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Cognitive impairment in older people with alcohol use disorders in a UK community mental health service
- Author:
- RAO Rahul
- Journal article citation:
- Advances in Dual Diagnosis, 9(4), 2016, pp.154-158.
- Publisher:
- Emerald
Purpose: The assessment of cognitive impairment in community services for older people remains under-explored. The paper aims to discuss this issue. Design/methodology/approach: Cognitive impairment was examined in 25 people aged 65 and over with alcohol use disorders, on the caseload of community mental health services over a six-month period. All subjects assessed using Addenbrooke’s Cognitive Assessment (ACE-III). Findings: In total, 76 per cent of the group scored below the cut-off point for likely dementia but only 45 per cent of people scored below the cut-off point for tests of language, compared with 68-84 per cent people in other domains. Research limitations/implications: This finding has implications for the detection of alcohol-related brain cognitive impairment in clinical settings. Practical implications: Standardised cognitive testing is common within mental health services for older people, but may also have utility within addiction services. Social implications: The early detection of alcohol-related cognitive impairment can improve social outcomes in both drinking behaviour and the social consequences of alcohol-related dementia. Originality/value: This may be the first published study of cognitive impairment in patients under a mental team for older people with alcohol use disorders and offers some unique findings within this sampling frame. (Publisher abstract)
Mild cognitive impairment in the older population: who is missed and does it matter?
- Authors:
- STEPHAN Blossom C. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.863-871.
- Publisher:
- Wiley
Classifications of mild cognitive impairment (MCI) vary in the precision of the defining criteria. Their value in clinical settings is different from population settings. This difference depending on setting is to be expected, but must be well understood if population screening for dementia and pre-dementia states is to be considered. Of importance is the impact of missed diagnosis. The magnitude of missed at-risk cases in the application of different MCI criteria in the population is unknown. Data were from the Medical Research Council Cognitive Function and Ageing Study, a large population based study of older aged individuals in the UK. Prevalence and two-year progression to dementia in individuals whose impairment failed to fulfil published criteria for MCI was evaluated. Prevalence estimates of individuals not classified from current MCI definitions were extremely variable (range 2.5-41.0%). Rates of progression to dementia in these non-classified groups were also very variable (3.7-30.0%), reflecting heterogeneity in MCI classification requirements. Narrow definitions of MCI developed for clinical settings when applied in the population result in a large proportion of individuals who progress to dementia being excluded from MCI classifications. More broadly defined criteria would be better for selection of individuals at risk of dementia in population settings, but at the possibility of high false positive rates. While exclusion may be a good thing in the population since most people are presumably normal, over-inclusion is more likely to be harmful. Further work needs to investigate the best classification system for application in the population.
Hospital discharge of older people with cognitive impairment to care homes
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2006
- Pagination:
- 2p.
The scope of this document is confined to the safe and appropriate discharge of older people with cognitive impairment from hospital to a care home. It is a given, within the context of this document, that discharge to any other care setting has been deemed inappropriate as the result of a comprehensive geriatric assessment (CGA). A separate British Geriatrics Society (BGS) compendium document deals with the wider context of hospital discharge of frail older people.
Dignity in care: communication
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Pagination:
- 16 minutes 7 seconds
- Place of publication:
- London
Good communication can help people to maintain their dignity. It is vital that staff develop other ways of communicating with people who have a cognitive impairment or limited speech. This film provides an example of communicating with Matthew, a young man with Down's Syndrome Matthew is encouraged to use a diary so that he knows what he's going to be doing on any particular week. It's a good way for staff to find out what's been happening in Matthew's life. The film also shows how, for older people, past memories of being at the beach can be used as a useful communication tool. Communication in practice can mean asking people how they prefer to be addressed and to respect their wishes; giving people information about the service in advance and in a suitable format; and not assuming that you know what people want because of their culture, ability or any other factor. (Edited publisher abstract)
Development of a theory-based intervention to increase cognitively able frail elders’ engagement with advance care planning using the behaviour change wheel
- Authors:
- COMBES S, et al
- Journal article citation:
- BMC Health Services Research, 21(712), 2021, Online only
- Publisher:
- BioMed Central Ltd
Background: Advance care planning (ACP) conversations support people to think about, discuss and document their beliefs, values and preferences regarding future care. This process means that should the person loose capacity in the future, care can be provided, consistent with their personal values and beliefs. The ACP process is particularly relevant for older people living with frailty (frail elders) as they are vulnerable to sudden deterioration. However, ACP is rarely undertaken by frail elders. The aim of this study was to develop an intervention to increase multidisciplinary health and social care professionals’ (H&SCPs) engagement of cognitively able, domestic-dwelling frail elders with ACP. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel. Multiple methods were used to understand ACP barriers and enablers: a systematic integrative review, a survey (n = 73 H&SCPs), and semi-structured interviews (n = 10 frail elders, n = 8 family members). A conceptual model, developed from the integrative review, underpinned data collection for the survey and interviews. Synthesis of this data, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change for ACP to be implemented and decide content and implementation for the intervention. Results: Following the Behaviour Change Wheel system, and based on the findings of the review, survey and interviews, the prototype intervention, Conversations on Living and Dying (CLaD), was developed. The CLaD prototype consisted of one 3.5-hour educational skills session for H&SCPs supported by a toolkit. Content focussed on the relevance of ACP for frail elders, experience of ACP by frail elders, and strategies H&SCPs could adopt to encourage frail elders’ engagement with ACP. Strategies include recognising the importance of relationships and living well now, preparing frail elders for ACP conversations and starting ACP early. Participants who took part in initial prototype refinement reported that the intervention helped them think differently about ACP and encouraged them to engage with frail elders. Conclusions: The use of behavioural theory enabled the development of CLaD, an evidence-based, theory-driven, person-centred intervention to support ACP engagement with frail elders. While feasibility testing is required, initial prototype refinement demonstrated that H&SCPs found the intervention to be acceptable, engaging, and clinically valuable in their practice with frail elders and their families. (Edited publisher abstract)
Cognitive impairment and treatment outcomes amongst people attending an alcohol intervention service for those aged 50+
- Authors:
- SEDDON Jennifer, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(2), 2021, pp.58-69.
- Publisher:
- Emerald
Purpose: No studies have evaluated the relationship between cognitive impairment and alcohol treatment outcomes amongst older drinkers. This study aims to explore the extent of cognitive impairment amongst older adults seeking alcohol treatment and examine the relationship between cognitive impairment, treatment retention and alcohol use following treatment. Design/methodology/approach: The study used data from the Drink Wise Age Well programme; an alcohol intervention service for older adults (aged 50+). The Montreal Cognitive Assessment was used to screen for cognitive impairment; alcohol use was assessed using the alcohol use disorders identification test. Findings: In total, 531 participants completed the assessment at treatment entry. Over half the sample were male (57%), with a mean age of 60 years (Standard deviation: 7.09). Almost half (48.4%) had cognitive impairment at the entry to treatment: 51.6% had a normal cognitive function, 41.4% had mild cognitive impairment, 5.8% had moderate cognitive impairment and 1.1% had severe cognitive impairment. Cognitive impairment was not associated with increased treatment drop-out and was not predictive of alcohol use following treatment. Alcohol treatment was associated with a significant improvement in cognitive functioning. Originality/value: This study suggests there may be a significant amount of unidentified cognitive impairment amongst older adults attending alcohol treatment. Assessment and routine screening for cognitive impairment in drug and alcohol services may help in care planning and setting treatment goals; in the absence of routine screening opportunities for treatment planning and intervention may be missed. (Edited publisher abstract)
Alcohol misuse and cognitive impairment in older people
- Authors:
- WADD S., et al, ALCOHOL RESEARCH UK. Substance Misuse and Ageing Research Team
- Publisher:
- Alcohol Research UK
- Publication year:
- 2013
- Pagination:
- 62
- Place of publication:
- London
Between 50-80% of individuals with chronic alcohol problems experience cognitive impairment, including memory problems, difficulties concentrating and difficulties explaining things to others. Older people are particularly sensitive to the toxic effects of alcohol on the brain and are at high risk of having a stroke or developing dementia, both of which are common causes of cognitive impairment. It is important that people who have alcohol problems and cognitive impairment are identified so that alcohol treatment can be adapted to meet their needs and they can receive other support from health and social services where necessary. This report describes the methods and presents findings on three research strands: indentifying cognitive impairment in people with alcohol problems; identifying alcohol problems in people with cognitive impairment; and adapting alcohol screening and treatment for people with cognitive impairment. The study methods comprised: a questionnaire sent to professionals in older people’ substance misuse services; interviews with 10 older people attending these services for an alcohol problem; a questionnaire sent to professionals in memory assessment services; two focus groups with practitioners from memory assessment services; and interviews with 10 people who have been diagnosed with mild cognitive impairment or dementia and who attend these services. One literature review identified which alcohol screening tools are most appropriate for those with cognitive impairment, and which screening tools for cognitive impairment are most suitable for use in substance misuse services. Another literature review was on how to work with people with cognitive impairment. Appendices detail the screening tools and surveys used. This study shows a significant amount of undiagnosed cognitive impairment in older people with alcohol problems and that this can cause distress, family conflict and disability. The older people with alcohol problems who took part wanted to know if they had cognitive impairment. The study demonstrated that screening for alcohol misuse in memory assessment services is important, but that most of these services are not using alcohol screening tools. This makes it difficult for practitioners to know when drinking is problematic, and when to intervene if alcohol misuse has been identified. (Edited publisher abstract)
Dementia: 'a death of the mind'
- Author:
- TERRY Paul
- Journal article citation:
- Therapy Today, 21(8), October 2010, pp.20-24.
- Publisher:
- British Association for Counselling and Psychotherapy
This paper, written from a psychodynamic perspective by a clinical psychologist lead for older people within a UK NHS Specialist Community Mental Health team, describes the early, transition and advanced stages of dementia and the care of those suffering from increasing memory problems through to loss of independent capacity for language and bodily functions, respectively. Carers of those with dementia may have unconscious and unmanaged fears, which could impact upon the sufferers’ quality of life and add to their distress, a process known as ‘projective identification’ which is described. An example from a dementia care dayroom is quoted by way of illustration. The article goes on to discuss “the value of understanding and support” and “helping to bear what is unbearable” and quotes the research and practice of many others in this field.
The hand in hand nature of nutrition and cognitive decline
- Author:
- SHEPHERD Alison
- Journal article citation:
- Nursing and Residential Care, 12(8), August 2010, pp.370-377.
- Publisher:
- MA Healthcare Ltd.
- Place of publication:
- London
A growing body of evidence suggests that nutrition may help reduce the risk of dementia. Research suggests that some of the molecular changes associated with ageing may be the result of molecular damage to cells and tissues that may be reduced as a result of improved nutrition. Evidence regarding the link between dementia and omega 3 fatty acids, cholesterols, and fats is discussed. The article then discusses eating difficulties associated with dementia patients, and the factors that lead many dementia patients to suffer from weight loss or to become obese. The article considers nutritional screening tools, promoting independence in patient feeding, overcoming dysphagia, and healthy food .The article concludes that ensuring that dementia patients are optimally nourished is important but can be a frustrating experience. When working with dementia patients, nurses should ensure that they maintain autonomy, dignity and respect. Nutritional interventions must be tailored to suit the individual’s condition and nutritional needs. These options include assisted eating, the use of sip feeds as an adjunct to normal food intake, or as a last resort the use of enteral feeding.
Do older adults presenting with memory complaints wish to be told if later diagnosed with Alzheimer's disease?
- Author:
- ELSON Paul
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(5), May 2006, pp.419-425.
- Publisher:
- Wiley
Many patients with Alzheimer's disease are not told their diagnosis. Studies have shown that relatives possess mixed views regarding whether or not patients should be told while elderly peers favour disclosure. Recent studies have shown that patients with diagnosed dementia also favour being told. The present study sought the views of patients prior to diagnosis. Participants in this UK study were a consecutive sample of patients aged 65 and over suffering from memory complaints. They were asked what they considered to be causing their memory problems and whether or not they would want to know the cause. They were then specifically asked if they would want to know if diagnosed with Alzheimer's disease and what were their reasons for this. Two-thirds of patients were uncertain regarding the cause of their memory difficulties although the remainder did offer some valid explanations. Eighty-six per cent wanted to know the cause while 69% wanted to know if diagnosed with Alzheimer's disease and a variety of reasons were offered to support their preference. The majority of older adults presenting to services with memory complaints had little understanding of the potential cause of their problems. Most were nevertheless keen to know the cause, even if this transpired to be Alzheimer's disease. The clinical implications of the findings are discussed and suggestions made for future research.