J.L. MacNeil Vroomen
- Clinical, economic and methodological studies in elderly patients with dementia and their informal caregivers
S.E.J.A. de Rooij
H.P.J. van Hout
- Award date
- 11 September 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
The first part of the thesis reviewed the definition of crisis in the context of dementia care and evaluated personal-level characteristics associated with location of death for persons with dementia based on Statistics Netherlands datasets.
The second part of the thesis evaluated outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group) by a prospective, observational, controlled, cohort study. The primary outcomes were the Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric Inventory (NPI) and psychological health in informal caregivers as measured with the General Health Questionnaire (GHQ-12). Secondary outcomes included care and support needs, quality of life, and institutionalization. No significant differences in changes in total NPI or GHQ-12 scores between the groups over 2 years were found. Secondary outcomes showed better quality-of-life scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet care needs were significantly less in the ICMM compared with the control group. The economic evaluation provided preliminary evidence that the ICMM is cost-effective compared to groups without access to case management and the LM.
The last part of the thesis investigated which multiple imputation strategy was most appropriate to use for missing cost-effectiveness data in randomized controlled trials. We recommend the use of the Log multiple-predictive mean matching with its ease of use and its reliable results related to increased amounts of missing data.
- Research conducted at: Universiteit van Amsterdam