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New approaches to understanding dementia
- Author:
- GINESI Laura
- Journal article citation:
- Nursing Times, 112(25), 2016, pp.16-19.
- Publisher:
- Nursing Times
Improving understanding of brain disorders is likely to be one of the core aims of physiological research in the 21st century. This article, the second in a four-part series, looks at the main types of dementia and explores emerging theories about how the condition develops. These theories are improving understanding of the neuro-degeneration that characterises the most common forms of dementia, and will help improve care for those living with dementia. (Publisher abstract)
The relationship between apathy and participation in therapeutic activities in nursing home residents with dementia: evidence for an association and directions for further research
- Authors:
- ELLIS Julie M., DOYLE Colleen J., SELVARAJAH Suganya
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(4), 2016, p.494–509.
- Publisher:
- Sage
Apathy is one of the most frequent and early symptoms of dementia. Because apathy is characterised by lack of initiative and motivation, it leads to considerable burden being placed on carers to ensure that the person living with dementia has a reasonable quality of life. The aim of this study was to investigate the relationship between apathy and participation in therapeutic activities for older people with dementia living in nursing homes. Ninety residents were recruited into the study, and apathy was measured by nursing home staff using the Apathy Evaluation Scale Clinician version. Staff also compiled data on each resident’s involvement in therapeutic activities. Among this sample, the mean age was 84.8 years, and mean length of stay in the nursing home was 1.8 years. The mean apathy score was 50.4, indicating that on average the residents had a moderate level of apathy. Overall, residents participated in six activities per week and those residents who were involved in the most activities had the lowest levels of apathy. This paper provides evidence that residents involved in therapeutic activities have lower levels of apathy. Further research should be conducted on the direction of causality, whether apathy levels can be changed through participation in therapeutic activities, the relationship between dementia severity and modifiability of apathy, and the intensity of therapeutic activities required to maintain functioning. (Publisher abstract)
PARO the seal shows promise
- Author:
- MEE Erin
- Journal article citation:
- Journal of Dementia Care, 24(5), 2016, p.15.
- Publisher:
- Hawker
There is a growing interest in the use of artificial intelligence and assistive technologies in dementia care. This article looks at how the PARO robot seal is being used with older adults with advanced care and support needs in Age UK's Lewisham and Southwark's Stones End Day Centre. (Edited publisher abstract)
Protecting cognition from aging and Alzheimer's disease: a computerized cognitive training combined with reminiscence therapy
- Authors:
- BARBAN Francesco, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(4), 2016, pp.340-348.
- Publisher:
- Wiley
Objective: The aim of this paper was to assess the efficacy of process-based cognitive training (pb-CT) combined with reminiscence therapy (RT) in patients with mild Alzheimer's disease (mAD) and mild cognitive impairment (MCI) and in healthy elderly (HE) subjects. Methods: This multicentre, randomised, controlled trial involved 348 participants with mAD, MCI, and HE from four European countries. Participants were randomly assigned to two arms of a crossover design: those in arm A underwent 3 months of computerised pb-CT for memory and executive functions combined with RT and 3 months of rest; those in arm B underwent the reverse. The primary outcome was the effect of the training on memory and executive functions performance. The secondary outcome was the effect of the training on functional abilities in mAD assessed with the instrumental activities of daily living. Results: The study found a significant effect of the training for memory in all three groups on delayed recall of the Rey Auditory Verbal Learning Test and for executive functions in HE on the phonological fluency test. MCI and HE participants maintained these effects at follow-up. MCI and mAD participants also showed a significant effect of the training on the Mini-mental state examination scale. Participants with mAD showed more stable instrumental activities of daily living during the training versus the rest period. Conclusions: The results corroborate the positive effect of pb-CT and its maintenance primarily on memory in HE and MCI participants that did not seem to be potentiated by RT. Moreover, our results are very promising for the mAD participants. (Edited publisher abstract)
Knowledge and perceptions of dementia and Alzheimer's disease in four ethnic groups in Copenhagen, Denmark
- Authors:
- NIELSEN T. Rune, WALDEMAR Gunhild
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(3), 2016, p.222–230.
- Publisher:
- Wiley
Objective: Older people from ethnic minorities are underrepresented in dementia care. Some of the determinants of access to care are knowledge and perceptions of dementia, which may vary between ethnic groups in the population. The aims of this study were to compare knowledge and perceptions of dementia and Alzheimer's disease (AD) among four ethnic groups in Copenhagen, Denmark, and to assess the influence of education and acculturation. Methods: Quantitative survey data from 260 participants were analysed: 100 native Danish, and 47 Polish, 51 Turkish, and 62 Pakistani immigrants. Knowledge and perceptions of dementia and AD were assessed with the Dementia Knowledge Questionnaire (DKQ) supplemented with two questions from the Alzheimer's Disease Awareness Test (ADAT). Knowledge and perceptions of dementia and AD in the four groups were compared, and the influence of education and acculturation was assessed. Results: Group differences were found on the DKQ total score as well as all sub-domains. Turkish and Pakistani people were most likely to hold normalizing and stigmatizing views of AD. Level of education and acculturation had limited influence on dementia knowledge, accounting for 22% of the variance at most and had only minor influence on perceptions of AD. Conclusions: Lacking knowledge and certain perceptions of dementia and AD may hamper access to services in some ethnic minority groups. Ongoing efforts to raise awareness that dementia and AD are not part of normal ageing, particularly among Turkish and Pakistani communities, should be a high priority for educational outreach. (Edited publisher abstract)
What is the current state of care for older people with dementia in general hospitals? a literature review
- Authors:
- DEWING Jan, DIJK Saskia
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(1), 2016, pp.106-124.
- Publisher:
- Sage
This paper summarises a literature review focusing on the literature directly pertaining to the acute care of older people with dementia in general hospitals from 2007 onwards. Following thematic analysis, one overarching theme emerged: the consequences of being in hospital with seven related subthemes. Significantly, this review highlights that overall there remains mostly negative consequences and outcomes for people with dementia when they go into general hospitals. Although not admitted to hospital directly due to dementia, there are usually negative effects on the dementia condition from hospitalisation. The review suggests this is primarily because there is a tension between prioritisation of acute care for existing co-morbidities and person-centred dementia care. This is complicated by insufficient understanding of what constitutes person-centred care in an acute care context and a lack of the requisite knowledge and skills set in health care practitioners. The review also reveals a worrying lack of evidence for the effectiveness of mental health liaison posts and dementia care specialist posts in nursing. Finally, although specialist posts such as liaison and clinical nurse specialists and specialist units/shared care wards can enhance quality of care and reduce adverse consequences of hospitalisation (they do not significantly) impact on reducing length of stay or the cost of care. (Publisher abstract)
Frailty: a costly phenomenon in caring for elders with cognitive impairment
- Authors:
- BUTLER Aine, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(2), 2016, pp.161-168.
- Publisher:
- Wiley
Objectives: Dementia draws on a variety of public and private resources. There is increasing pressure to define the cost components in this area to improve resource allocation and accountability. The aim of this study was to characterize frailty in a group of cognitively impaired community-dwelling elders and evaluate its relationship with cost and resource utilization. Methods: The study assessed a cross-sectional, convenient sample of 115 cognitively impaired patients of age >55 years who attended the National Memory Clinic in St James' University Hospital, a Trinity College-affiliated hospital in Dublin, Ireland. Participants had a clinical diagnosis of possible Alzheimer's disease or mild cognitive impairment. Frailty was measured using the biological syndrome model. Formal health and social care costs and daily informal caregiving costs were collected and the total costs of care estimated by applying the appropriate unit cost estimate for each resource activity. Stepwise regression models were constructed to establish the factors associated with increased care costs. Results: Patient dependence, frailty and number of co-morbid illnesses explained 43.3% of the variance in observed daily informal care costs in dementia and cognitively impaired patients. Dependence was the sole factor retained in an optimal model explaining 19% of the variance in formal health and social care costs. Conclusion: Frailty retained a strong association with daily informal care costs even in the context of other known risk factors for increasing care costs. Interventions that reduce frailty as well as patient dependence on others may be associated with cost savings. (Edited publisher abstract)
Activity involvement and quality of life of people at different stages of dementia in long term care facilities
- Authors:
- SMIT Dieneke, et al
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.100-109.
- Publisher:
- Taylor and Francis
Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. Results: Despite resident's cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement. (Publisher abstract)
Together but apart: caring for a spouse with dementia resident in a care facility
- Authors:
- HEMINGWAY Dawn, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(4), 2016, pp.872-890.
- Publisher:
- Sage
This longitudinal, exploratory study was designed to better understand the lived experience of spousal caregivers age 60 and older providing care to partners with Alzheimer’s disease and related dementias resident in a care facility. Twenty eight spousal caregivers were interviewed up to three times over a period of 2 years, and long-term care facility staff from four locations across British Columbia (BC), Canada participated in four focus groups. Thematic analysis of interview and focus group transcripts revealed a central, unifying theme ‘together but apart’. The results identify key targets for policy makers and service providers to support positive health and well-being outcomes for spousal caregivers providing care to their partners diagnosed with Alzheimer’s disease and related dementia and living in care facilities. (Publisher abstract)
Negotiating access to a diagnosis of dementia: implications for policies in health and social care
- Authors:
- KOEHN Sharon, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 15(6), 2016, pp.1436-1456.
- Publisher:
- Sage
The ‘Pathways to Diagnosis’ study captured the experience of the prediagnosis period of Alzheimer’s disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, the authors use the ‘Candidacy’ framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups. (Edited publisher abstract)