The goal of this study is to evaluate whether the Cognitive Model for Behavioral Interventions (CoMBI), a person-centered, non-pharmacological intervention, can reduce behavioral and psychological symptoms of dementia (BPSD) in people with dementia living in nursing homes. The study also aims to examine whether CoMBI can reduce caregiver burden and improve quality of life in people with dementia.
The main questions it aims to answer are:
Does CoMBI reduce the severity of behavioral and psychological symptoms of dementia compared to care as usual?
Does a reduction in BPSD lead to lower caregiver burden and improved quality of life for people with dementia?
Do personal factors, such as personality (dys)functioning, gender, level of cognitive impairment and stage of dementia, influence the effectiveness of CoMBI?
Researchers will compare CoMBI to care as usual to determine whether CoMBI leads to better outcomes for people with dementia and their caregivers.
Participants will:
Receive care in residential long-term care facilities where care staff are trained to apply CoMBI.
Be observed and assessed repeatedly over time as part of a stepped-wedge cluster randomized trial design.
Being a resident in a participating nursing home
Having a formal diagnosis of neurocognitive disorder (NCD) accord-ing to DSM-5-TR (e.g. Alzheimer's disease, NCD with Lewy Bodies, Vascular NCD, …) or a medical record indicating probable dementia
Presence of one or more BPSD symptoms at moment of inclusion in the study (measured with the NPI-Q at baseline). Symptoms measured by the NPI-Q include delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, euphoria/elated mood, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, nighttime behavior disturbances/sleep disturbances, and changes in appetite and eating behavior.
Primary caregivers (i.e. nurses providing daily care) and patient's representative and/or a close relative/friend (i.e. informant who will fill in the premorbid personality questionnaire) are proficient in Dutch (i.e., are able to fill in the questionnaires)
None
Single group
CoMBI
BehavioralCoMBI describes a four-step approach. First, the primary caregiver systematically observes and assesses the resident's BPSD using the NPI-Q. Second, the person's core needs are identified. An informant completes the PID-5-BF+M. The results of the PID-5-BF+M together with the overview of the different personality types, help identify the resident's core needs. Third, the care team selects one core need based on the most prominent and challenging BPSD. They choose a maximum of three interventions, which can focus on the substantive contact, attitude and environment of the resident. Finally, The selected interventions are further specified and personalized so that they are appropriate for the person with dementia, taking into account their life history This is documented in a CoMBI care plan, specifying which interventions will be applied and the desired behavioral outcomes.
Neuropsychiatric Inventory - Questionnaire (NPI-Q)
The Neuropsychiatric Inventory - Questionnaire (NPI-Q) (de Jonghe et al., 2003; Kaufer et al., 2000) is a validated informant evaluation of BPSD measuring severity (rating 0-3) and caregiver distress (0-5) of 12 BPSD domains (delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, motor disturb-ance, nighttime behaviors, appetite/eating).
Qualidem
The Qualidem (Ettema et al., 2007) is a forty-item validated behavior observation-scale for patients (i.e. nursing homes) with up to severe dementia and can be administered in 15 minutes. Nine sub-scales (care relationship, positive affect, negative affect, restless tense behavior, positive self-image, social relations, social isolation, feeling at home, having something to do) provide a QoL-profile that can be used to evaluate the effects of intervention.
Montreal Cognitive Assessment (MoCA)
The MoCA is a brief (10-15 minute) 30-point cognitive screening instrument which has been prov-en useful in identifying cognitive symptoms associated with dementia.
the Global Deterioration Scale
The GDS, describes clinical characteristics (e.g., memory, sleep, social impairment) for stages of cognitive function for those suffering from a primary degenerative dementia. Primary caregivers estimate the level of where an individual is in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS stage descriptions.
the Level of Personality Functioning-scale brief form 2.0 informant version (LPFS-BF 2.0)
Higher total scores indicate higher dysfunctioning.
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Vrije Universiteit Brussel
Lead sponsor
Alexianen Zorggroep Tienen
Collaborator
woonzorggroep Begralim
Collaborator
Mondriaan GGZ
Collaborator
