Improving Mental Health by Sharing Knowledge
Vroege interventies voor mensen met dementie en hun hall mantelzorgers Anne Margriet Pot Hoogleraar Ouderenpsychologie, VU Amsterdam, Programmahoofd Ouderen Trimbos-instituut
Jaarcongres Verenso 25 november 2011
Some facts in the Netherlands 1. Estimation: 230,000 persons with dementia 690,000 family caregivers 2. Almost 1:4 depressive disorder 3. Mostly psychoeducation (a.o. groups or Alzheimers cafés) or respite care 4. Increase knowledge + decrease burden
Vroege interventies voor mensen met dementie en hun mantelzorgers Onderzoekslijn: ontwikkeling vroege evidence-based interventies • GPS (Pot et al., Mental health & Aging, 2011) • Dementie de baas (www.dementiedebaas.nl www.masteryoverdementia.com) • Trainingsprogramma voor in de thuissituatie • Innovatieve dyadische interventie • Indicatie voor drie activerende interventies
www.masteryoverdementia.com
ONLINE STEPPED CARE
•information •screening •tailor made advise •selfhelp (+) •diagnostics •short interventions •treatment •selfmanagement
•relapse prevention •care
PREVENTION
TREATMENT
CARE
E-mental health Trimbos-institute Educational sites •Drugsinfo.nl •Steunpunt.uitgaanendrugs.nl •DGSG.nl •ZegNeederland.nl •Rokendrinkendrugs.nl (+) •Uwkindenalcohol.nl (+)
Interactive: selfhelp Interactive: guided self-help •Kleurjeleven.nl •Gripopjedip.nl •Sterkopjewerk.nl •Kopstoring.nl •Minderdrinken.nl •KopOpOuders.nl •Geenpaniek.nl •Happyles.nl •Mentalfitness.nl •Dementiedebaas.nl •Boostyourmood.nl
•Infectieziekten.net •Sickofit.nl
6
Computer & Internet usage older adults Netherlands • Total population (16.7 million): 90% • >=65 yr (2,6 million): about 65% Source: Internet World Stats + CBS
E-mental health interventions for family caregivers
• • • •
Promising Effect on depressive symptoms Improvement copingstrategies Decrease burden (Mann-Poll, De Lange & Pot, 2007)
Site map
Characteristics caregiver zorg stress model
zorg stress model
Disease
appraisal
support coping
mental health problems
Effective psychological interventions • • • • •
Individual interventions Cognitive Behavior Therapy Interactive psycho-education Improvement coping strategies Combination individual and groupsupport
Pinquart & Sörenson. Int Psychogeriatr 2007:18;577-95; Gallagher-Thompson & Coon. Psychol Aging 2007:22;3751; Selwood A et al. J Affect Disord 2007:101; 75-89.
'Mastery over dementia' • • • • •
Psycho-education Relaxation Cognitive Behavior Therapy Problemsolving Therapy Assertiveness training
• Support from a coach (health care professional)
Feasibility and (cost)effectiveness )
Feasibility Masteryoverdementia.com Caregiver characteristics at baseline (N=88)
• • • •
Sexe: 67% female, 33% male Average age: 62.5 years (33-87) Relationship: 66% partner, 34% child(-in-law) Living situation: 68% in same household Carereceiver characteristics at baseline (N=88)
• Sexe: 57% female, 43% male • Age care receiver: 76.5 (55-93)
Caregiver characteristics at baseline (N=88)
Trainingsprogramma voor in de thuissituatie
Effects of combined intervention programmes for people with dementia living at home and their caregivers Smits et al. Int J Geriatr Psychiatry. 2007 Dec;22(12):1181-93.
22 programma's: • Best results on general mental health • Other outcomes often modest and varying results • Effects on the cognitive and physical functioning, behavioural problems and survival of the persons with dementia were modest and inconsistent • Mental health positively affected and admittance to long stay care often delayed
Trainingsprogramma
Beweging en mantelzorgondersteuning Studie Teri: - Wat - Doel - Resultaat
: gecombineerde interventie : verbeteren stemming en lichamelijke conditie : significante verbetering stemming en lichamelijke conditie in AD-patient
Trainingsprogramma Huidige studie vs studie Linda Teri: - trainingsprogramma geschikt maken aan NL situatie - toevoegen nieuwe uitkomstmaten: cognitie / lichamelijke gezondheid persoon met dementie - effect stemming mantelzorger - ontwikkeling protocol
INTAKE SCREENING EXCLUSION: exclusion criteria met / not meeting inclusion criteria
WEEK 0: ASSESSMENT I – BASE LINE
RANDOMIZATION
INTERVENTION: TRAINING PROGRAM
CONTROL GROUP: CARE AS USUAL
WEEK 13: ASSESSMENT II – POST-TREATMENT
WEEK 25: ASSESSMENT III – FIRST FOLLOW UP MEASUREMENT
1 YEAR: ASSESSMENT IV – SECOND FOLLOW UP MEASUREMENT
Thuisprogramma AJC Prick & AM Pot
THUISPROGRAMMA menden met dementie & hun mantelzorger: - Beweging: 30 minuten actief bewegen gedurende min. 3 dagen per week (balans / rek, strek / flexibiliteit etc) - Mantelzorgondersteuning: psycho-educatie: leren omgaan met dementie / communicatie / plezierige activiteiten
BEZOEK COACH (8 sessies): Wekelijks bezoek MAAND 1
2-wekelijks bezoek
MAAND 2
2-wekelijks bezoek
MAAND 3
Bewegingsprogramma
Bewegingsprogramma Dementie: • • • •
Warm-up / cool-down: flexibiliteit verhogen / voorkomen spierblessures Krachtoefeningen: kracht benen versterken / zelfstandig wandelen Evenwichtsoefeningen: minder valpartijen / /aankleden Uithoudingsoefeningen: humeur / algemene fysieke welzijn verbeteren
Stukje film bewegingsprogramma
More information: Anne Margriet Pot E-mail:
[email protected] Twitter: ampot1 Linkedin: Anne Margriet Pot www.masteryoverdementia.com
