Mild cognitive impairment and early stage dementia: Assessment and treatment of everyday functioning

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the influenza vaccine. The pneumococcal and tetanus vaccination coverage of the investigated population is low. GPs are often not aware of the vaccination status of their patients. The information on vaccination status given by patients, their family members and their GPs is not concordant. The use of vaccine registration cards for patients and electronic medical records by GPs is associated with a higher vaccination coverage. Conclusions.– Vaccination coverage in older patients is low. Improving the knowledge on vaccine recommendations in older persons and their family members and a centralized registration of vaccination status for and by GPs could improve the vaccination status of older persons. http://dx.doi.org/10.1016/j.eurger.2012.07.395 O032

Outcomes and effectiveness of pneumococcal vaccine M. Cankurtaran Geriatric Medicine, Hacettepe University Medical Faculty, Ankara, Turkey Introduction.– The burden of pneumococcal disease is high and increasing among elderly but there are some doubts about the effectiveness and efficacy of the pneumococcal vaccines especially in this group. There are 3 different vaccines for elderly pneumonia prevention; 23-valent polysaccharide pneumococcal vaccine (PPV), 7-valent pneumococcal conjugate vaccine (PCV-7) and 13-valent pneumococcal conjugate vaccines’ (PCV-13). Methods.– Very few clinical studies are present at the moment regarding the effectiveness and cost-effectivity of these vaccines in the elderly. PPV studies were generally nonrandomized, observational studies, and its effects on the occurrence of CAP have not been ascertained. Cost-effectiveness models are used in some studies for this purpose with PCV 13 with age-specific epidemiologic data and health-care utilization and costs. Costs, life-years gained (LYGs), quality-adjusted life-years, and incremental cost-effectiveness ratios (ICERs) are used in these models. Results.– The effectiveness of the previous vaccines were lower than expected and the experience and literature with PCV-13 is increasing and there are ongoing studies with it. Polysaccharide vaccine causes inadequate protection against non-bacteremic pneumonia, while the benefit against invasive pneumococcal disease in highrisk population is not clear. There is also an increasing focus on economic aspects, particularly cost-effectiveness ratios especially with PCV 13 which is highly effective for adults. Conclusion.– Pneumococcal vaccination recommendations for elderly adults is very crucial. Conjugate vaccines due to their superior immunogenicity, could also be offered more for adult vaccination, but still there are certain issues that needs to be clarified. PCV 13 seems to have potential to be more effective in elderly but we need to wait for the ongoing studies about the outcomes and effectivity of PCV13 in elderly. http://dx.doi.org/10.1016/j.eurger.2012.07.396 O033

Do we need to update the pneumococcal vaccine guidelines for midlife and older adults? M. Paccalin France Community acquired pneumonia is one of the most frequent hospital discharge diagnosis. It remains an increasing problem among the elderly (impaired gag reflex, decreased mucociliary function, waning immunity) according to what Osler considered as the

special enemy of old age. Studies show that the incidence rose five-fold as age increased from 65–69 to ≥ 90. Hospital mortality increases with age, as does impairment of functional status. Pneumococcal vaccine has been available for years with limited impact to prevent invasive disease but efficiency to decrease hospitalizations and mortality. Still recommendations and fundings are very heterogeneous in Europe: sometimes used routinely at age of 65, sometimes reimbursed. We will comment the guidelines recommended in European countries. http://dx.doi.org/10.1016/j.eurger.2012.07.397 O034

Mild cognitive impairment and early stage dementia: Assessment and treatment of everyday functioning P. De Vriendt a,∗ , E. Gorus a , T. Mets a , M. Petrovic b , L. Nygard c,∗ , A. Kottorp c , L. Rosenberg c , C. Malinowsky c , A. Öhman c,∗ , S. Josephsson c , M. Graff d,∗ , M. Vernooij-Dassen e , M. Olde-Rikkert f a Frailty In Ageing Research & Gerontology, Vrije Universiteit Brussel, Brussels, Belgium b Service Of Geriatrics, Ghent University Hospital, Ghent, Belgium c Division Of Occupational Therapy, Department Of Neurobiology, Care Science And Society, Karolinska Insitutet, Huddinge, Sweden d Scientific Institute For Quality Of Healthcare – Iq Healthcare 114, Radboud University Nijmegen, Medical Center, HB Nijmegen, Netherlands e Alzheimer Centre Nijmegen, Scientific Institute For Quality In Health Care, Radboud University Nijmegen, Medical Center, HB Nijmegen, Netherlands f Department Of Geriatrics, Alzheimer Centre Nijmegen, Iq Healthcare 114, Radboud University Nijmegen, Medical Center, HB Nijmegen, Netherlands ∗ Corresponding authors. Session Description/Moderator Detail.– Session description Dementia approximately affects 5% of the 65 to 69 years old and over 40% of nonagenarians. The ageing of the world population results in an increasing prevalence of dementia, making it a major health problem which clearly needs further research efforts with regard to detection and treatment. The increased research focus on early identification of dementia has raised an interest in the transitional phase between normal cognitive ageing and dementia, which has been labelled as mild cognitive impairment (MCI). The prevalence of MCI varies between 3 and 19%, depending on the setting and the inclusion criteria. The risk of developing dementia within 2 years is estimated at 11–33% in comparison to healthy controls who show progression rates of 1–2% per year. Clinically, dementia is mainly characterized by cognitive and functional decline and is most often accompanied by neuropsychiatric symptoms, behavioural problems and loss of independence. MCI has been defined as a condition with cognitive deterioration that is more pronounced than expected for age, but clearly not as severe as in dementia. In contrast to dementia, activities of daily living (ADL) should remain relatively intact in MCI. Nevertheless, several studies have demonstrated subtle but obvious problems in MCI patients for more complex ADL. Although most research has focused on cognitive markers and biomarkers the extent of limitations in ADL is essential for the diagnostic differentiation between normal cognitive ageing, MCI and mild dementia. Furthermore improvement in functional independence is an important goal for therapeutic interventions in dementia. Different aspects of functioning in everyday life in MCI and dementia will be addressed in this symposium: – the process of functional decline in MCI and the development and validation of an assessment tool for advanced ADL in MCI and mild dementia (Patricia De Vriendt); – development and validation of two new assessment tools of the ability to use everyday technology that separate people with

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MCI from controls and people with early stage dementia (Louise Nygard); – awareness of disability in people with MCI and dementia (Annika Öhman); – the development, evaluation and implementation of a community based occupational therapy intervention to improve functional independence in patients with dementia and to improve the sense of competence of their caregivers (Maud Graff) Moderator details. Prof Dr Ellen Gorus (MSc Clinical Psychology, MSc Gerontology and PhD in Gerontology) is a member of the department of Gerontology at the Vrije Universiteit Brussel (VUB). She teaches on psychological aspects of ageing (life cycle, psychogeriatrics, assessment. . .). She also works as a clinical psychologist in the Geriatric Dayhospital of University Hospital Brussel (UZBrussel), where she is responsible for the cognitive and emotional assessment of geriatric patients. Her research activities are primarily aimed at the early detection of Alzheimer’s disease and Mild Cognitive Impairment, active ageing in frail elderly and psychosocial aspects of physical activity in frail elderly. Abstract 1.– Evaluation of Advanced Activities of Daily Living in the diagnosis of Mild Cognitive Impairment and early dementia: development and validation of an a-ADL tool The criterion ‘basic ADL are preserved and a minimal impairment in instrumental ADL is allowed’ determines the difference between normal ageing, MCI, and early dementia. We hypothesized that assessment of the advanced ADL could serve the early diagnosis of MCI. In a first qualitative study on MCI it was shown that all participants were engaged in a wide range of a-ADL (hobby, leisure, semi-professional work, etc.), but experienced subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to problems in functioning. Based on these results, an a-ADL assessment tool was developed and tested. It distinguishes a “Total Disability Index” and a “Cognitive Disability Index”, based on the number of personal activities, the quality of performance (scoring system based on the International Classification of Functioning, Disability and Health) and the reasons of limited performance. Participants in the validation study were cognitively healthy subjects, patients with MCI or mild AD. Psychometrical properties were satisfying (inter-rater reliability, agreement patient and proxy, correlations with cognitive tests). Both indices were significantly different between groups (P < 0.001). The sensitivity and specificity in discriminating healthy persons from MCI and MCI from AD varied between 69% and 74%. This tool might offer a useful contribution to the identification of patients with mild cognitive disorders in an older population. Abstract 2.– Assessing the ability to use everyday technology in people with MCI or AD. The use of everyday technology, ET, (e.g. cell phones) is important for participation in today’s society. ET has a potential to simplify our lives and compensate for disability, but it also may obscure participation for those who cannot access or use ET. Two instruments have been developed; Everyday Technology Use Questionnaire, ETUQ, and Management of Everyday Technology Assessment, META. Data have been collected in several studies including samples with Alzheimer’s disease, AD, Mild Cognitive Impairment, MCI and controls and analyzed statistically. Both instruments demonstrate good psychometric qualities in person response validity, task goodness-of-fit, and rating scale and internal scale validity. A short and easily administered version of the ETUQ has also been developed; SETUQ. Our studies show that ability to use ET sensitively separates people with MCI from controls as well as from people with AD. We have also found a positive relationship between difficulty in ET use and engagement in ADL/IADL. From these data, we have also developed two hierarchies: The skill hierarchy and the technology hierarchy. The findings show that ET use is an important dimension of everyday life activities, and call for attention to this issue, as disability occurs already in MCI. Both hierarchies might be clinically utilized, for example, in design and adaptation of health care interventions and technology.

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Abstract 3.– Awareness in people with MCI or dementia. An increasing body of research has shown that people with MCI or dementia experience and reflect on their disabilities in contrast to the traditional view of unawareness. To reflect different perspectives, two studies were conducted: – the aim was to explore and describe awareness of the consequences of having Alzheimer’s disease on everyday life occupations from a phenomenological perspective. Six community dwelling participants were interviewed about their everyday occupations. In conclusion, these people were able to express awareness through their reflections on their experiences of the interaction between their occupations and their social environment; – the aim was to examine the relationship between occupational performance and awareness of disability in people with MCI or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). The findings showed that there were an overall positive relationship between performance and awareness of disability. However, individual variations in the sample implied that awareness of disability should be assessed individually. A multidimensional approach using both measures and interviews would reflect different aspects and provide a more comprehensive understanding of awareness in MCI or dementia. This could better support both clinicians and families in interventions that will facilitate the persons’ adjustment process and well-being. Abstract 4.– Cross-national transfer of community occupational therapy in dementia. The British Medical Research Council (MRC) guidance states that developing and evaluating complex interventions is a lengthy process. All steps should sufficiently be addressed. These steps include: – development of intervention including modelling phase; – pilot study on feasibility; – RCT on effectiveness; – implementation study. The Dutch Community Occupational Therapy in Dementia patients and caregivers intervention (COTiD) is a complex psychosocial intervention developed and evaluated following these consecutive MRC phases and was proven effective in the Netherlands. Patients’ daily functioning, patients’ and caregivers’ mood, quality of life, and caregivers’ sense of competence improved. Barriers and facilitators for implementation were determined and nationwide implementation is investigated. Cross-national transfer of complex interventions is recommended also to be best prepared by a careful process, including consecutive phases similar to the MRC process. European research to evaluate cross-national transfer of complex psychosocial interventions would be interesting since literature is scarce. A German project was performed to the effectiveness of COTiD intervention but no effects were found. However, no preparatory steps were performed before RCT. Process evaluation showed poor COTiD treatment, limited room for improvement and comparison with active control group. The COTiD intervention is promising and relevant to be cross-national transferred and evaluated according to the MRC framework in different European countries in future. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.398 O035

Getting insight into preferences of older patients and their informal caregiver: Results from a multicentric study in Switzerland S. Pautex Geriatrician and palliative care physician, University Hospital Geneva, Geneva, Switzerland There is a growing emphasis on patient’s rights to make decisions about treatment options. However, despite a widespread