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Soundscape improvement with MoSART+ to reduce neuropsychiatric symptoms in nursing home patients with dementia: a randomized controlled trial and implementation evaluation

Projectomschrijving

Geluid kan irriteren. Een deur die dichtslaat, piepend gekras van bestek op een bord, een keffende hond. Mensen in goede gezondheid stoppen het geluid of lopen er van weg. Verpleeghuisbewoners met dementie zijn voor een prettige leefomgeving afhankelijk van verzorgenden. Leidt geluidshinder bij hen tot irritatie, apathie, depressie of ander probleemgedrag? En vermindert het probleemgedrag als de geluidsomgeving verbetert? Dat onderzocht de studie MOSART+ in verpleeghuizen van het Universitair Netwerk Ouderenzorg van het UMCG.

Doel en werkwijze

Belangrijk doel is om zorgverleners bewust te maken van de impact van geluid: door 1) ‘geluidsambassadeurs’ op te leiden 2) de app MoSART+ in te zetten, die verzorgenden helpt hen bewust te worden van de geluidsomgeving, 3) door geluidsverbeteringen te bedenken samen met mantelzorgers. De onderzoekers hebben gemeten of de acties bij bewoners leiden tot minder probleemgedrag, een beter welbevinden en bij verzorgenden tot minder werkstress.

Resultaten

Met de MoSART+ interventie hebben we zorgverleners bewust kunnen maken van de impact van geluid. Wij leidden ‘geluidsambassadeurs’ op en instrueerden verzorgenden hoe ze de MoSART app konden gebruiken. In de app beantwoordden zij vragen over de geluidsomgeving: Welke geluiden hoor je nu? Waar ben je? De zorgverleners scoorden ook of de geluidsomgeving op dat moment kalm, saai, chaotisch of levendig was.

Door deze uitkomsten te bespreken hebben zorgverleners kleine verbeteringen in de omgeving kunnen maken met zogenaamde microinterventies: een piepende deur repareren, zachte dopjes op keukenkastdeurtjes, of een tafelkleed bij het dekken van de tafel. De verzorgenden beoordeelden de geluidsomgeving na de interventie als kalmer en minder chaotisch. Bewoners van de verpleeghuizen vertoonden ook minder probleemgedrag. Er was geen effect op hun welbevinden of op werkstress bij zorgverleners.

Vervolg

Om vervolg te geven aan het project, ontving het een VIMP-subsidie ten bate van Verspreiding- en Implementatie. Dit project heeft als titel: Vervolg MoSART+

Producten

Binnen het project zijn een aantal producten ontwikkeld:

Producten

Titel: Sounds in nursing homes and their effect on health in dementia: a systematic review.
Auteur: Janus SIM, Kosters J, van den Bosch KA, Andringa TC, Zuidema SU, Luijendijk HJ.
Magazine: International Psychogeriatrics
Titel: Soundscapes De juiste toon vinden helpt bij dementie
Auteur: Willem Schoonen
Magazine: Trouw
Titel: Onverwachte geluiden en dementie gaan moeilijk samen
Auteur: Eddy Zwerver
Magazine: RTV Noord
Titel: Validation of a modified ambiance scale in nursing homes.
Auteur: Kosters J, Kunz M, van den Bosch KA, Andringa TC, Zuidema SU, Luijendijk HJ, Janus SIM.
Magazine: Aging and Mental Health
Titel: Soundscape awareness intervention reduced neuropsychiatric symptoms in nursing home residents with dementia; a cluster-randomized trial with MoSART+
Auteur: Kosters J, Janus SIM, Van den Bosch KA, Andringa TC, Oomen-de Hoop E, De Boer MR, Elburg RAJ, Warmelink S, Zuidema SU, Luijendijk HJ
Magazine: JAMDA
Titel: Soundscape optimization in nursing homes through raising sound awareness among staff with MoSART+
Auteur: Kosters J, Janus SIM, Van den Bosch KA, Zuidema SU, Luijendijk HJ, Andringa TC
Magazine: Frontiers in Psychology
Titel: VERWARD & BANG DOOR GELUIDEN!
Auteur: J Kosters
Titel: Waarom we stilte serieus moeten nemen
Auteur: Petra Platschorre
Titel: Thuis veilig door geluid
Auteur: J Kosters
Titel: Veilig door geluid
Auteur: J Kosters
Titel: Soundscape optimization with MoSART+ in dementia nursing home wards.
Auteur: Kosters J, Janus SIM, Zuidema SU, Luijendijk HJ, Andringa TC.
Titel: Werken aan een goede geluidsomgeving in het verpleeghuis
Auteur: J Kosters
Titel: The influence of sound on patients with dementia
Auteur: J Kosters
Titel: Informatie filmpje over MoSART+
Auteur: UNO-UMCG
Link: https://youtu.be/gw4EWmJq88w

Verslagen


Samenvatting van de aanvraag

Most people with dementia spent their last months or years of their life in a nursing home. The perceived auditory environment, or soundscape, in nursing homes is often suboptimal for its residents. Staff, household appliances, and other patients, produce unexpected, repetitive, loud and droning noises. These noises can be experienced as unpleasant, disturbing, and even unsafe. On the other hand, pleasant sounds such as music of the patient’s liking are offered sparsely. Poor quality soundscapes have been shown to harm the physical health of people in general. Moreover, noise in nursing homes has been associated with neuropsychiatric symptoms in dementia, such as sleep disturbances, agitation and depression. It is possible that patients with dementia process sounds differently due to hearing loss and diminished cognitive functions. Moreover, they lack the cognitive and functional capacity to adjust the soundscape to their own needs. The nursing home is the home of many patients with dementia. For nurse-assistants, however, the nursing home is their workplace. The sonic preferences of staff for their workplace differ from those of patients for their home. Nurse-assistants have been shown to produce much of the noise in nursing homes (unintentionally). Moreover, every human’s awareness of the auditory environment is hindered by biological mechanisms to filter out frequent unpleasant sounds. Interventions to improve the auditory environment of institutions for people with dementia are scarce. We developed the intervention MoSART+. It combines the use of the smartphone application MoSART and specially trained sound-ambassadors. Nurse-assistants will use MoSART to register the actual soundscape at two to three random moments during their shift. They are asked to assess the quality of the soundscape too (calm, chaotic, etc). Thus, MoSART helps nurse-assistants become aware of the auditory environment in nursing homes for people with dementia. Subsequently, the ambassadors facilitate nurse-assistants to invent and implement micro-interventions to improve the quality of the auditory environment. Examples of such interventions are the use of a table cloth, and turning of an unwatched television. The aim of this project is to investigate the effect of MoSART+ on neuropsychiatric symptoms in dementia. We will perform a stepped wedge cluster-randomised trial among 88 patients in 11 dementia specialist care units (clusters) of 5 nursing homes participating in the academic network UNO-UMCG. Every three months, a randomly allocated nursing homes will switch from usual care to the intervention. After 18 months, all nursing homes will have received the intervention. Assessments will take place every 3 months from baseline until end of follow-up. We expect that soundscape improvement leads to a decrease of neuropsychiatric symptoms (primary outcome), and subsequently to improved quality of life and decreased psychotropic drug use (secondary outcomes). In addition, job distress among staff may decline and job satisfaction may increase. Informal caregivers might become more satisfied with the care provided. We will also record the quality of the auditory environments before and after the intervention, and the number and type of micro-interventions undertaken. In the second stage of the project, after completion of the trial, we will evaluate the implementation of MoSART+ in 5 other nursing homes of UNO-UMCG. The evaluation will cover the results of the recruitment process, the reach and perceived quality of MoSART+, the micro-interventions proposed and carried out, as well as barriers and facilitators of implementation including costs. In this way, we can identify the most effective ways to implement this intervention in other nursing homes outside of the UNO-UMCG. To aid this process, a toolkit will be developed with all necessary information and materials for effectively implementing MoSART+. Proven effectiveness of MoSART+ in a randomized trial is an important requirement for its dissemination. We will stimulate the dissemination further through distribution of this toolkit to the national collaboration of Dutch academic networks for long-term care organisation, and other relevant parties such as Vilans, V&VN (Dutch body representing Nurses and Nurses assistants), and potentially internationally. Informal caregivers and staff have been actively involved from the beginning of the project. We continue to seek their feedback during the project. This will safeguard the relevance of the project for patients with dementia.

Kenmerken

Projectnummer:
733050833
Looptijd: 100%
Looptijd: 100 %
2017
2023
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Dr. H.J. Luijendijk
Verantwoordelijke organisatie:
Universitair Medisch Centrum Groningen