later, with scores ranging between 0 and 30 and higher scores indicating better function. Linear regression and growth mixture models were estimated to assess associations and to identify groups with distinct MoCA trajectories, respectively. Among 298 patients with a mean age of 73.6 years (SD 6.3), the baseline mean MoCA score was 24.0 (SD 3.7). Compared to Norwegian norm data, 37.9% had cognitive impairment. Compromised cognition was independently associated with older age, lower education, and physical impairments. Four groups with distinct trajectories were identified: the very poor (6.4%), poor (8.1%), fair (37.9%), and good (47.7%) groups. The MoCA trajectories were mainly stable. We conclude that cognitive impairment was frequent but, for most patients, was not affected by RT. For older patients with cancer, and in particular for those with physical impairments, we recommend an assessment of cognitive function.

The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used. The DC group included 181 participants recruited from 53 day-care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self-reported QoL than the CG at all time points (p < 0.001 at T0, p = 0.018 at T12, and p = 0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL-AD than persons with full awareness (p = 0.017). More depressive symptoms (p < 0.001) and higher functional dependency (p < 0.001) were associated with lower self-reported QoL. The study revealed higher scores of self-reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia., (© 2021 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background: There is a lack of tools for selecting patients with advanced lung cancer who benefit the most from systemic treatment. Patient-reported physical function (PRPF) has been identified as a prognostic factor in this setting, but little is known about the prognostic value in advanced non-small-cell lung cancer (NSCLC). The aim of this study was to investigate if measured physical performance was an independent or stronger prognostic factor than PRPF in patients with advanced NSCLC receiving platinum-doublet chemotherapy. Methods: We analyzed patients from a randomized trial comparing immediate and delayed pemetrexed therapy in stage III/IV NSCLC (n = 232) who performed timed up and go (TUG) and 5 m walk test (5 mWT) and reported physical function on the EORTC QLQ-C30 before chemotherapy commenced. Results: Overall, 208 patients performed TUG and 5 mWT and were included in the present study. Poor physical function was significantly associated with poor survival (TUG: HR 1.05, p < 0.01, 5 mWT: HR 1.05, p = 0.03, PRPF: 1.01, p < 0.01), but only PRPF remained an independent prognostic factor in multivariable analyses adjusting for baseline characteristics (HR 1.01, p = 0.03). Conclusions: Patient-reported, but not measured, physical performance was an independent prognostic factor for survival in patients with advanced NSCLC receiving platinum-doublet chemotherapy.

About 50% of patients with cancer are expected to need radiotherapy (RT), and the majority of these are older. To improve outcomes for older patients with cancer, geriatric assessment (GA) with management (GAM) is highly recommended. Evidence for its benefits is still scarce, in particular for patients receiving RT. We report the protocol of a cluster-randomised pilot study designed to test the effect, feasibility and health economic impact of a GAM intervention for patients ≥65 years, referred for palliative or curative RT. The randomising units are municipalities and city districts. The intervention is municipality-based and carried out in collaboration between hospital and municipal health services from the start of RT to eight weeks after the end of RT. Its main constituents are an initial GA followed by measures adapted to individual patients' impairments and needs, systematic symptom assessments and regular follow-up by municipal cancer nurses, appointed to coordinate the patient's care. Follow-up includes at least one weekly phone call, and a house call four weeks after the end of RT. All patients receive an individually adapted physical exercise program and nutritional counselling. Detailed guidelines for management of patients' impairments are provided. Patients allocated to the intervention group will be compared to controls receiving standard care. The primary outcome is physical function assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire C-30. Secondary outcomes are global quality of life, objectively tested physical performance and use of health care services. Economic evaluation will be based on a comparison of costs and effects (measured by the main outcome measures). Feasibility will be assessed with mixed methodology, based on log notes and questionnaires filled in by the municipal nurses and interviews with patients and nurses. The study is carried out at two Norwegian RT centres. It was opened in May 2019. Follow-up will proceed until June 2022. Statistical analyses will start by the end of 2021. We expect the trial to provide important new knowledge about the effect, feasibility and costs of a GAM intervention for older patients receiving RT. Trial registration: ClinTrials.gov, ID NCT03881137, initial release 13th of March 2019., Competing Interests: Declaration of Competing Interest There are no conflicts of interest connected with this manuscript., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT)., Material and Methods: A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis., Results: Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly decreased with an increasing number of impairments ( p  < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], p  = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], p  = .027) were independent predictors of OS., Conclusion: Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS., Trial Registration: Cinicaltrials.gov ID:NCT03071640.

Patient-reported data are important for quality assurance and improvement. Our main aim was to investigate the association between patient-reported symptoms among patients undergoing radical prostatectomy and their perceived quality of information before treatment. In this single-centre study, 235 men treated with robotic-assisted radical prostatectomy (RARP) between August 2017 and June 2019, responded to a follow-up questionnaire 20−42 months after surgery. A logistic regression analysis was performed to assess the association between patient-reported symptoms, measured with Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), and the perceived quality of information. Adverse effects were defined as a higher EPIC score at follow-up than at baseline. The majority (77%) rated the general information as good. Higher EPIC-CP at follow-up was significantly associated with lower perceived quality of information, also after adjustment for age and level of education (bivariate model OR 1.12, 95% CI 1.07; 1.16, p < 0.001 and multiple model OR 1.12 95% CI 1.08; 1.17, p < 0.001). The share who rated information as good was almost identical among those who reported more symptoms after treatment and those who reported less symptoms (78.3% and 79.2%). Consequently, adverse effects could not explain the results. Our findings suggest a need for improvement of preoperative communication.

Introduction: Prostate-specific antigen (PSA) density has previously been identified as a predictor of histological upgrading at radical prostatectomy, but how information from pre-treatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clarification. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Grade group (GG) 1 and pre-treatment bpMRI., Material and Methods: This single-center study included men with GG 1 cancer on prediagnostic biopsy, who underwent bpMRI and robotic-assisted radical prostatectomy (RARP) between March 2014 and September 2019. We estimated logistic regression models to explore predictors for upgrading. The explored potential predictors were age, PSA density, tumor stage and Prostate Imaging Reporting and Data System (PI-RADS) score (dichotomised 1-3 versus 4-5)., Results: Upgrading was observed in 56% (73/130) of the men. PSA density was the only significant predictor for upgrading (unadjusted OR = 1.7, 95% CI 1.2; 2.4 adjusted OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was lower for men with a PIRADS 1-3 than for PIRADS 4-5, but the difference was not statistically significant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). Among men with PI-RADS 1-3, the probability increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range., Conclusions: PSA density is a clinically important factor to predict upgrading from GG1 when bpMRI shows PI-RADS 1-3. In men with PI-RADS 4-5 on bpMRI, the probability of an undetected GG 2-5 cancer is high regardless of the PSA density., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Purpose: The Norwegian Survey of Health and Ageing (NORSE) was set up to provide internationally comparable data on ageing in Norway, which includes measured intrinsic capacity and cognitive function., Participants: NORSE is a population-based health examination study of seniors aged 60+ from the 1921-1958 birth cohorts in the former Norwegian county of Oppland, interviewed and examined during 2017-19 (N = 957, 16% response rate). NORSE is to some extent based on the SHARE-questionnaire ( share-project.org ), which includes work-related information, self-assessed and retrospective health, and expectations on longevity, quality of life, volunteering activities, consumption, and financial arrangements. In addition, several objective measures of intrinsic and cognitive capacity are included in NORSE., Findings to Date: A shorter preferred life expectancy (PLE) was found to be associated with the prospects of a life with dementia and chronic pain. Motivation for retirement was found to be related to work-life experience and health. Social media was mostly used in the younger age groups and there was a tendency towards more use in the higher educational groups. NORSE incorporates questions on religion, and older women tend to have a higher degree of religiosity (proxied as self-assessed religiosity) than men in their 80s, but more similar (and lower levels) among those in their 60s., Future Plans: NORSE participants have allowed their data to be linked to National registry data and midlife health examination studies and thereby provide a longitudinal design as well as information on disability status, socioeconomic status, household and marital status, support to/from children and parents, and pension status., (© 2021. The Author(s).)

Purpose: Farm-based daycare (FDC) is a type of daycare service for people with dementia. The aim of the present study was to explore the next of kin's experiences with FDC and how the service may affect their daily life., Methods: The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis., Results: We identified three main categories: (1) I am fine when you are fine, (2) Significant aspects of the service at the farm, and (3) FDC as a part of the dementia trajectory. The findings were summarized in one overarching, latent theme: "Being sheltered from a demanding everyday life"., Conclusions: The findings indicate that next of kin's experience of respite is closely connected to the well-being of their relatives at the FDC and the quality of the service. FDC provides significant support through a part of the trajectory of dementia. Despite experiencing respite and support, next of kin continue to struggle with ethical and moral decisions about the futures of their relatives with dementia.

Purpose: To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment., Methods: Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed., Results: Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding "just enough". The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients' perception and understanding; Involvement of next of kin is crucial to patients' comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability., Conclusions: Findings from this study describe how understanding "just enough" - not too much nor too little - may assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding "just enough". Cancer nurses may map comprehension of information, as well as reveal patients' previous experiences., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Patient-reported experience measures (PREMs) are important to capture the patients' voice. No such measure is routinely used for evaluation after robotic-assisted radical prostatectomy for prostate cancer. The aim of this study was to adapt the short version of the PREM questionnaire quality from the patients' perspective (QPP), and assess the construct validity of this version. Quality from the patients' perspective assesses 4 dimensions of quality of care. Involving discussion with user representatives, the QPP short version was adapted by adding 7 context-specific questions based on items from the Expanded Prostate Cancer Index Composite for Clinical Practice. This short version was answered on smartphone or tablet by 265 patients. We used exploratory factor analysis to assess dimensionality. For comparison with previous publications of the QPP, the analysis was repeated after mean imputation of missing values. The factor analysis identified 7 factors among the 30 analyzed items included in the analysis, explaining 64.9% of the variance. After imputation of missing, 2 factors explained 48.6% of the variance. None of these analysis captured the 4 dimensions of the QPP., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Purpose: Caring for people with dementia is often associated with burden of care and may influence the quality of life of the next of kin. The aim of this study was to describe the characteristics of the next of kin to people with dementia attending farm-based day care service (FDC) and identify characteristics associated with burden of care and quality of life (QoL) of next of kin., Participants and Methods: Ninety-four dyads of people with dementia and their next of kin were included from 25 FDCs in Norway in this descriptive cross-sectional study. The Relative Stress Scale (RSS) and the QoL-Alzheimer's Disease Scale (QoL-AD) were used as outcomes measures., Results: The participants consisted of those who lived with a person with dementia (spouse/partner, 62%) and those who did not (children), with significant differences in age, education level, work employment, perceived social support, depression symptoms, burden of care, and QoL. In multiple regression models, RSS and QoL were associated with living with the person with dementia, anxiety symptoms and perceived social support. In addition, RSS was associated with neuropsychiatric symptoms (NPS) in the people with dementia., Conclusion: Our findings underline the importance of obtaining knowledge about the next of kin's burden of care and QoL, of people with dementia attending an FDC. This knowledge is essential for those responsible for providing the best possible services for the next of kin and for developing targeted interventions to support the next of kin., Competing Interests: This work is funded by a grant from the Research Council of Norway (No 255033). The authors declare no conflicts of interest in this work., (© 2020 Taranrød et al.)

Background: Farm-based day care services (FDCs) for people with dementia are intending to provide social relationships and meaningful activities in an agricultural landscape and offer respite for next of kin. As this requires a certain cognitive and physical functioning, it is of interest to investigate how this service contribute during the course of dementia. In this study we aim to explore the individual characteristics predicting dropout from FDC. Furthermore, we investigate whether the participants who drop out of the service continue to live at home with another day care service or if they move to a residential care facility., Methods: The study includes 92 people with dementia attending FDCs in Norway, assessed with standardized instruments at baseline between January 2017 and January 2018. They were followed for 1 year, and dropouts from FDC during this period were mapped. The association between individual characteristics and dropout was assessed using a Cox proportional hazards regression analysis., Results: Thirty-eight people stopped attending FDCs during the study. Twenty-six moved to residential care. Among the 12 who continued to live in their own homes, 9 people started in a regular day care service. Higher score on educational level and more severe dementia, as well as lower scores on social support, increased the probability of stopping FDC., Conclusion: FDCs appeared as a service that is stable over time for most participants, as more than two-third could use the care facility until the need of residential care. The transfers within care services and levels of care seemed to be characterized by continuity. More research on the growing population of educated older adults with dementia are warranted, to facilitate for their course of care needs. Finally, extended knowledge is needed to improve the collaboration between private and public networks, such as day care services, to improve the experience of social support for people with dementia.

Background: The global health challenge of dementia is exceptional in size, cost and impact. It is the only top ten cause of death that cannot be prevented, cured or substantially slowed, leaving disease management, caregiver support and service innovation as the main targets for reduction of disease burden. Institutionalization of persons with dementia is common in western countries, despite patients preferring to live longer at home, supported by caregivers. Such complex health challenges warrant multicomponent interventions thoroughly implemented in daily clinical practice. This article describes the rationale, development, feasibility testing and implementation process of the LIVE@Home.Path trial., Methods: The LIVE@Home.Path trial is a 2-year, multicenter, mixed-method, stepped-wedge randomized controlled trial, aiming to include 315 dyads of home-dwelling people with dementia and their caregivers, recruited from 3 municipalities in Norway. The stepped-wedge randomization implies that all dyads receive the intervention, but the timing is determined by randomization. The control group constitutes the dyads waiting for the intervention. The multicomponent intervention was developed in collaboration with user-representatives, researchers and stakeholders to meet the requirements from the national Dementia Plan 2020. During the 6-month intervention period, the participants will be allocated to a municipal coordinator, the core feature of the intervention, responsible for regular contact with the dyads to facilitate L: Learning, I: Innovation, V: Volunteering and E: Empowerment (LIVE). The primary outcome is resource utilization. This is measured by the Resource Utilization in Dementia (RUD) instrument and the Relative Stress Scale (RSS), reflecting that resource utilization is more than the actual time required for caring but also how burdensome the task is experienced by the caregiver., Discussion: We expect the implementation of LIVE to lead to a pathway for dementia treatment and care which is cost-effective, compared to treatment as usual, and will support high-quality independent living, at home., Trial Registration: ClinicalTrials.gov: NCT04043364. Registered on 15 March 2019.

Farm-based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm-based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm-based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants' quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p = .023), a low score on depressive symptoms (p < .001), and spending time outdoors at the farm (p < .001). The variation between the farm-based day care services in the participants' reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm-based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care., (© 2019 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background: Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment., Methods: Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated., Results: 288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDS-scores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p < .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group., Conclusion: Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time., Methods: In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated., Results: The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously., Conclusion: The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.

Introduction: The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin., Methods and Design: The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016-2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon., Discussion: Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin., Competing Interests: Professor Siren Eriksen reports grants from the Research Council of Norway, grant number 255033, outside the submitted work. Dr Ingeborg Pedersen reports grants from the Research Council of Norway, during the conduct of the study. Dr Lina Harvold Ellingsen-Dalskau reports grants from the Research Council of Norway, during the conduct of the study. Mr Bjørnar Finnanger Garshol reports grants from the Research Council of Norway, during the conduct of the study. Dr Grete Grindal Patil reports grants from the Research Council of Norway, during the conduct of the study. The authors report no other conflicts of interest in this work., (© 2019 Eriksen et al.)

Background: Day care services aim to offer meaningful activities and a safe environment for the attendees and a respite for family caregivers while being cost effective. This study compares the use of formal and informal care in users and non-users of day care centres designed for persons with dementia., Method: Users of day care designed for dementia (DC group) and non-users (NDC group) were followed over a period of 24 months or until nursing home admission (NHA) respectively death. Demographic and clinical characteristics were collected at baseline and after 12 and 24 months. The use of care was recorded by Resource Utilization in Dementia (RUD)., Results: A total of 257 persons with dementia participated in the study, 181 in the DC group and 76 in the NDC group. Users of day care centres cause higher costs due to the expenses for day care, while neither the use of home nursing, secondary care, informal care nor the time until NHA did show any differences between users and non-users. The overall costs were higher in the DC group at baseline and after 12 months, but this difference was no longer present at the end of the two-year study period., Conclusion: Our results indicate no potential cost-saving effect of day care designed for people with dementia, as the use of day care did neither result in a reduced use of care nor in a delay of NHA. Future research should balance the non-monetary benefits of day care against its costs for a full cost-effectiveness analysis, most favourable in a RCT-design., Competing Interests: The authors have declared that no competing interests exist.

Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.

Background: The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance)., Methods: An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial., Results: Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention., Implementation: 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance., Conclusions: A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes., Trial Registration: The trial was registered January 6, 2016 with ClinicalTrials.gov ( NCT02655003 ).

Background: Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission., Method: A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates., Results: The mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG., Conclusion: The study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate., Trial Registration: The study is registered in Clinical Trials ( NCT01943071 ).

Objectives: This study aimed to identify possible groups of people with dementia (PWD) in nursing homes with different trajectories of proxy-rated quality of life (QoL), and to explore how anxiety (along with other characteristics) was associated with these trajectories of QoL of PWD in nursing homes at a 12-month follow-up., Methods: We included 298 PWD aged 65 years and older from 17 Norwegian nursing homes. The Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) was used to assess anxiety, defined as RAID-N score ≥12; proxy-rated QoL was assessed by Quality of Life in Late-Stage Dementia (QUALID). The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). A growth mixture model identified two distinct trajectories of QUALID scores. Association between the QUALID score trajectories and demographic and clinical characteristics were analyzed with logistic regression models., Results: Trajectory group 1 (206 participants) had a lower proportion of participants with anxiety, and a more stable and better QoL, compared to trajectory group 2 (92 participants) at a 12-month follow-up. In a multivariate logistic regression analysis, more severe impairment in activities of daily living, along with presence of anxiety, depression, agitation, and use of antipsychotics at baseline, were associated with belonging to the trajectory group with proxy-rated poor QoL., Significances: This study reveals that anxiety is associated with proxy-rated poor QoL of PWD at a 12-month follow-up. Efforts should be made to identify anxiety among nursing home residents with dementia to initiate treatment., Competing Interests: Alka R. Goyal is currently receiving PhD grant from Innlandet Hospital Trust and the Norwegian National Advisory Unit on Ageing and Health. The remaining authors have declared that no competing interests exist.

ABSTRACTBackground:Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs)., Methods: Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC., Results: Higher levels of PCC were associated with a greater job satisfaction, three years or more of health-related education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC., Conclusion: This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.

Background: Knowledge is scarce about the course of anxiety in persons with dementia (PWD) in nursing homes. This study aimed to describe the course of anxiety, anxiety symptoms, and the correlates of change in the Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) score in PWD in nursing homes., Methods: Using the RAID-N, anxiety was assessed in 298 PWD aged 65 years and above from 17 Norwegian nursing homes. The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). Associations between the change in RAID-N score and demographic and clinical characteristics were analyzed with multilevel regression models., Results: At 12 months, 93 participants (31.2%) had died. There was no significant change in the proportion of participants with anxiety, defined as RAID-N score ≥12, from baseline (33.7%) to follow-up (31.2%) (McNemar, p = 0.597). "Motor tension", "frightened and anxious", and "irritability" were the most frequent anxiety symptoms among those with dementia and anxiety. A higher Neuropsychiatric Inventory-Questionnaire (NPI-Q) sub-syndrome affective baseline score and more use of anxiolytics were associated with reduction in RAID-N score, whereas a higher NPI-Q sub-syndrome aroused baseline score and more use of antipsychotics were associated with an increase in RAID-N score at follow-up., Limitations: The study did not control for ongoing treatment or changes of comorbidities., Conclusions: Anxiety and anxiety symptoms are highly prevalent among PWD in nursing homes over a12-month period. The symptoms "motor tension", "frightened and anxious", and "irritability" require attention in screening for anxiety., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Earlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia., Methods: We included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders., Results: Forty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models., Conclusion: Nursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.

Objective: To determine the effectiveness of the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) for treatment of moderate to severe agitation in people with dementia., Methods: In a single-blinded, cluster randomized controlled trial in 33 nursing homes (clusters) from 20 municipalities in Norway, 229 patients (104 patients in 17 nursing homes and 125 patients in 16 nursing homes) were randomized to an intervention or control group, respectively. The intervention group received TIME, and the control group received a brief education-only intervention. TIME is an interdisciplinary multicomponent intervention and consists of a comprehensive assessment of the patient with the goal to create and put into action a tailored treatment plan. The primary outcome was the between-group difference in change at the agitation/aggression item of the Neuropsychiatric Inventory Nursing Home version between baseline and 8 weeks. Secondary outcomes were the between-group difference in change at the agitation/aggression between baseline and 12 weeks in other neuropsychiatric symptoms, quality of life, and use of psychotropic and analgesic medications between baseline and 8 and 12 weeks., Results: A significant between-group difference in reduction of agitation at both 8 weeks (1.1; 95% confidence interval: 0.1-2.1; p = 0.03) and 12 weeks (1.6; 95% confidence interval: 0.6-2.7; p = 0.002) in favor of the TIME intervention was found., Conclusion: The implementation of TIME resulted in a significant reduction of agitation among nursing homes patients with dementia. These results should inform training programs for care staff in Norway and internationally., (Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: Dementia-specific anxiety scales in the Norwegian language are lacking; the aim of this study was to investigate the validity and inter-rater reliability of a Norwegian version of the Rating Anxiety in Dementia (RAID-N) scale., Method: The validity of the RAID-N was tested in a sample of 101 patients with dementia from seven Norwegian nursing homes. One psychogeriatrician (n = 50) or a physician with long experience with nursing home patients (n = 51) 'blind' to the RAID-N score diagnosed anxiety according to DSM-5 criteria of generalised anxiety disorder (GAD). A receiver operating characteristic (ROC) analysis assessed the best cut-off point for the RAID-N, and the area under the curve (AUC) was calculated. Inter-rater reliability was tested in a subgroup of 53 patients by intraclass correlation (ICC) and Cohen's kappa., Results: Twenty-eight of 101 (27.7%) met the GAD criteria. The mean RAID-N score for patients with GAD was 16.1 (SD 6.3) and without GAD, 8.8 (SD 6.5) (p < 0.001). A cut-off score of ≥12 on the RAID-N gave a sensitivity of 82.1%, specificity of 70.0%, and 73.3% accuracy in identifying clinically significant GAD in patients with dementia. Inter-rater reliability on overall RAID-N items was good (ICC = 0.82), Cohen's kappa was 0.58 for total RAID-N score, with satisfactory internal consistency (Cronbach's alpha = 0.81)., Conclusion: The RAID-N has fairly good validity and inter-rater reliability, and could be useful to assess GAD in patients with dementia. Further studies should investigate the optimal RAID-N cut-off score in different settings.

Background: People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study., Methods: We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention., Results: Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness., Conclusions: Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships., Trial Registration: The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.

Aim and Objectives: The objective of the study was to evaluate the impact of the Dementia ABC educational programme on the participants' competence in person-centred care and on their level of job satisfaction., Background: The development of person-centred care for people with dementia is highly recommended, and staff training that enhances such an approach may positively influence job satisfaction and the possibility of recruiting and retaining competent care staff., Design: The study is a longitudinal survey, following participants over a period of 24 months with a 6-month follow-up after completion of the programme., Methods: A total of 1,795 participants from 90 municipalities in Norway are included, and 580 from 52 municipalities completed all measurements. The person-centred care assessment tool (P-CAT) is used to evaluate person-centredness. The psychosocial workplace environment and job satisfaction questionnaire is used to investigate job satisfaction. Measurements are made at baseline, and after 12, 24 and 30 months., Results: A statistically significant increase in the mean P-CAT subscore of person-centred practice and the P-CAT total score is found at 12, 24 and 30 months compared to baseline. A statistically significant decrease in scores in the P-CAT subscore for organisational support is found at all points of measurement compared to baseline. Statistically significant increases in satisfaction with workload, personal and professional development, demands balanced with qualifications and variation in job tasks as elements of job satisfaction are reported., Conclusion: The evaluation of the Dementia ABC educational programme identifies statistically significant increases in scores of person-centredness and job satisfaction, indicating that the training has a positive impact., Implications for Practice: The results indicate that a multicomponent training programme including written material, multidisciplinary reflection groups and workshops has a positive impact on the development of person-centred care practice and the job satisfaction of care staff., (© 2016 John Wiley & Sons Ltd.)

Background: Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home., Methods: We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected., Results: Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 - 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer's disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms., Conclusions: Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.

Background: Day care that is designed for people with dementia aims to increase the users' quality of life (QoL). The objective of the study was to compare the QoL of people with dementia attending day care with those not attending day care., Methods: The study is based on baseline data from a project using a quasi-experimental design, including a group of day care users (n = 183) and a comparison group not receiving day care (n = 78). Quality of Life-Alzheimer's Disease (QoL-AD) was used as the primary outcome, to collect both self-reported and proxy-based information from family carers on the users' QoL. A linear mixed model was used to examine the differences between groups., Results: Attending day care was significantly associated with higher mean scores of self-reported QoL. There was no difference between the groups in proxy-reported QoL. Analyses of the interaction between group belonging and awareness of memory loss revealed that the participants with shallow or no awareness who attended day care had significant higher mean scores of QoL-AD compared to those not attending day care., Conclusions: Higher self-reported QoL was found among people attending day care designed for people with dementia compared to the comparison group. The difference in QoL ratings was found in the group of day care users with shallow or no awareness of their memory loss. Hence, day care designed for people with dementia might have the potential to increase QoL as it is experienced by the users.

Background/aims: Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes., Methods: In all, 298 participants with dementia ≥65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models., Results: Anxiety, according to a cutoff of ≥12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores., Conclusion: Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes., (© 2017 S. Karger AG, Basel.)

Background: Nearly all persons with dementia will experience neuropsychiatric symptoms (NPS) during the course of their disease. Clinicians and researchers emphasize the need for an evidence-informed standardized approach to managing NPS that integrates pharmacological and nonpharmacological treatments for real-world implementation. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) represents such an approach and is a multicomponent intervention based on the theoretical framework of cognitive behavioural therapy., Methods/design: The trial is a 3-month cluster randomized trial conducted in 30 nursing homes including 168 participants with dementia and a high level of agitation. Each nursing home defined as a cluster will be randomized to receive either the TIME intervention (the intervention group) or a brief education-only intervention regarding dementia and NPS (the control group). TIME is a manual-based, multicomponent programme that includes a rigorous assessment, one or more case conferences and the treatment and evaluation of NPS. Patient-level measurements are taken at baseline (prior to randomization) and 8 and 12 weeks later. The primary outcome measure is the change in agitation, as defined by the Neuropsychiatric Inventory-Nursing Home Version, at 8 weeks from baseline. Secondary outcome measures include change in agitation at 12 weeks from baseline, and change from baseline at 8 and 12 weeks in other NPS, quality of life, and the use of psychotropic and analgesic medications. Mixed methods will be used to follow, measure and explore the implementation process and the effect of the intervention at the individual staff level and the organization level. Combining measurements of clinical effectiveness and implementation outcomes define this trial as an effectiveness-implementation hybrid trial., Discussion: Measuring the implementation and effect of complex interventions aimed at reducing NPS in nursing homes is challenging. In this study protocol, we describe a multicomponent program, TIME, and discuss how an effectiveness-implementation cluster randomized hybrid trial can meet these challenges., Trial Registration: ClinicalTrials.gov identifier NCT02655003 . Registered 6 January 2016.