Meeting centres for people with dementia and their informal caregiver(s)

Warum wurde diese Initiative implementiert?

In the last decades, several initiatives have been developed to support the growing number of dementia patients and their informal carers, such as psycho-geriatric day care, discussions groups and respite care. Because these activities are fragmented, do not fit individual needs and focus on either the client or the informal carer, the department of psychiatry of the Vrije Universiteit medical centre (VUmc) in Amsterdam developed the Meeting Centre support programme, that integrates different types of care for both the client and the informal carer, to supports them in coping with the adaptive tasks they encounter as a result of the dementia. The Amsterdam model was offered as an experiment between 1993 and 1996 in several locations in Amsterdam and offered on a structural basis from the year 1997. At this moment, more than 60 Meeting Centres are operational across the Netherlands, almost half of them in the region around Amsterdam.

Beschreibung

Meeting Centres are based on the Amsterdam Model that was first implemented as an initiative of the VUmc. They are located in socio-cultural community centres and easily accessible. A small permanent professional staff offers a wide range of activities for clients with mild to moderately severe dementia, three days a week:

• recreational and social activities, such as reading the newspaper, painting, singing, preparing lunch and shopping, in the form of group activities or adapted to the individual preferences,
• training and therapy, such as reminiscence, psychomotor therapy and music therapy.

For their informal carers they offer:

• eight to ten informative meetings,
• bi-weekly discussion groups,
• assistance in practical, emotional and social problems.

For both clients with dementia and their carers they offer:

• weekly consulting hours,
• social festivities and excursions.

Staff collaborate with all relevant health and welfare services. Some Meeting Centres received a start-up subsidy from the municipal or provincial authorities. In other cases, the initiating organisations financed the first phases of the Meeting Centres. In most cases, structural funding comes from regional care insurers. Some Meeting Centres ask a small contribution for coffee, tea, lunch and birthdays. Small variations exist between the Meeting Centres. They differ in the frequency the activities are offered, education of staff, ways of funding and client characteristics.

Welche Effekte wurden erzielt?

Compared to psycho-geriatric day-care, where the family carers are only marginally involved, Meeting Centres offer a support programme which integrates practical, emotional and social support for both client and informal carer, based on the adaptation-coping model and types of support that had been proven effective in practice or research.

Several quasi-experimental studies were conducted to compare these two types of support in two matched groups of persons with mild to moderately severe dementia and their family carers. Measurements were executed at baseline and after three and seven months of support. The clients visiting Meeting Centres showed less inactivity, less non-social behaviour (Dröes, 2000; 2004b) and less depressive symptoms and a higher self-esteem (Dröes, 2004b) than clients in regular day-care. Their informal caregivers experienced more support, had an increased feeling of competence (Dröes, 2004a), felt less burdened and especially benefitted more when feeling lonely (Dröes, 2006). The time to nursing home admission was much higher in the Meeting Centres group (Dröes, 2004a; 2006), which is not only a positive effect for the client and carer, but also decreases health care costs. These effects were found in the original Meeting Centres in Amsterdam, as well as other Meeting Centres in the Netherlands. Some of the effects occur especially after seven months of participation, which is an argument in favour of long term support.

Worin bestehen die Stärken und Schwächen der Initiative?

Strengths

• Integration of care for the demented person and the informal carer, fitting their individual needs.
• The clients visiting Meeting Centres show less depressive symptoms.
• Caregivers visiting Meeting Centres experience more support and feel less burdened.
• Admissions to nursing homes are postponed. 

Weaknesses

• Not every Meeting Centre receives structural funding. 
• Dementia clients and their informal caregivers can only visit Meeting Centres when health insurance approval is present.

Opportunities

• Young people with Alzheimer’s disease generally do not visit day-care because of the high average age. These people do tend to visit Meeting Centres in community centres that are visited by people of all ages. 

Threats

• Meeting Centres require cooperation from organisations and sectors that have possibly not yet worked together.
• The surplus value of the Meeting Centres is not yet clear to everyone.

Impressum

Links zu anderen INTERLINKS-Initiativen

• Athens Association of Alzheimer Disease and Related Disorders (AAADRD)

Externe Links und Literatur

References:

• Dröes RM, Breebaart E, Tilburg W van, GJ Mellenbergh. The effect of integrated family support versus day care only on behavior and mood of patients with dementia. International Psychogeriatrics, 2000;12(1):99-116.
• Dröes RM, Breebaart E, Meiland FJM, Tilburg W. van, Mellenbergh GJ. Effect of Meeting Centres Support Programme on feeling of competence of family caregivers and delay of institutionalization of people with dementia. Aging & Mental Health, 2004a;8(3):201-211.
• Dröes RM, Meiland FJM, Schmitz M, Tilburg W. van. Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood of persons with dementia: results from a multi-centre implementation study. International Journal of Geriatric Psychiatry, 2004b;19:1-12.
• Dröes RM, Meiland FJM. Schmitz MJ, Tilburg W van. Effect of the Meeting Centres Support Program in informal carers of people with dementia: Results from a multi-centre study. Aging & Mental Health 2006;10(2):112-24.

  Websites:

• www.ontmoetingscentradementie.nl (in Dutch)

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