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COVID 19 and dementia: experience from six European countries
- Authors:
- BURNS Alistair, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, early cite 18 January 2021,
- Publisher:
- Wiley
The effects of Covid‐19 have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer‐term effects such as neurological damage. The International Dementia Alliance (IDEAL) is a group of dementia specialists from six European countries and this paper is a summary of our experience of the effects of COVID‐19 on our populations. Experience from England, France, Germany, the Netherlands, Spain and Switzerland highlight the differential response from health and social care systems and the measures taken to maximise support for older people and those with dementia. The common themes include recognition of the atypical presentation of COVID‐19 in older people (and those with dementia) the need to pay particular attention to the care of people with dementia in care homes; the recognition of the toll that isolation can bring on older people and the complexity of the response by health and social services to minimise the negative impact of the pandemic. Potential new ways of working identified during the pandemic could serve as a positive legacy from the crisis. (Edited publisher abstract)
Major depression as a risk factor for early institutionalization of dementia patients living in the community
- Authors:
- DORENLOT Pascale, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(5), May 2005, pp.471-478.
- Publisher:
- Wiley
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
Dementia and minority ethnic older people: managing care in the UK, Denmark and France
- Authors:
- PATEL Naina, et al
- Publisher:
- Russell House
- Publication year:
- 1998
- Pagination:
- 183p.,tables,bibliog.
- Place of publication:
- Lyme Regis
Report from a project looking at the care needs of black and minority ethnic elders with dementia in the UK, Denmark and France. Designed to be both a guide and a starting point for service developments and improvements throughout Europe.
The family accompaniment of persons with dementia seen through the lens of the capability approach
- Authors:
- LE GALES Catherine, BUNGENER Martine
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 18(1), 2019, pp.55-79.
- Publisher:
- Sage
Using the capability approach initially developed by A Sen as a theoretical framework, this paper analyses both what people with dementia and their families do in response to difficulties in their daily life brought about by the disease, and the reasons they give for acting as they do. Individual and collective interviews and ethnographic observations with 15 persons with dementia and one or more of their family members were conducted. Follow-up interviews were possible for nine families. Results highlight a great diversity in ways of doing things and in accompaniment by family members. Daily adjustments are often hidden or minimized, at least at the onset of the dementia. Later, they become more frequent, repetitive and indispensable but remain influenced by the social and gender roles that existed prior to the illness. The inventiveness of families, in a context marked by various kinds of constraints, is primarily motivated by their desire to maintain the apparently intact abilities of the person with dementia but especially to preserve forms of liberty and what counted for the person, what that person valued before the disease. There are some ways of living with dementia, even when accompanied, which may long remain preferable to others, which better answer to the past and present aspirations of persons with dementia and the purposes of the accompanying persons. It is thus essential that health professionals, as well as society in general, recognize and address this issue. (Edited publisher abstract)
Nutritional status of community-dwelling older people with dementia: associations with individual and family caregivers' characteristics
- Authors:
- RULLIER Laetitia, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(6), 2013, pp.580-588.
- Publisher:
- Wiley
The object of this study was to explore the associations of individual characteristics of both older people with dementia and family caregivers with the nutritional status of older people with dementia. The cross-sectional study comprising community-dwelling older persons with dementia and 56 family caregivers was conducted at home by a psychogerontologist working for a community gerontological center. Older people with dementia were assessed with Mini mental state examination, Instrumental Activities of Daily Living, Activities of Daily Living (ADL), and NeuroPsychiatric Inventory (NPI) and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the emotional impact measure of NPI. For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA). Among older people with dementia, 58.9% were at risk of malnutrition and 23.2% presented a poor nutritional status, and among the family caregivers, 32.1% and 5.4%, respectively. The MNA score of older people with dementia was strongly and inversely associated with the ADL score and was strongly and positively associated with the MNA score of family caregiver. These two factors significantly explained 32% of variation of MNA score of older people with dementia. These findings confirm the value of investigating nutritional deficiencies in dementia within the caregiving dyad and suggest that the functional status of older people with dementia and the nutritional status of family caregivers should be carefully assessed. (Publisher abstract)
Specific psychological and behavioral symptoms of depression in patients with dementia
- Authors:
- PRADO-JEAN Annie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.1065-1072.
- Publisher:
- Wiley
Ninety percent of patients experience at least one behavioural and psychological symptom in dementia (BPSD) during the course of the disease. One-third of people with dementia have depressive symptoms. This study characterised the psychological and behavioural manifestations of depression in patients with dementia. Patients with dementia from several nursing homes in the Limousin region of France participated. Depression was as diagnosed by the Cornell Scale for Depression in Dementia, and BPSD were assessed using the Neuropsychiatric Inventory (NPI). Of 319 patients with dementia, 43% were depressed and 76% had BPSD. All BPSD were significantly more prevalent among depressed patients, but no significant differences were observed according to sex and age. The NPI showed that the most common additional symptoms in depressed patients were agitation, anxiety and irritability. Depression in dementia patients was significantly associated with dis-inhibition, irritability, agitation, and anxiety. The authors concluded that, before addressing them as isolated symptoms, it is important to consider comorbidity with depression in order to optimise the therapeutic approach.
Sharing meals with institutionalized people with dementia: a natural experiment
- Authors:
- CHARRAS Kevin, FREMONTIER Michele
- Journal article citation:
- Journal of Gerontological Social Work, 53(5), July 2010, pp.436-448.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A natural experiment was conducted in two French special care units located in nursing homes to study the impact of changed mealtime experiences for people with Alzheimer type dementia. One special care unit implemented shared meal times between residents and caregivers, and the other served as a comparison group. The weight of participants was measured at baseline and six months afterwards, and staff reports and observations were analysed. Participants in the study who had the benefit of shared meals gained weight in comparison to participants who did not, and observations indicated that in terms of autonomy residents were seen as more independent in feeding themselves and regulating their food intake, that quality of interactions was enhanced and that shared meals seem to have improved staff perception of work conditions. The article describes the intervention and discusses the findings and their implications.
Predictors of rapid cognitive decline among demented subjects aged 75 or more: (Sujet Agé Fragile - Evaluation et Suivi Cohort - SAFES)
- Authors:
- VIATONOU Saturnin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.709-715.
- Publisher:
- Wiley
This study aimed to identify factors predictive of rapid cognitive decline (RCD) among elderly subjects aged 75 or over suffering from dementia. The analysis concerned 250 patients drawn from the Sujet Agé Fragile - Evaluation et Suivi (SAFES) cohort, presenting a dementia syndrome at inclusion and followed-up for at least 1 year. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) in the follow-up period of 12 months. All patients underwent a standardised geriatric evaluation. Logistic regression was used to identify factors predictive of RCD. In the study sample, 84 patients (33.6%) presented RCD. The factors identified in multivariate analysis as predictive of RCD were: high level of education, risk of depression, and the initial MMSE score. Among subjects with a main caregiver (n = 177), the predictive factors were malnutrition or risk thereof, risk of a fall, caregiver burden and initial MMSE score. The authors conclude that as soon as dementia is diagnosed in elderly subjects, information should be collected about the subject's socioeconomic status, nutritional status, risk of falling, mood state, and caregiver burden. This would enable the provision of appropriate therapeutic care, and make it possible to adapt follow-up in case of a risk of accelerated cognitive deterioration.
Dementia patients caregivers quality of life: the pixel study
- Author:
- THOMAS Philippe
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(1), January 2006, pp.50-56.
- Publisher:
- Wiley
This French survey aimed to determine parameters influencing caregivers' quality of life, and its possible link with patients' quality of life. A scale measuring caregivers' quality of life, developed from data from previous PIXEL studies was used. It is a questionnaire composed of 20 items. The scale was related to the socio-demographic data of both patients and their main caregivers, to the ADRQL scale (Alzheimer Disease Related Quality Life) of Rabins for the QoL of dementia patients, to the patients medical and therapeutic data, specially a neuropsychological inventory: Folstein's cognition test, Cornell's depression scale, the fast battery of frontal assessment, Katz's dependence index, Cummings' neuropsychiatric inventory for behavioural and psychological symptoms of dementia and to a physician evaluation of caregiver's depression. One hundred patients diagnosed with dementia who live at home with their principal caregivers were recruited for this survey. The caregivers' quality of life was correlated to the quality of life of the patients they cared for, the importance of behavioural disorders, and the duration of dementia evolution. Women caregivers had a worse quality of life and were more depressive than men.
Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups
- Authors:
- ILIFFE S., et al
- Journal article citation:
- Aging and Mental Health, 9(1), January 2005, pp.1-6.
- Publisher:
- Taylor and Francis
Experts from eight European countries (Belgium, France, The Netherlands, Ireland, Italy, Portugal, Spain and the United Kingdom) and the disciplines of clinical psychology, general practice, geriatric medicine, old age psychiatry, medical sociology, nursing and voluntary body organisation met in 2003 to explore obstacles to recognition of and response to dementia in general practice within Europe. A modified focus group methodology was used in this exploratory process. Groups were conducted over a two-day period, with five sessions lasting 1-1.5 hours each. An adapted nominal group method was used to record themes arising from the group discussion, and these themes were used in a grounded theory approach to generate explanations for delayed recognition of and response to dementia. The overarching theme that arose from the focus groups was movement, which had three different expressions. These were: population movement and its consequences for localities, services and professional experience; the journey of the person with dementia along the disease process; and the referral pathway to access services and support. Change is the core issue in dementia care, with multiple pathways of change that need to be understood at clinical and organisational levels. Practitioners and people with dementia are engaged in managing emotional, social and physical risks, making explicit risk management a potentially important component of dementia care. The boundary between generalist and specialist services is a particular problem, with great potential for dysfunctionality. Stigma and ageism are variably distributed phenomena both within and between countries.