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Background. The Meeting Centers Support Programme (MCSP) offers information and practical, emotional and social support to persons with dementia and their carers in local community centers. In this study the support programme was evaluated by participants (persons with dementia and carers) who utilized the MCSP for at least three months. Methods. Data collection took place within the framework of an implementation study in 11 meeting centers. 148 persons with dementia and 148 carers participated in the study. Data were collected after three and seven months of participation by means of questionnaires. Results. In general the persons with dementia and the carers were satisfied to very satisfied with the different elements of the support programme, the enrolment procedure, the contact with personnel, the location, and the facilities the centers have to offer. Half of the persons with dementia and one third of all carers indicated that they had made new acquaintances and friends at the center. Though satisfied with the programme, a majority of the persons with dementia (67% after three months and 58% after seven months) said that they were never asked what they wanted to do. The large majority of the carers feel somewhat less (42%) or much less (46%) burdened as a result of participating in the programme. This reduction of experienced burden proved to be related to satisfaction about the total programme (rs=0.35, p

This case report offers a different perspective on a patient with a long-term non-psychotic psychiatric disorder that was difficult to specify. The patient, a man in his 50s, was unable to profit from outpatient treatment and became increasingly dependent on mental healthcare - which could not be understood based on his history and psychiatric symptoms alone. By separating symptoms from illness behaviour, the negative course of this patient's treatment is analysed. Focusing on ineffective chronic illness behaviour by the patient, and mutual ineffective treatment behaviour by the clinicians, it becomes clear that basic requirements of effective treatment were unmet. By making a proper diagnosis, clarifying expectations and offering a suitable therapy, ineffective illness behaviour was diminished and this 'difficult' case became much easier for both patient and clinicians. The illness behaviour framework offers a useful, systematic tool to analyse difficulties between patients and clinicians beyond psychiatric symptoms or explanations.

Objectives: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. Design: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. Setting: Sixteen psychogeriatric wards in fourteen nursing homes in the Netherlands. Participants: One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer (DAT) type, mixed DAT and vascular dementia, and dementia syndrome (NAO) and 99 nursing assistants. Interventions: Integrated emotion-oriented care and usual care. Measurements: Demented elderly: Behaviour and mood related to adaptation to the illness and the institutionalization. Nursing assistants: General health as measured by feelings of stress, stress reactions, feeling of competence and illness. Results: Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks: maintaining an emotional balance (less anxiety) and preserving a positive self-image (less dissatisfaction). In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training. Conclusion: Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia. For the severely demented elderly we did not find this surplus value. This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes. With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them.