Multi-Sensory Stimulation in 24-hour Dementia Care - Nivel

ecomes less common after age 75, while the incidence of Alzheimer’s disease
continues to rise (APA, 1997). The relationship between Alzheimer’s disease and
vascular dementia is complex, because recent evidence suggests that small strokes
may lead to increased clinical expression of Alzheimer’s disease (Snowdon et al.,
1997).
The remaining types of dementia account for a much smaller fraction of the total
(APA, 1997). Other types of dementia are for instance dementia due to Lewy body
disease, dementia due to Parkinson’s disease, dementia due to Pick’s disease and
other frontal lobe dementias, dementia due to Huntington’s disease or Creutzfeldt-
Jakob disease, and dementia due to medical conditions (e.g., structural lesions, head
trauma, endocrine conditions, nutrition conditions).
Dementia is often accompanied by behavioural and psychological disturbances that
can be highly problematic for patients and caregivers. The International Psychogeriatric
Association has defined Behavioural and Psychological Symptoms of
Dementia (BPSD) as ‘signs and symptoms of disturbed perception, thought content,
mood or behaviour that frequently occur in patients with dementia’ (APA, 1997).
BPSD, such as aggression, agitation, depression or apathy, occur and are problematic
in up to 97 percent of the cases (Buettner et al., 1996).
Dementia in nursing homes
Mental and functional loss forces a large number of elderly people with dementia to
move to nursing homes. A nursing home is defined as an institution providing
nursing care 24 hours a day, assistance with activities of daily living and mobility,
psychosocial and personal care, paramedical care, such as physiotherapy and
occupational therapy, as well as room and board. Nursing homes usually provide care
that can be characterised as the ‘highest level of care’ (Ribbe et al., 1997). In the
Netherlands there are 330 nursing homes, with a total of 57,000 beds (27 per 1000
inhabitants aged 65 and older). About 2.5% of the population above 65 years stay in
nursing homes and another 6.5% in residential homes or homes for the aged with a
lower level of care (Ribbe et al., 1997). The Dutch nursing home is a healthcare
institution for chronically ill persons in need of permanent complex nursing care and
is comparable to skilled nursing facilities in the United States. It differs from nursing
homes in other countries in that the staff includes nursing assistants, specially
trained nursing home physicians, psychologists, activity therapists, speech therapists,
physical therapists, nutrition assistants, and others, all of whom are employed by the
nursing home (Hoek et al, 2000). Medical care is provided by specially trained
physicians, who are employed by the nursing home, with an average ration of one
full-time doctor per 100 beds (Ribbe et al., 1997). Residents are admitted to nursing
homes for several reasons: 50% require long-term institutional care, 40% use
predominantly rehabilitative services, 5% have a terminal illness and another 5%
Introduction 11