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Depression in dementia: development and testing of a nursing guideline.

Verkaik, R. Depression in dementia: development and testing of a nursing guideline. Utrecht: NIVEL, 2009. 246 p. Proefschrift Universiteit Utrecht.
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Guideline for pleasure in dementia care

Depression in nursing home residents with dementia can be decreased by the introduction of a nursing guideline. This is the main conclusion of the PhD thesis on depression in dementia that was presented by researcher Renate Verkaik on April 20th at the Utrecht University in The Netherlands.

On Dutch psychogeriatric nursing home wards 85% of the residents is demented and 19% suffers from comorbid depression. Depression decreases quality of life and residents utilize more care. NIVEL researcher Renate Verkaik searched for a method to reduce depression in demented nursing home residents. She came up with a guideline for Certified Nurse Assistants (CNAs) because they provide most of the residents’ daily care. In collaboration with nursing home Waerthove, Verkaik developed the evidence based guideline ‘Supporting residents with depression in dementia’ (NIVEL, Waerthove, 2004). As a next step Verkaik – in collaboration with VU University Medical Center Amsterdam and INHolland University of Applied Sciences – tested the introduction, use and effects of the guideline in nine Dutch nursing homes.

Individualized
The guideline proved applicable in daily practice. Most of the residents in nursing homes that used the guideline became less depressed. Verkaik: “We found indications that the more successful the guideline was introduced, the more residents gained from it”. CNAs learned how they could systematically collect information on pleasant activities that fitted best with the individual residents, like listening to favourite music or taking a walk in the garden. CNAs, for example, look back at residents’ hobbies in the past. Doing this they take into account current limitations of the residents.

Singing together
Verkaik: “It often concerns small pleasant activities, like singing together, playing a game, polishing nails….. But also going to the mall or taking a small group of residents to the local pub, can reduce depression in dementia. Many CNAs state that undertaking pleasant activities does not have to cost much time. Many can be integrated into daily usual care. Sometimes family members or voluntary workers can be involved. Following the guideline is mainly about looking at depression in dementia from a different perspective. Be aware of the consequences of depression for a resident and what you, as a CNA, can do about it”. The guideline was based on the ‘BehaviorTherapy-PleasantEvents’ method that earlier proved to be effective in reducing depression in home dwelling people with dementia in the United States (Teri et al., 1997).

The study was funded by ZonMW; Netherlands Organisation for Health Research and Development, research program ‘Nursing professions; In between knowing and acting’.

Teri L, Logsdon RG, Uomoto J et al. Behavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci, 1997; 52:159-66