Pilot behavioral changes in homes for the elderly.

Little is known about the prevalence of behavioural problems in homes for the
elderly. Little is known about the prevalence of delirium, depression and
dementia in relation to behavioural changes. For the feasibility of future
studies about extensive diagnostic methods and prognosis in these cases, more
information about prevalence and incidence is needed. The hypothesis is that
the prevalence and incidence found in this study will be higher than prevalence
found by the GP in usual care.

Primary objectives:
This is a pilot study. The main objective is to investigate the feasibility of
the study. This feasibility will be tested by estimating: 1. the percentage of
inclusion, 2. the incidence of behavioural changes for which the GP is
consulted. The incidence behavioural changes found will be influenced by the
cooperation of the geriatric nurses and the GP*s.

Secondary objective is to investigate the prevalence of behavioral changes at
baseline and the prevalence and incidence of symptoms of delirium, depression
and dementia associated with these behavioral changes.

About eighty inhabitants of one home for the elder in the city of Groningen
will be asked to participate in this study. At baseline all inhabitants who
signed an informed consent will be tested with a MMSE (mini mental state
examination), a GDS-8 or a CSDD (Geriatrc depression scale, Cornell scale of
depression in dementia) and a CAM (confusion assessment method).
During the 3 following moths all inhabitants who show a new behavioural change
for which the geriatric nurse decides to ask the GP for a house-visit, will be
reported to the investigators. After that the investigators will fill in an
NPI-Q ( Neuro-psychiatric inventory- questionnaire) asking the geriatric nurse
about the behavioural changes they observed. The inhabitant will be tested
again using the MMSE, GDS or CSDD and CAM. The results of this testing will
not be reported to the GP. The GP will perform 'care as usual'.
After three months the investigator will check with the participating GP's for
their diagnoses in the patients that showed behavioural changes.

The nature of the burden for participants in this study is a one-time visit of
an investigator for baseline testing. For some participants, who show
behavioural changes during the following three months, there will be a second
visit for testing. During these visits participants are asked to conduct a MMSE
and to answer 8 yes/no questions about depressive symptoms (GDS-8). This will
take about 30-45 minutes of their time. The other tests are observational tests
that are filled in after the interview with help of observations of the
geriatric nurses. This will be no burden to the participant. Taking this test
and answering those 8 questions can in some cases cause a little tiredness or
maybe a slight feeling of disturbance with the participant.
The participant will receive care as usual from his or her own GP. I think
that this investigation is no risk for the participants. The investigations are
quite similar to the tests the own GP will sometimes perform during usual care.