Previous projects at SEFAS

An innovative and interdisciplinary study focused on improving care for home-dwelling people with dementia. The study took place in 2019 to 2023. Read more about the project here.

A study on dignity-preserving care for elderly women living at home with cancer. The study took place in 2018 to 2021. More text in Norwegian only.

A study that investigated whether pain management has a positive effect on sleep in nursing home patients with dementia.

Does pain treatment improve sleep in nursing home patients with dementia?

Sleep problems are common symptoms of dementia and pain. Previous studies show that nursing home patients on average spend 13 hours a day in bed, but only sleep ¾ of that time.

The cause of sleep problems is often multifactorial and it is challenging to differentiate between sleep problems due to normal aging, to the presence of pain or depression, or due to dementia. The cause of sleep problems is manifold and complex. Sleep problems in older people have been related to the presence of untreated pain and also to depression. Studies suggest that sleep problems in patients with dementia increase with the severity of pain symptoms. This is further complicated by the demented persons’ reduced ability to communicate their experiences. It is quite possible that some patients receive sleep medication when actually a pain condition is keeping them awake.

Poor quality of sleep is associated with negative consequences, such as reduced memory and reaction time. These functional outcomes can be particularly negative for the elderly, since such symptoms can be misinterpreted as cognitive decline due or a further reduction of their cognitive abilities due to dementia. Previous studies also indicate that sleep problems increase the use of health resources, and reduce quality of life. There is need for further knowledge about how sleep disturbances among patients with dementia are expressed, and how they may be treated.

Method

SLEEP.PAIN.DEM is a randomized, placebo-controlled study which investigates if individual pain treatment has positive effect on sleep in nursing home patients with dementia. Actigraphs are used for registering sleep and circadian rhythm. We have included 108 long-term patients recruited from 47 nursing homes throughout Norway, and started analyzing data.

Funding: Helse Vest.

PhD candidate: Kjersti Marie Blytt

Main supervisor: Associate Professor Elisabeth Flo

Co-supervisors: Professor Bjørn Bjorvatn and Associate Professor Bettina Husebø

A retrospective register study that included all deaths in Norway between 2012 and 2013.

More information in Norwegian only.

An intervention study with organized activities, preparatory interviews, medication review, pain assessment and pain management in nursing homes.

Nursing home patients have complex mental health problems, disabilities, and social needs, compounded by widespread prescription of psychotropic drugs. Preserving their dignity and quality of life is an important goal. This can only be achieved within NHs that offer highly competent conditions of treatment and care.

COSMOS (COmmunication, Systematic pain assessment and treatment, Medication review, Organization of activities, and Safety) is a practical intervention aimed at improving the quality of life in nursing home patients. The intervention combines the most effective research results to improve staff competence, and patients’ mental health, safety, quality of life, and to reduce psychotropic drug use and costs. A total of 545 patients from 67 nursing home units from the eastern and western parts of Norway were included.

The nursing home staff was educated in the five focus areas:

• Communication with advance care planning (ACP)
• Systematic pain assessment and treatment
• Medication reviews
• Organization of activities
• Safety

The intervention involved a thorough implementation process and was carried out in all units. The intervention lasted for four months, with follow-up after nine months. The protocol for the study is published (Husebo et al. 2015), and more articles are coming in 2017.

Method

The COSMOS intervention combines the most effective research results to improve staff competence, and patients’ mental health, safety, QoL, and to reduce psychotropic drug use and costs. The efficacy testing of COSMOS includes a systematic literature review, a pilot study, a 9-month RCT, and a dissemination plan. Data collection took place at baseline, months 4, and 9.

The intervention entails the provision of staff training, study guidelines, and manuals. 67 NH long-term-care (LTC) wards in Kvam, Sund, Øygarden, Askøy, Bærum, Bergen, and Sarpsborg, in total 545 patients, ≥65 years are included.

Outcome measures

Quality of life, psychiatric behavior like depression and agitation, use of medications, pain, advance care planning, activities of daily living, hospital admission, and mortality. 

References:

1. Detering, KM. et al. 2010 The impact of advance care planning on end of life care in elderly patients: RCT. BMJ.
2. Husebo, BS. et al. 2011 Efficacy of treating pain to reduce BPSD in NH patients: RCT trial. BMJ.
3. Helse direktoratet. 2012 Veileder om medikamentgjennomgang (IS-1998).
4. Testad, I et al. 2014 The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. Int Psychogeriatr

Funding: The Research Council of Norway, Rebekka Ege Hegermanns legat, University of Bergen. COSMOS has been approved by the Regional committee for health ethics.

PhD candidates: Irene Aasmul MSc and Christine Gulla MD

Postdoc: Elisabeth Flo

Main supervisor: Bettina Husebø

Co-supervisors: Elisabeth Flo and Reidun Kjome

COSMOS - A cooperation between the Universities of Bergen, Stavanger and Oslo, King’s College London and the European COST action TD 1005

A study investigating whether treatment of pain had a positive effect on depression in nursing home patients with dementia.

Depression is one of the most common neuropsychiatric symptoms in dementia. We know that many patients with dementia have difficulty communicating pain. When pain and depression co-occur, the conditions may exacerbate each other and make it more difficult to treat symptoms successfully.

Almost half of nursing home patients in Norway use antidepressants, often without sufficient assessment of treatment effect and adverse effects. Recent studies suggest that antidepressants may be less effective in patients with dementia compared to cognitively intact patients. Additionally, we know that antidepressants often have adverse effects in elderly patients, such as nausea, reduced appetite, drowsiness, low blood pressure, and increased risk of falls and mortality.

Because previous studies have shown that undiagnosed and undertreated pain may increase the risk of depression, we want to examine whether an increase in pain treatment may have a positive effect on symptoms of depression in people with dementia.

Method

DEP.PAIN.DEM is a multicentre, randomised, placebo controlled trial which aims to determine whether an individualised increase in analgesic treatment over 13 weeks effectively reduces symptoms of depression in nursing home patients with dementia and depression.

The research team has included 165 patients from 47 nursing homes in different regions of Norway (Hordaland, Møre og Romsdal, Rogaland, Oslo, Akershus and Østfold). Data collection was completed in December 2016.

Funding: The Research Council of Norway (2013-2017)

PhD candidate: Ane Erdal, MSc Pharm

Main supervisor: Bettina Husebø

Co-supervisors: Elisabeth Flo, Professor Dag Aarsland, MD, PH.D., Kings College London, Stavanger University Hospital

User participation in the design of municipal services for people with dementia.

More information in Norwegian only.

Reidun K. Sandvik’s thesis aimed to investigate whether use of pain medication can improve the lives of people with dementia and agitation. She also studied patients in their last phase of life in Norwegian nursing homes. 

Sandvik found that individual treatment with pain medication reduced the intensity of pain in people with dementia. The use of pain medication in Norwegian nursing homes shows that people with dementia were undertreated compared to patients without dementia from 2000 to 2009, while in 2011 it was the same for both groups. Sandvik also revealed that pain medicine prescribed to nursing home patients increased by 65 % between 2000 and 2011. Strong opioids such as morphine were prescribed nine times more often.   

Another important finding was that healthcare professionals found it difficult to recognize signs of imminent dying. Almost 40 % of patients were not considered dying when death occurred, something that may affect the assessment of symptoms and treatment.

The thesis revealed a need for better implementation of guidelines and staff education regarding the treatment of nursing home patients with and without dementia.

Articles:

Sandvik J, Selbaek G, Aarsland D, Ballard C, Seifert R, Husebo BS. Impact of a Stepwise Protocol for Treating Pain on Pain Intensity in Nursing Home Patients with Dementia: A Cluster Randomized Trial Eur J Pain. 2014;10:1490-500

Reidun Sandvik, Geir Selbæk, Øyvind Kirkevold, Dag Aarsland, Bettina Sandgathe Husebø. Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples. Age and Ageing 2016; 45: 54–60

Reidun K. Sandvik, Geir Selbaek, Sverre Bergh, Dag Aarsland, Bettina S. Husebo. Signs of Imminent Dying and Change in Symptom Intensity During Pharmacological Treatment in Dying Nursing Home Patients: A Prospective Trajectory Study. JAMDA, Published Online: June 16, 2016

Funding: Alderspsykiatrisk forskningssenter ved Sykehuset Innlandet HF

Main supervisor: Bettina Husebø

Co-supervisors: Geir Selbæk, Professor MD, PhD, Universitetet i Oslo & Alderspsykiatrisk forskningssenter ved Sykehuset Innlandet HF / Dag Årsland, Professor MD, PhD, King’s College London & Stavanger Universitetssjukehus