M. Smalbrugge - Academia.edu (original) (raw)

Papers by M. Smalbrugge

Research paper thumbnail of From Admission to Death: Prevalence and Course of Pain, Agitation, and Shortness of Breath, and Treatment of These Symptoms in Nursing Home Residents With Dementia

Journal of the American Medical Directors Association, Jan 23, 2015

Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality o... more Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality of life. We explore the course of symptoms and their treatment during nursing home stay to help target adequate symptom management. Data were collected as part of the Dutch End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up. Physicians performed assessments at baseline, semiannually, and shortly after death of pain, agitation, shortness of breath, and treatment provided for these symptoms. Long-term care facilities (28) in the Netherlands. Newly admitted nursing home residents (372) in variable stages of dementia. We described prevalence and course of symptoms, and treatment provided for these symptoms. We used generalized estimating equations to evaluate the longitudinal change in symptoms and their treatment, and the associations between the symptoms of pain and agitation, as well as between stage of dementia and symptoms. Pain was common...

Research paper thumbnail of Apathy: Risk Factor for Mortality in Nursing Home Patients

Journal of the American Geriatrics Society, 2017

To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementi... more To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementia special care (DSC) nursing home (NH) units. DESIGN: Longitudinal design, secondary analyses of a 2year, cluster-randomized trial with six measurements, approximately 4 months in between. SETTING: SC and DSC-units of Dutch NHs. PARTICIPANTS: NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371). MEASUREMENTS: Data were available for 713 NHpatients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale (AES-10) and applied as categorical variable using known cutoff scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. RESULTS: Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio (HR) = 1.77; 95% confidence interval (CI] = 1.35-2.31, P < .001). Results remained significant (HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ (P > .05) in the effect of apathy on mortality. Male gender (HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years (HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk (HR = 1.62, 95% CI = 1.40-1.88, P < .001). CONCLUSIONS: Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population.

Research paper thumbnail of Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands: Results From a Prospective Observational Study

Alzheimer disease and associated disorders, Jan 15, 2016

We explored how pneumonia and intake problems affect survival in nursing home residents in variab... more We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28%) and intake problems in 126 (34%) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Developing pneumonia and intake problems affects surviva...

Research paper thumbnail of Changes in Care Goals and Treatment Orders Around the Occurrence of Health Problems and Hospital Transfers in Dementia: A Prospective Study

Journal of the American Geriatrics Society, Jan 21, 2016

To explore changes in care goals and treatment orders around the occurrence of pneumonia and inta... more To explore changes in care goals and treatment orders around the occurrence of pneumonia and intake problems, and whether hospitalization is in line with earlier agreed-upon do-not-hospitalize orders. Data were collected as part of the Dutch End of Life in Dementia study (2007-2011), a longitudinal observational study with up to 3.5 years of follow-up. Long-term care facilities (N = 28) in the Netherlands. Newly admitted nursing home patients (N = 372) in various stages of dementia. Semiannually, physicians completed questionnaires about care goals and treatment orders, and they continuously registered episodes of pneumonia, intake problems and hospitalization. We report on changes in care goals and treatment orders during follow-up in relation to the developing of pneumonia and intake problems and on hospitalization and reasons for hospitalization. The proportion of patients with palliative care goals and do-not-treat orders rose during follow-up, especially before death. Treatment...

Research paper thumbnail of De angstige patiënt

Research paper thumbnail of Bayesian Analyses Showed More Evidence for Apathy than for Depression Being Associated With Cognitive Functioning in Nursing Home Residents

Journal of the American Medical Directors Association, 2018

Objectives: Depression, apathy, and cognitive impairments are widespread in nursing home (NH) res... more Objectives: Depression, apathy, and cognitive impairments are widespread in nursing home (NH) residents. Scarce research that explicitly compares apathy to depression suggests that the association between apathy and cognitive functioning is stronger than the association between depression and cognitive functioning. This study in Dutch NH residents aimed to use Bayesian methods for comparing the evidence for the relationship of cognitive performance with apathy to that with depression. Design: Cross-sectional. Setting and Participants: Sixteen NH somatic care units (N ¼ 190 residents; mean age 77.2 years, standard deviation 12.9), and 17 dementia special care units (N ¼ 243 residents; mean age 82.8 years standard deviation, 6.8]). Measures: The Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were administered in residents for cognitive performance. Professional carers were interviewed for the Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Results: Regression models built with the BayesFactor package in R showed Bayesian factors (BFs) that implied extremely strong evidence in terms of the Jeffrey classification for the relationship of apathy with MMSE [standardized effect size, À0.57 (À0.66 to À0.48), BF ¼ 3.4Eþ28], and with FAB [À0.50 (À0.59 to À0.42), BF ¼ 3.0Eþ24]. Regarding depression, evidence was a minor fraction of that for apathy [MMSE, À0.17 (À0.27 to À0.06), BF ¼ 15.45; FAB, À0.12 (À0.22 to À0.02), BF ¼ 2.11]. The most evidence existed for the associations of apathy with MMSE orientation problems, especially orientation in time. Conclusions/Implications: The study implies that cognitive assessments are important to differentiate apathy from depression in NH residents both with dementia and without dementia. More research is needed to clarify whether disorientation in time is a specific cognitive marker of apathy that may be used to reduce false positive depression diagnoses. Ó 2018 AMDA e The Society for Post-Acute and Long-Term Care Medicine. Depression and apathy are among the most widespread neuropsychiatric conditions in nursing home (NH) residents. 1e4 Both conditions are associated with reduced functional status, 5,6 poor quality of life, 7,8 caregiver burden, 9-11 reduced cognitive performance, 12-16 and increased mortality. 17-19 Etiologic and nosologic overlaps may partially explain similar adversities found in studies on depression and apathy. For example, abnormalities in frontal subcortical circuits that are associated with reduced executive

Research paper thumbnail of Apathy and health-related quality of life in nursing home residents

Quality of Life Research, 2018

Purpose To explore the association between apathy and health-related quality of life (HRQoL) from... more Purpose To explore the association between apathy and health-related quality of life (HRQoL) from resident and proxy perspectives and whether cognition and depression moderate this relationship. Methods Secondary analyses with baseline data from a cluster randomized trial on the effects of a care program for depression in Nursing Homes (NHs) were conducted. For HRQoL, the Visual Analogue Scale (VAS) and the Dutch version of the European Quality of Life (EQ-5D) were administered to 521 NH residents, and to professional caregivers reporting from the perspective of the NH resident (Resident-Proxy) and from their own perspective (Proxy-Proxy). Utility scores (U) were calculated for the three perspectives. Apathy, depression, and cognition were measured using the 10-item Apathy Evaluation Scale, the Cornell Scale for Depression in Dementia, and the standardized Mini-Mental State Examination, respectively.

Research paper thumbnail of Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia

International Psychogeriatrics, 2017

Background: We studied the patient and non-patients factors of inappropriate psychotropic drug (P... more Background: We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia. Methods: In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug–drug interactions, drug–disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics. Results: The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxio...

Research paper thumbnail of Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents

International Journal of Geriatric Psychiatry, 2011

This study aims to test the accuracy of the Nijmegen observer-rated depression (NORD) scale, a ne... more This study aims to test the accuracy of the Nijmegen observer-rated depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. This cross-sectional study with 103 residents with dementia (N = 19 depressed) and 72 residents without dementia (N = 10 depressed) was undertaken in 13 Dutch NH units. An elderly care physician and a psychologist of each unit assessed residents for the presence of clinical depression. Primary professional caregivers administered the NORD scale. Five of the six proposed items showed acceptable performance in screening for depression. Receiver operating characteristic analyses revealed significant areas under the empirical curve (AUC) for the 5-item NORD scale in the total sample (AUC = 0.83, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), as well as in residents with dementia (AUC = 0.84, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and without dementia (AUC = 0.84, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The cutoff score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 showed the highest sum of sensitivity (100) and specificity (69) in non-dementia and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 the highest sum of sensitivity (79) and specificity (77) in dementia. The cutoff score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 showed the lowest negative likelihood ratio of 0.0 in non-dementia and of 0.2 in dementia. The highest positive likelihood ratios were found for the cutoff of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 in non-dementia (3.4) and for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 in dementia (26.5). The 5-item NORD scale showed acceptable accuracy comparable with those of more extensive scales in other studies. It is easy and quick to administer and can be used for screening of depression in NH residents with or without dementia.

Research paper thumbnail of Continuous Palliative Sedation in Nursing Home Residents With Dementia and Refractory Neuropsychiatric Symptoms

Journal of the American Medical Directors Association, 2020

OBJECTIVES Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) resident... more OBJECTIVES Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) residents, relatives, and caregivers. Sometimes, when extreme neuropsychiatric symptoms are considered refractory, continuous palliative sedation is administered. The aim of this study was to explore the trajectory leading to continuous palliative sedation and its administration in NH residents with dementia and refractory neuropsychiatric symptoms. DESIGN A qualitative interview and explorative study was performed. SETTING AND PARTICIPANTS Relatives, older adult care physicians, and other staff members involved with 3 NH residents with dementia and extreme refractory neuropsychiatric symptoms who received continuous palliative sedation were interviewed. These NH residents lived on dementia special care units of 3 NHs in the Netherlands. METHODS Consecutive sampling was used to select participants. Medical files were studied. Semistructured interviews were conducted. Transcriptions were analyzed...

Research paper thumbnail of De Plezierige-Activiteiten-Methode na een beroerte

Na een beroerte ontwikkelen veel mensen depressieve klachten. Uit een pilotonderzoek blijkt dat d... more Na een beroerte ontwikkelen veel mensen depressieve klachten. Uit een pilotonderzoek blijkt dat de Plezierige-Activiteiten-Methode deze klachten mogelijk kan voorkomen. Deze methode is eerder effectief gebleken voor mensen met dementie. Nu is de bruikbaarheid ervan onderzocht voor de begeleiding van mensen na een beroerte, die verblijveen op revalidatie- en somatische verpleeghuisafdelingen. (aut.ref.)

Research paper thumbnail of Influenzavaccinatie in Verpleeghuizen

Vox Hospitii, 1995

The immunization rate (1993-1994) in 50 nursing homes and the knowledge and opinions about influe... more The immunization rate (1993-1994) in 50 nursing homes and the knowledge and opinions about influenza vaccination of 146 physicians working in these nursing homes, were studied. Relations between immunization rate and factors of influence on this rate (knowledge and opinions about influenza vaccination, 'function' and 'experience') are described. Understanding of these relations can lead to recommendations for achieving an optimal immunization rate in Dutch nursing homes

Research paper thumbnail of 210 - Palliative Care in Dementia

International Psychogeriatrics, 2020

Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-... more Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-residents, relatives and caregivers. When conventional treatments are ineffective or have intolerable side effects, extreme NPS can be considered refractory. In these situations, continuous palliative sedation (CPS) is sometimes administered. We explored the trajectory leading to CPS and its application in NH-residents with dementia and refractory NPS.Methods:A qualitative interview study was performed in 2017. Relatives, elderly care physicians and other staff members involved with three NH-residents with dementia and extreme refractory NPS who received CPS were interviewed. These NH-residents lived on dementia special care units of three NHs in the Netherlands. We used consecutive sampling to select participants. Medical files were studied. Semi-structured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis.Results:Nine in...

Research paper thumbnail of Pharmacotherapy audit meetings (PTAMs) using quality circles: A cost-effective strategy to improve guideline adherence in nursing homes? Study protocol

International Psychogeriatrics, 2011

The designed hour traffic volume is an important parameter in the construction of highway toll st... more The designed hour traffic volume is an important parameter in the construction of highway toll station. It is usually calculated by using the ratio of the 30th traffic volume and annual average daily traffic volume. Based on toll data of Shaanxi highway, the method of calculating 30th hour traffic volume was improved in the paper. After deducting the national legal holiday period for the free passage of small passenger cars，the ratio of hourly traffic volume in smooth and annual average daily traffic was obtained as the designed hour traffic volume coefficient. This algorithm is more scientific and accurate and easy to implement. It meets the requirement of highway toll station traffic volume forecast.

Research paper thumbnail of Continuous palliative sedation in nursing home residents with dementia suffering from extreme refractory BPSD symptoms: A qualitative study

Alzheimer's & Dementia, 2020

BPSD are highly prevalent in nursing home (NH) residents with dementia. Sometimes these BPSD are ... more BPSD are highly prevalent in nursing home (NH) residents with dementia. Sometimes these BPSD are very severe or even extreme resulting in the application of continuous palliative sedation (CPS) CPS is defined as “the deliberate lowering of a patient’s level of consciousness in the last stages of life”. The aim of this study was to explore the trajectory leading to CPS and its application NH‐residents with dementia and case of so called ‘refractory BPSD’.

Research paper thumbnail of ANW-diensten tijdens de opleiding: Leerzaam voor aios, risico voor patiënt?

Opleiden is balanceren: aan de ene kant moet de aios voldoende vrijheid en zelfstandigheid krijge... more Opleiden is balanceren: aan de ene kant moet de aios voldoende vrijheid en zelfstandigheid krijgen, aan de andere kant moet de patientveiligheid niet in gevaar komen. In ANW-diensten kan dit extra spannend zijn voor aios en opleider. De auteurs geven een overzicht van de beschikbare literatuur over supervisie tijdens de vervolgopleidingen en geven een aantal aanbevelingen voor verbeterde supervisie tijdens ANW-diensten.

Research paper thumbnail of Symptom based and transmission-prevention based testing in long-term care facilities: Symptomatology, clinical course and mortality for residents with COVID-19

ObjectivesInitially, for preventing COVID-19 transmission in long-term care facilities (LTCF) pri... more ObjectivesInitially, for preventing COVID-19 transmission in long-term care facilities (LTCF) primarily rely on presence of core symptoms (fever, cough, dyspnea), but LTCF residents may also show an atypical course of a SARS-CoV-2 infection. We described the clinical presentation and course of COVID-19 in LTCF residents who were tested either because of presence of core symptoms (S-based) or because of transmission prevention (TP-based)DesignRetrospective cohort study.Setting and participantsAmsta (Amsterdam, The Netherlands), is a 1185-bed LTCF. All LTCF residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 were included (n = 380).MeasuresClinical symptoms, temperature and oxygen saturation were extracted from medical records, 7 days before testing up to 14 days after testing.ResultsSARS-CoV-2 was confirmed in 81 (21%) residents. Of these 81, 36 (44%) residents were tested S-based and 45 (56%) residents were tested TP-based. Yet, CT-values did no...

Research paper thumbnail of Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial

BMC Geriatrics, 2020

Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing home... more Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing homes (NHs) is common. Typical clinical scenarios in which antibiotics are inappropriately prescribed include response to nonspecific signs and symptoms and/or a positive urine test in the absence of symptoms referable to the urinary tract. These and other scenarios for inappropriate antibiotic prescribing were addressed in a recent international Delphi study which resulted in the development of a decision tool for the empiric treatment of UTI in frail older adults. The aim of the current study is to implement this decision tool, by integrating it into the electronic health record (EHR) and providing education on its content and use, and to evaluate its effect on appropriate antibiotic prescribing. An additional aim is to evaluate the quality of the intervention and the implementation process. Methods A cluster Randomized Controlled Trial (cRCT) is conducted in sixteen NHs and aims to includ...

Research paper thumbnail of Language as an Application of Mindfulness

Journal of the American Medical Directors Association, 2018

Research paper thumbnail of A Review of Pain Prevalence in Alzheimer's, Vascular, Frontotemporal and Lewy Body Dementias

Dementia and geriatric cognitive disorders, 2016

Numerous studies have reported on pain in dementia. It has been hypothesized that pain perception... more Numerous studies have reported on pain in dementia. It has been hypothesized that pain perception differs between dementia subtypes, and therefore, the prevalence of pain differs between dementia subtypes. However, there remains a paucity of evidence on the differences in the prevalence of pain in different dementia subtypes. This review aimed to determine the prevalence of pain for the major dementia subtypes: Alzheimer's disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD) and dementia with Lewy bodies (DLB). We found 10 studies that met our inclusion criteria. Most of these studies reported on AD; studies reporting the prevalence of pain in people with DLB were scarce, and for FTD, we found no studies. The sample-weighted prevalence of pain could only be calculated for AD, VaD and mixed dementia: AD 45.8% (95% confidence interval, CI: 33.4-58.5%), VaD 56.2% (95% CI: 47.7-64.4%) and mixed dementia 53.9% (95% CI: 37.4-70.1%). Studies investigating the prevalence...

Research paper thumbnail of From Admission to Death: Prevalence and Course of Pain, Agitation, and Shortness of Breath, and Treatment of These Symptoms in Nursing Home Residents With Dementia

Journal of the American Medical Directors Association, Jan 23, 2015

Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality o... more Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality of life. We explore the course of symptoms and their treatment during nursing home stay to help target adequate symptom management. Data were collected as part of the Dutch End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up. Physicians performed assessments at baseline, semiannually, and shortly after death of pain, agitation, shortness of breath, and treatment provided for these symptoms. Long-term care facilities (28) in the Netherlands. Newly admitted nursing home residents (372) in variable stages of dementia. We described prevalence and course of symptoms, and treatment provided for these symptoms. We used generalized estimating equations to evaluate the longitudinal change in symptoms and their treatment, and the associations between the symptoms of pain and agitation, as well as between stage of dementia and symptoms. Pain was common...

Research paper thumbnail of Apathy: Risk Factor for Mortality in Nursing Home Patients

Journal of the American Geriatrics Society, 2017

To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementi... more To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementia special care (DSC) nursing home (NH) units. DESIGN: Longitudinal design, secondary analyses of a 2year, cluster-randomized trial with six measurements, approximately 4 months in between. SETTING: SC and DSC-units of Dutch NHs. PARTICIPANTS: NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371). MEASUREMENTS: Data were available for 713 NHpatients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale (AES-10) and applied as categorical variable using known cutoff scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. RESULTS: Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio (HR) = 1.77; 95% confidence interval (CI] = 1.35-2.31, P < .001). Results remained significant (HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ (P > .05) in the effect of apathy on mortality. Male gender (HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years (HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk (HR = 1.62, 95% CI = 1.40-1.88, P < .001). CONCLUSIONS: Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population.

Research paper thumbnail of Pneumonia, Intake Problems, and Survival Among Nursing Home Residents With Variable Stages of Dementia in the Netherlands: Results From a Prospective Observational Study

Alzheimer disease and associated disorders, Jan 15, 2016

We explored how pneumonia and intake problems affect survival in nursing home residents in variab... more We explored how pneumonia and intake problems affect survival in nursing home residents in variable stages of dementia. In a longitudinal observational study (372 residents) with up to 3.5 years of follow-up, we examined relationships between dementia severity, the development of pneumonia, intake problems, and mortality using joint modeling, Cox models, and mediation analyses. Dementia severity was measured semiannually with the Bedford Alzheimer Nursing Severity-Scale (BANS-S). The median BANS-S score at baseline was 13 (range, 7 to 28). Pneumonia occurred in 103 (28%) and intake problems in 126 (34%) of 367 residents with complete registration of pneumonia and intake problems. Compared with dementia severity, incident pneumonia and, even more so, incident intake problems were more strongly associated with mortality risk. Pneumonia and intake problems both mediated the relationship between more severe dementia and mortality. Developing pneumonia and intake problems affects surviva...

Research paper thumbnail of Changes in Care Goals and Treatment Orders Around the Occurrence of Health Problems and Hospital Transfers in Dementia: A Prospective Study

Journal of the American Geriatrics Society, Jan 21, 2016

To explore changes in care goals and treatment orders around the occurrence of pneumonia and inta... more To explore changes in care goals and treatment orders around the occurrence of pneumonia and intake problems, and whether hospitalization is in line with earlier agreed-upon do-not-hospitalize orders. Data were collected as part of the Dutch End of Life in Dementia study (2007-2011), a longitudinal observational study with up to 3.5 years of follow-up. Long-term care facilities (N = 28) in the Netherlands. Newly admitted nursing home patients (N = 372) in various stages of dementia. Semiannually, physicians completed questionnaires about care goals and treatment orders, and they continuously registered episodes of pneumonia, intake problems and hospitalization. We report on changes in care goals and treatment orders during follow-up in relation to the developing of pneumonia and intake problems and on hospitalization and reasons for hospitalization. The proportion of patients with palliative care goals and do-not-treat orders rose during follow-up, especially before death. Treatment...

Research paper thumbnail of De angstige patiënt

Research paper thumbnail of Bayesian Analyses Showed More Evidence for Apathy than for Depression Being Associated With Cognitive Functioning in Nursing Home Residents

Journal of the American Medical Directors Association, 2018

Objectives: Depression, apathy, and cognitive impairments are widespread in nursing home (NH) res... more Objectives: Depression, apathy, and cognitive impairments are widespread in nursing home (NH) residents. Scarce research that explicitly compares apathy to depression suggests that the association between apathy and cognitive functioning is stronger than the association between depression and cognitive functioning. This study in Dutch NH residents aimed to use Bayesian methods for comparing the evidence for the relationship of cognitive performance with apathy to that with depression. Design: Cross-sectional. Setting and Participants: Sixteen NH somatic care units (N ¼ 190 residents; mean age 77.2 years, standard deviation 12.9), and 17 dementia special care units (N ¼ 243 residents; mean age 82.8 years standard deviation, 6.8]). Measures: The Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were administered in residents for cognitive performance. Professional carers were interviewed for the Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Results: Regression models built with the BayesFactor package in R showed Bayesian factors (BFs) that implied extremely strong evidence in terms of the Jeffrey classification for the relationship of apathy with MMSE [standardized effect size, À0.57 (À0.66 to À0.48), BF ¼ 3.4Eþ28], and with FAB [À0.50 (À0.59 to À0.42), BF ¼ 3.0Eþ24]. Regarding depression, evidence was a minor fraction of that for apathy [MMSE, À0.17 (À0.27 to À0.06), BF ¼ 15.45; FAB, À0.12 (À0.22 to À0.02), BF ¼ 2.11]. The most evidence existed for the associations of apathy with MMSE orientation problems, especially orientation in time. Conclusions/Implications: The study implies that cognitive assessments are important to differentiate apathy from depression in NH residents both with dementia and without dementia. More research is needed to clarify whether disorientation in time is a specific cognitive marker of apathy that may be used to reduce false positive depression diagnoses. Ó 2018 AMDA e The Society for Post-Acute and Long-Term Care Medicine. Depression and apathy are among the most widespread neuropsychiatric conditions in nursing home (NH) residents. 1e4 Both conditions are associated with reduced functional status, 5,6 poor quality of life, 7,8 caregiver burden, 9-11 reduced cognitive performance, 12-16 and increased mortality. 17-19 Etiologic and nosologic overlaps may partially explain similar adversities found in studies on depression and apathy. For example, abnormalities in frontal subcortical circuits that are associated with reduced executive

Research paper thumbnail of Apathy and health-related quality of life in nursing home residents

Quality of Life Research, 2018

Purpose To explore the association between apathy and health-related quality of life (HRQoL) from... more Purpose To explore the association between apathy and health-related quality of life (HRQoL) from resident and proxy perspectives and whether cognition and depression moderate this relationship. Methods Secondary analyses with baseline data from a cluster randomized trial on the effects of a care program for depression in Nursing Homes (NHs) were conducted. For HRQoL, the Visual Analogue Scale (VAS) and the Dutch version of the European Quality of Life (EQ-5D) were administered to 521 NH residents, and to professional caregivers reporting from the perspective of the NH resident (Resident-Proxy) and from their own perspective (Proxy-Proxy). Utility scores (U) were calculated for the three perspectives. Apathy, depression, and cognition were measured using the 10-item Apathy Evaluation Scale, the Cornell Scale for Depression in Dementia, and the standardized Mini-Mental State Examination, respectively.

Research paper thumbnail of Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia

International Psychogeriatrics, 2017

Background: We studied the patient and non-patients factors of inappropriate psychotropic drug (P... more Background: We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia. Methods: In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug–drug interactions, drug–disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics. Results: The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxio...

Research paper thumbnail of Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents

International Journal of Geriatric Psychiatry, 2011

This study aims to test the accuracy of the Nijmegen observer-rated depression (NORD) scale, a ne... more This study aims to test the accuracy of the Nijmegen observer-rated depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia. This cross-sectional study with 103 residents with dementia (N = 19 depressed) and 72 residents without dementia (N = 10 depressed) was undertaken in 13 Dutch NH units. An elderly care physician and a psychologist of each unit assessed residents for the presence of clinical depression. Primary professional caregivers administered the NORD scale. Five of the six proposed items showed acceptable performance in screening for depression. Receiver operating characteristic analyses revealed significant areas under the empirical curve (AUC) for the 5-item NORD scale in the total sample (AUC = 0.83, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), as well as in residents with dementia (AUC = 0.84, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and without dementia (AUC = 0.84, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The cutoff score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 showed the highest sum of sensitivity (100) and specificity (69) in non-dementia and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 the highest sum of sensitivity (79) and specificity (77) in dementia. The cutoff score of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 showed the lowest negative likelihood ratio of 0.0 in non-dementia and of 0.2 in dementia. The highest positive likelihood ratios were found for the cutoff of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 in non-dementia (3.4) and for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 in dementia (26.5). The 5-item NORD scale showed acceptable accuracy comparable with those of more extensive scales in other studies. It is easy and quick to administer and can be used for screening of depression in NH residents with or without dementia.

Research paper thumbnail of Continuous Palliative Sedation in Nursing Home Residents With Dementia and Refractory Neuropsychiatric Symptoms

Journal of the American Medical Directors Association, 2020

OBJECTIVES Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) resident... more OBJECTIVES Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) residents, relatives, and caregivers. Sometimes, when extreme neuropsychiatric symptoms are considered refractory, continuous palliative sedation is administered. The aim of this study was to explore the trajectory leading to continuous palliative sedation and its administration in NH residents with dementia and refractory neuropsychiatric symptoms. DESIGN A qualitative interview and explorative study was performed. SETTING AND PARTICIPANTS Relatives, older adult care physicians, and other staff members involved with 3 NH residents with dementia and extreme refractory neuropsychiatric symptoms who received continuous palliative sedation were interviewed. These NH residents lived on dementia special care units of 3 NHs in the Netherlands. METHODS Consecutive sampling was used to select participants. Medical files were studied. Semistructured interviews were conducted. Transcriptions were analyzed...

Research paper thumbnail of De Plezierige-Activiteiten-Methode na een beroerte

Na een beroerte ontwikkelen veel mensen depressieve klachten. Uit een pilotonderzoek blijkt dat d... more Na een beroerte ontwikkelen veel mensen depressieve klachten. Uit een pilotonderzoek blijkt dat de Plezierige-Activiteiten-Methode deze klachten mogelijk kan voorkomen. Deze methode is eerder effectief gebleken voor mensen met dementie. Nu is de bruikbaarheid ervan onderzocht voor de begeleiding van mensen na een beroerte, die verblijveen op revalidatie- en somatische verpleeghuisafdelingen. (aut.ref.)

Research paper thumbnail of Influenzavaccinatie in Verpleeghuizen

Vox Hospitii, 1995

The immunization rate (1993-1994) in 50 nursing homes and the knowledge and opinions about influe... more The immunization rate (1993-1994) in 50 nursing homes and the knowledge and opinions about influenza vaccination of 146 physicians working in these nursing homes, were studied. Relations between immunization rate and factors of influence on this rate (knowledge and opinions about influenza vaccination, 'function' and 'experience') are described. Understanding of these relations can lead to recommendations for achieving an optimal immunization rate in Dutch nursing homes

Research paper thumbnail of 210 - Palliative Care in Dementia

International Psychogeriatrics, 2020

Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-... more Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-residents, relatives and caregivers. When conventional treatments are ineffective or have intolerable side effects, extreme NPS can be considered refractory. In these situations, continuous palliative sedation (CPS) is sometimes administered. We explored the trajectory leading to CPS and its application in NH-residents with dementia and refractory NPS.Methods:A qualitative interview study was performed in 2017. Relatives, elderly care physicians and other staff members involved with three NH-residents with dementia and extreme refractory NPS who received CPS were interviewed. These NH-residents lived on dementia special care units of three NHs in the Netherlands. We used consecutive sampling to select participants. Medical files were studied. Semi-structured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis.Results:Nine in...

Research paper thumbnail of Pharmacotherapy audit meetings (PTAMs) using quality circles: A cost-effective strategy to improve guideline adherence in nursing homes? Study protocol

International Psychogeriatrics, 2011

The designed hour traffic volume is an important parameter in the construction of highway toll st... more The designed hour traffic volume is an important parameter in the construction of highway toll station. It is usually calculated by using the ratio of the 30th traffic volume and annual average daily traffic volume. Based on toll data of Shaanxi highway, the method of calculating 30th hour traffic volume was improved in the paper. After deducting the national legal holiday period for the free passage of small passenger cars，the ratio of hourly traffic volume in smooth and annual average daily traffic was obtained as the designed hour traffic volume coefficient. This algorithm is more scientific and accurate and easy to implement. It meets the requirement of highway toll station traffic volume forecast.

Research paper thumbnail of Continuous palliative sedation in nursing home residents with dementia suffering from extreme refractory BPSD symptoms: A qualitative study

Alzheimer's & Dementia, 2020

BPSD are highly prevalent in nursing home (NH) residents with dementia. Sometimes these BPSD are ... more BPSD are highly prevalent in nursing home (NH) residents with dementia. Sometimes these BPSD are very severe or even extreme resulting in the application of continuous palliative sedation (CPS) CPS is defined as “the deliberate lowering of a patient’s level of consciousness in the last stages of life”. The aim of this study was to explore the trajectory leading to CPS and its application NH‐residents with dementia and case of so called ‘refractory BPSD’.

Research paper thumbnail of ANW-diensten tijdens de opleiding: Leerzaam voor aios, risico voor patiënt?

Opleiden is balanceren: aan de ene kant moet de aios voldoende vrijheid en zelfstandigheid krijge... more Opleiden is balanceren: aan de ene kant moet de aios voldoende vrijheid en zelfstandigheid krijgen, aan de andere kant moet de patientveiligheid niet in gevaar komen. In ANW-diensten kan dit extra spannend zijn voor aios en opleider. De auteurs geven een overzicht van de beschikbare literatuur over supervisie tijdens de vervolgopleidingen en geven een aantal aanbevelingen voor verbeterde supervisie tijdens ANW-diensten.

Research paper thumbnail of Symptom based and transmission-prevention based testing in long-term care facilities: Symptomatology, clinical course and mortality for residents with COVID-19

ObjectivesInitially, for preventing COVID-19 transmission in long-term care facilities (LTCF) pri... more ObjectivesInitially, for preventing COVID-19 transmission in long-term care facilities (LTCF) primarily rely on presence of core symptoms (fever, cough, dyspnea), but LTCF residents may also show an atypical course of a SARS-CoV-2 infection. We described the clinical presentation and course of COVID-19 in LTCF residents who were tested either because of presence of core symptoms (S-based) or because of transmission prevention (TP-based)DesignRetrospective cohort study.Setting and participantsAmsta (Amsterdam, The Netherlands), is a 1185-bed LTCF. All LTCF residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 were included (n = 380).MeasuresClinical symptoms, temperature and oxygen saturation were extracted from medical records, 7 days before testing up to 14 days after testing.ResultsSARS-CoV-2 was confirmed in 81 (21%) residents. Of these 81, 36 (44%) residents were tested S-based and 45 (56%) residents were tested TP-based. Yet, CT-values did no...

Research paper thumbnail of Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA): study protocol for a cluster randomized controlled trial

BMC Geriatrics, 2020

Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing home... more Background Antibiotic overprescribing for suspected urinary tract infection (UTI) in nursing homes (NHs) is common. Typical clinical scenarios in which antibiotics are inappropriately prescribed include response to nonspecific signs and symptoms and/or a positive urine test in the absence of symptoms referable to the urinary tract. These and other scenarios for inappropriate antibiotic prescribing were addressed in a recent international Delphi study which resulted in the development of a decision tool for the empiric treatment of UTI in frail older adults. The aim of the current study is to implement this decision tool, by integrating it into the electronic health record (EHR) and providing education on its content and use, and to evaluate its effect on appropriate antibiotic prescribing. An additional aim is to evaluate the quality of the intervention and the implementation process. Methods A cluster Randomized Controlled Trial (cRCT) is conducted in sixteen NHs and aims to includ...

Research paper thumbnail of Language as an Application of Mindfulness

Journal of the American Medical Directors Association, 2018

Research paper thumbnail of A Review of Pain Prevalence in Alzheimer's, Vascular, Frontotemporal and Lewy Body Dementias

Dementia and geriatric cognitive disorders, 2016

Numerous studies have reported on pain in dementia. It has been hypothesized that pain perception... more Numerous studies have reported on pain in dementia. It has been hypothesized that pain perception differs between dementia subtypes, and therefore, the prevalence of pain differs between dementia subtypes. However, there remains a paucity of evidence on the differences in the prevalence of pain in different dementia subtypes. This review aimed to determine the prevalence of pain for the major dementia subtypes: Alzheimer's disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD) and dementia with Lewy bodies (DLB). We found 10 studies that met our inclusion criteria. Most of these studies reported on AD; studies reporting the prevalence of pain in people with DLB were scarce, and for FTD, we found no studies. The sample-weighted prevalence of pain could only be calculated for AD, VaD and mixed dementia: AD 45.8% (95% confidence interval, CI: 33.4-58.5%), VaD 56.2% (95% CI: 47.7-64.4%) and mixed dementia 53.9% (95% CI: 37.4-70.1%). Studies investigating the prevalence...