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Bankole A, Anderson MS, Homdee N, Alam R, Lofton A, Fyffe N, Goins H, Newbold T, Smith-Jackson T, Lach J. BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment-Phases 1 and 2. Am J Alzheimers Dis Other Demen 2020; 35:1533317520906686. [PMID: 32162529 PMCID: PMC10624017 DOI: 10.1177/1533317520906686] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Caregiver burden associated with dementia-related agitation is one of the commonest reasons a community-dwelling person with dementia (PWD) transitions to a care facility. Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment (BESI) is a system of body-worn and in-home sensors developed to provide continuous, noninvasive agitation assessment and environmental context monitoring to detect early signs of agitation and its environmental triggers. RESEARCH DESIGN AND METHODS This mixed methods, remote ethnographic study is explored in a 3-phase, multiyear plan. In Phase 1, we developed and refined the BESI system and completed usability studies. Validation of the system and the development of dyad-specific models of the relationship between agitation and the environment occurred in Phase 2. RESULTS Phases 1 and 2 results facilitated targeted changes in BESI, thus improving its overall usability for the final phase of the study, when real-time notifications and interventions will be implemented. CONCLUSION Our results show a valid relationship between the presence of dementia related agitation and environmental factors and that persons with dementia and their caregivers prefer a home-based monitoring system like BESI.
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Affiliation(s)
- Azziza Bankole
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Martha S. Anderson
- Department of Interprofessionalism, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Nutta Homdee
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Ridwan Alam
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Ashley Lofton
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, NC, USA
| | - Nykesha Fyffe
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, NC, USA
| | - Hilda Goins
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, NC, USA
| | - Temple Newbold
- Department of Geriatric Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Tonya Smith-Jackson
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, NC, USA
| | - John Lach
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
- Department of Electrical and Computer Engineering, George Washington University, Washington, DC, USA
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Henskens M, Nauta IM, Vrijkotte S, Drost KT, Milders MV, Scherder EJA. Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study. PLoS One 2019; 14:e0223704. [PMID: 31860641 PMCID: PMC6924675 DOI: 10.1371/journal.pone.0223704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/26/2019] [Indexed: 01/28/2023] Open
Abstract
Objectives To examine the predictors associated with quality of life of nursing home residents with dementia, in order to identify which predictors are most important and hold most promise for future intervention studies. Methods/Design This cross-sectional analysis of data collected in two intervention trials included 143 participants with moderate to severe dementia who resided in 40 psychogeriatric wards in 13 nursing homes. The outcome measure quality of life was assessed with the Qualidem. Predictors examined were demographic factors, cognition, mood, behavioral problems, and comorbid conditions. Results Linear mixed regression analyses showed that all nine domains of quality of life showed independent (negative) associations with either depression, agitation, apathy, or a combination of these predictors. Agitation, apathy, depression, and the presence of neurological disease explained 50% of the variance in total quality of life. Male gender, psychiatric/mood disorders, and having one or more comorbid conditions was associated with worse social relations, while the presence of comorbid neurological diseases was associated with more social isolation and a worse care relationship. The presence of endocrine/metabolic disorders and pulmonary disorders was associated with less restless tense behavior. Conclusions Different domains of quality of life showed different associations, confirming the multidimensionality of quality of life in nursing home residents with dementia. Quality of life is independently associated with mood and behavioral problems, comorbid conditions, and gender. This knowledge may help to identify older persons at risk of a lower quality of life, and to offer targeted interventions to improve quality of life. Trial registration Dutch Trial registration NTR5641
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Affiliation(s)
- Marinda Henskens
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Ilse M. Nauta
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Maarten V. Milders
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Erik J. A. Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Sano M, Soto M, Carrillo M, Cummings J, Hendrix S, Mintzer J, Porsteinsson A, Rosenberg P, Schneider L, Touchon J, Aisen P, Vellas B, Lyketsos C. Identifying Better Outcome Measures to Improve Treatment of Agitation in Dementia: A Report from the EU/US/CTAD Task Force. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2019; 5:98-102. [PMID: 29616702 DOI: 10.14283/jjpad.2018.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For the second time in the past 3 years, the EU-US CTAD Task Force addressed challenges related to designing clinical trials for agitation in dementia, which is one of the most disruptive aspects of the condition for both patients and caregivers. Six recommendations emerged from the Task Force meeting: 1 - Operationalizing agitation criteria established by the IPA; 2 - Combining clinician- and caregiver-derived outcomes as primary outcome measures; 3 - Using global ratings to define clinically meaningful effects and power studies; 4 - Improving the accuracy of caregiver reports by better training and education of caregivers; 5 - Employing emerging technologies to collect near real-time behavioral data; and 6 - Utilizing innovative trial designs and increasing the use of biomarkers to maximize the productivity of clinical trials for neuropsychiatric symptoms.
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Affiliation(s)
- M Sano
- Mary Sano, Mount Sinai School of Medicine, Bronx, NY, USA,
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154
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Figueiro MG, Plitnick B, Roohan C, Sahin L, Kalsher M, Rea MS. Effects of a Tailored Lighting Intervention on Sleep Quality, Rest-Activity, Mood, and Behavior in Older Adults With Alzheimer Disease and Related Dementias: A Randomized Clinical Trial. J Clin Sleep Med 2019; 15:1757-1767. [PMID: 31855161 PMCID: PMC7099185 DOI: 10.5664/jcsm.8078] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We investigated the effectiveness of a lighting intervention tailored to maximally affect the circadian system as a nonpharmacological therapy for treating problems with sleep, mood, and behavior in persons with Alzheimer disease and related dementias (ADRD). METHODS This 14-week randomized, placebo-controlled, crossover design clinical trial administered an all-day active or control lighting intervention to 46 patients with ADRD in 8 long-term care facilities for two 4-week periods (separated by a 4-week washout). The study employed wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. RESULTS The active intervention significantly improved Pittsburgh Sleep Quality Index scores compared to the active baseline and control intervention (mean ± SEM: 6.67 ± 0.48 after active intervention, 10.30 ± 0.40 at active baseline, 8.41 ± 0.47 after control intervention). The active intervention also resulted in significantly greater active versus control differences in intradaily variability. As for secondary outcomes, the active intervention resulted in significant improvements in Cornell Scale for Depression in Dementia scores (mean ± SEM: 10.30 ± 1.02 at baseline, 7.05 ± 0.67 after active intervention) and significantly greater active versus control differences in Cohen-Mansfield Agitation Inventory scores (mean ± SEM: -5.51 ± 1.03 for the active intervention, -1.50 ± 1.24 for the control intervention). CONCLUSIONS A lighting intervention tailored to maximally entrain the circadian system can improve sleep, mood, and behavior in patients with dementia living in controlled environments. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, title: Methodology Issues in a Tailored Light Treatment for Persons With Dementia, URL: https://clinicaltrials.gov/ct2/show/NCT01816152, identifier: NCT01816152.
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Affiliation(s)
- Mariana G. Figueiro
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Barbara Plitnick
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Charles Roohan
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Levent Sahin
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Michael Kalsher
- Cognitive Science Department, School of Humanities, Arts and Social Sciences, Rensselaer Polytechnic Institute, Troy, New York, United States
| | - Mark S. Rea
- Lighting Research Center, Rensselaer Polytechnic Institute, Troy, New York, United States
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Chapman KR, Spitznagel MB. Measurement of sexual disinhibition in dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1747-1757. [PMID: 31489715 DOI: 10.1002/gps.5208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/31/2019] [Indexed: 11/07/2022]
Abstract
Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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156
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Costello H, Cooper C, Marston L, Livingston G. Burnout in UK care home staff and its effect on staff turnover: MARQUE English national care home longitudinal survey. Age Ageing 2019; 49:74-81. [PMID: 31665204 PMCID: PMC6939288 DOI: 10.1093/ageing/afz118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/23/2019] [Accepted: 08/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND staff burnout and turnover lead to care home residents receiving poorer quality care. Burnout is thought to cause turnover, but this has never been investigated. We know little about which care home staffs are burnt out. AIMS to explore burnout's relationship with staff turnover and prevalence and predictors of burnout. METHOD we calculated the relationship between Maslach Burnout Inventory scores and future staff turnover (12-month number of staff leaving/number employed). We explored staff, resident and care home predictors of burnout, measured as emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). RESULTS two-thousand sixty-two care staff in 97 care home units participated. Median yearly staff turnover was 22.7%, interquartile range (IQR) 14.0-37.7%. Care staff recorded low median burnout (median EE: 14, IQR: 7-22; DP: 1, IQR: 0-5; PA 42, IQR: 36-45). We found no association between staff burnout and turnover rate. Younger staff age was associated with higher burnout (EE coefficient - 0.09; 95% confidence interval (CI): -0.13, -0.05; DP -0.02; 95% CI: -0.04, -0.01; PA 0.05; 95% CI: 0.02, 0.08). Speaking English as a second language predicted higher EE (1.59; 95% CI: 0.32, 2.85), males had higher DP (0.02; 95% CI: 0.01, 0.04) and staff working only night shifts lower PA (-2.08; 95% CI: -4.05, -1.30). CONCLUSIONS we found no association between care homes staff burnout level and staff turnover rates. It is a myth that burnout levels are high. Interventions for burnout could focus on at-risk groups. Future studies could consider turnover at an individual level.
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Affiliation(s)
- Harry Costello
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Louise Marston
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London W1T 7NF, UK
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157
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Abstract
BACKGROUND Dementia is a chronic condition which progressively affects memory and other cognitive functions, social behaviour, and ability to carry out daily activities. To date, no treatment is clearly effective in preventing progression of the disease, and most treatments are symptomatic, often aiming to improve people's psychological symptoms or behaviours which are challenging for carers. A range of new therapeutic strategies has been evaluated in research, and the use of trained animals in therapy sessions, termed animal-assisted therapy (AAT), is receiving increasing attention. OBJECTIVES To evaluate the efficacy and safety of animal-assisted therapy for people with dementia. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialised Register on 5 September 2019. ALOIS contains records of clinical trials identified from monthly searches of major healthcare databases, trial registries, and grey literature sources. We also searched MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), ISI Web of Science, ClinicalTrials.gov, and the WHO's trial registry portal. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and randomised cross-over trials that compared AAT versus no AAT, AAT using live animals versus alternatives such as robots or toys, or AAT versus any other active intervention. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of Cochrane Dementia. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using mean difference (MD), standardised mean difference (SMD), and risk ratio (RR) with their 95% confidence intervals (CIs) where appropriate. MAIN RESULTS We included nine RCTs from 10 reports. All nine studies were conducted in Europe and the US. Six studies were parallel-group, individually randomised RCTs; one was a randomised cross-over trial; and two were cluster-RCTs that were possibly related where randomisation took place at the level of the day care and nursing home. We identified two ongoing trials from trial registries. There were three comparisons: AAT versus no AAT (standard care or various non-animal-related activities), AAT using live animals versus robotic animals, and AAT using live animals versus the use of a soft animal toy. The studies evaluated 305 participants with dementia. One study used horses and the remainder used dogs as the therapy animal. The duration of the intervention ranged from six weeks to six months, and the therapy sessions lasted between 10 and 90 minutes each, with a frequency ranging from one session every two weeks to two sessions per week. There was a wide variety of instruments used to measure the outcomes. All studies were at high risk of performance bias and unclear risk of selection bias. Our certainty about the results for all major outcomes was very low to moderate. Comparing AAT versus no AAT, participants who received AAT may be slightly less depressed after the intervention (MD -2.87, 95% CI -5.24 to -0.50; 2 studies, 83 participants; low-certainty evidence), but they did not appear to have improved quality of life (MD 0.45, 95% CI -1.28 to 2.18; 3 studies, 164 participants; moderate-certainty evidence). There were no clear differences in all other major outcomes, including social functioning (MD -0.40, 95% CI -3.41 to 2.61; 1 study, 58 participants; low-certainty evidence), problematic behaviour (SMD -0.34, 95% CI -0.98 to 0.30; 3 studies, 142 participants; very-low-certainty evidence), agitation (SMD -0.39, 95% CI -0.89 to 0.10; 3 studies, 143 participants; very-low-certainty evidence), activities of daily living (MD 4.65, 95% CI -16.05 to 25.35; 1 study, 37 participants; low-certainty evidence), and self-care ability (MD 2.20, 95% CI -1.23 to 5.63; 1 study, 58 participants; low-certainty evidence). There were no data on adverse events. Comparing AAT using live animals versus robotic animals, one study (68 participants) found mixed effects on social function, with longer duration of physical contact but shorter duration of talking in participants who received AAT using live animals versus robotic animals (median: 93 seconds with live versus 28 seconds with robotic for physical contact; 164 seconds with live versus 206 seconds with robotic for talk directed at a person; 263 seconds with live versus 307 seconds with robotic for talk in total). Another study showed no clear differences between groups in behaviour measured using the Neuropsychiatric Inventory (MD -6.96, 95% CI -14.58 to 0.66; 78 participants; low-certainty evidence) or quality of life (MD -2.42, 95% CI -5.71 to 0.87; 78 participants; low-certainty evidence). There were no data on the other outcomes. Comparing AAT using live animals versus a soft toy cat, one study (64 participants) evaluated only social functioning, in the form of duration of contact and talking. The data were expressed as median and interquartile ranges. Duration of contact was slightly longer in participants in the AAT group and duration of talking slightly longer in those exposed to the toy cat. This was low-certainty evidence. AUTHORS' CONCLUSIONS We found low-certainty evidence that AAT may slightly reduce depressive symptoms in people with dementia. We found no clear evidence that AAT affects other outcomes in this population, with our certainty in the evidence ranging from very-low to moderate depending on the outcome. We found no evidence on safety or effects on the animals. Therefore, clear conclusions cannot yet be drawn about the overall benefits and risks of AAT in people with dementia. Further well-conducted RCTs are needed to improve the certainty of the evidence. In view of the difficulty in achieving blinding of participants and personnel in such trials, future RCTs should work on blinding outcome assessors, document allocation methods clearly, and include major patient-important outcomes such as affect, emotional and social functioning, quality of life, adverse events, and outcomes for animals.
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Affiliation(s)
- Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
| | | | - Siok Shen Ng
- Hospital MelakaPharmacy Resources and Information Centre (PRIC)Jalan Mufti Haji‐KhalilMelakaMelakaMalaysia75400
- Monash University MalaysiaJeffrey Cheah School of Medicine and Health SciencesJalan Lagoon SelatanBandar SunwaySelangorMalaysia47500
| | - Shir Ley Tan
- Calvary North Adelaide HospitalHPS PharmaciesAdelaideSouth AustraliaAustralia
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of UtahDepartment of PharmacotherapySalt Lake CityUtahUSA84112
| | - Fiona Stanaway
- University of SydneySydney School of Public Health, Faculty of Medicine and HealthEdward Ford Building A27SydneyNSWAustralia2042
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Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Tricco AC, Straus SE. Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis. Ann Intern Med 2019; 171:633-642. [PMID: 31610547 DOI: 10.7326/m19-0993] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. PURPOSE To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews. STUDY SELECTION Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia. DATA EXTRACTION Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias. DATA SYNTHESIS After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care. LIMITATIONS Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated. CONCLUSION Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia. PRIMARY FUNDING SOURCE Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).
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Affiliation(s)
- Jennifer A Watt
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
| | | | - Areti Angeliki Veroniki
- St. Michael's Hospital, Toronto, Ontario, Canada, University of Ioannina, Ioannina, Greece, and Imperial College, London, United Kingdom (A.A.V.)
| | - Vera Nincic
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Paul A Khan
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Marco Ghassemi
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Yuan Thompson
- St. Michael's Hospital, Toronto, Ontario, Canada (V.N., P.A.K., M.G., Y.T.)
| | - Andrea C Tricco
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
| | - Sharon E Straus
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.)
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Morelli N, Barello S, Mayan M, Graffigna G. Supporting family caregiver engagement in the care of old persons living in hard to reach communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1363-1374. [PMID: 31441179 DOI: 10.1111/hsc.12826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Today, 8.5% of the world's population is 65 and over, and this statistic will reach 17% by 2050 (He et al., U.S. Census Bureau, international population reports, P95/16-1, An ageing world: 2015, U.S., 2016). They are the people who, with increasing age, will find themselves more closely interfacing with the national health system, which in many countries shows strong imbalances between rural and urban areas. In this context, a fundamental role is played by the relatives who find themselves becoming informal caregivers to compensate for lack of services. To date, however, little has been done to help these people. In this article, we want to identify the nature and extent of research evidence that had its objective to help informal caregivers in rural, hard to reach areas (Grant & Booth, Health Information & Libraries Journal, 2009, 26, 91). Following the approach set out by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19), we conducted a scoping review in May 2018 and closed the review with an update in September 2018. We identified 14 studies published from 2012, the European Year of Active Ageing, promoted by the European Commission, which had three domains of implementation: emotional support to decrease the emotional burden of caregivers, educational support to increase their skills, and organisational support to improve the mobility of caregivers and carereceivers. Although informal caregivers play a fundamental role in many countries, the studies that have been involved in alleviating their caring burden are few; nevertheless, they provide interesting indications. This lack of attention confirms how this portion of the population is still neglected by scientific research and risks having unequal access to health and social care. Future research is needed, not only to create and improve services to caregivers in rural, hard to reach areas, but also to evaluate and focus on the participation and the engagement of caregivers in the co-design of these services.
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Affiliation(s)
- Niccolò Morelli
- Department of Sociology and Business Law, Engage Minds Hub Consumer & Health Research Center, Università di Bologna, Bologna, Italy
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Consumer & Health Research Center, Università Cattolica del Sacro Cuore (Milano), Milano, Italy
| | - Maria Mayan
- Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Consumer & Health Research Center, Università Cattolica del Sacro Cuore (Milano), Milano, Italy
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Aerts L, Cations M, Harrison F, Jessop T, Shell A, Chenoweth L, Brodaty H. Why deprescribing antipsychotics in older people with dementia in long-term care is not always successful: Insights from the HALT study. Int J Geriatr Psychiatry 2019; 34:1572-1581. [PMID: 31276255 DOI: 10.1002/gps.5167] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/29/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Antipsychotic medications are commonly used to manage behavioural and psychological symptoms of dementia despite their side effects and harms. While the Halting Antipsychotic Use in Long-Term care (HALT) deprescribing trial was successful at reducing antipsychotic use, 19% of participants had their antipsychotics represcribed or never reached a dose of zero. The aim of this study was to investigate the reasons for represcription of antipsychotic medication and factors associated with ongoing antipsychotic use, relating to care staff requests and perceived behavioural changes. MATERIALS AND METHODS Thirty-nine of 133 HALT participants never ceased their antipsychotic medication or were represcribed a regular or pro re nata (PRN) antipsychotic after initial deprescribing. The views of nursing staff, general practitioner, and family on the circumstances leading up to these outcomes were collected via a questionnaire-based approach. This information was triangulated with observation and detailed file audit (including progress notes, medical notes, medication charts, incident reports, and hospital discharge summaries). A consensus panel reconstructed the represcribing context. RESULTS Nurses were the most common drivers of represcribing (63.2%), followed by family members (39.5%), GPs (23.7%), specialists (13.2%), and hospital staff (10.5%). There were multiple drivers for antipsychotic use in 46.2% of participants. Increased agitated and aggressive behaviours were the most commonly reported reasons for represcribing even though these changes were not identified over time on objective measures. Consent and dosage practices remained poor despite education. DISCUSSION Nursing staff are the key drivers of deprescribing particularly in response to perceived worsening agitation and aggression among male residents. The train-the-trainer model used in the HALT trial may have been insufficient on its own to improve staff competence and confidence in applying nonpharmacological approaches when responding to behaviour change.
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Affiliation(s)
- Liesbeth Aerts
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Monica Cations
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Fleur Harrison
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Tiffany Jessop
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Allan Shell
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Lynn Chenoweth
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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161
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Gerritsen DL, van Beek APA, Woods RT. Relationship of care staff attitudes with social well-being and challenging behavior of nursing home residents with dementia: a cross sectional study. Aging Ment Health 2019; 23:1517-1523. [PMID: 30409022 DOI: 10.1080/13607863.2018.1506737] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: This study investigates the relationship between attitudes of care staff and social well-being and challenging behavior of residents in long-term dementia care. Methods: The study was based on a cross-sectional design using questionnaires. Care staff members (N = 291) of 15 long-term care facilities in the Netherlands completed the Approaches to Dementia Questionnaire. Additionally, the primary professional caregiver of each participating resident (N = 239) completed an observational questionnaire regarding that resident's behavior, which contained the scale for Social Wellbeing Of Nursing home residents and the Cohen-Mansfield Agitation Inventory. Data were analyzed using multilevel analyses, taking characteristics of residents into account. Results: Attitudes of care staff towards residents with dementia differed between facilities. Further, residents experienced more social well-being and displayed less challenging behavior in facilities where care staff had more hopeful attitudes. Conclusion: This study demonstrates a relationship between attitudes of care staff and resident well-being. The results indicate that it is important to address attitudes towards residents with dementia in the education of (future) care staff. Care processes may also be improved by focusing on the attitudes of care staff. In this way, the well-being of residents with dementia can potentially be improved as well.
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Affiliation(s)
- D L Gerritsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - A P A van Beek
- NIVEL, Netherlands Institute for Health Services Research , Utrecht , the Netherlands
| | - R T Woods
- Dementia Services Development Centre Wales, Bangor University , Bangor , UK
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162
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McCreedy E, Ogarek JA, Thomas KS, Mor V. The Minimum Data Set Agitated and Reactive Behavior Scale: Measuring Behaviors in Nursing Home Residents With Dementia. J Am Med Dir Assoc 2019; 20:1548-1552. [PMID: 31678075 DOI: 10.1016/j.jamda.2019.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/24/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Interventions aimed at managing agitated and aggressive behaviors in dementia without the use of antipsychotics are currently being tested in nursing homes (NHs). Researchers and clinicians require a measure that can capture the severity of residents' behaviors. We test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created using data from mandatory NH assessments. DESIGN Cross-sectional. SETTING AND PARTICIPANTS The 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The analytic sample included 489,854 new admissions and 765,367 long-stay residents (at least 90 days in NH). All participants have a dementia diagnosis. METHODS Minimum Data Set (MDS), version 3.0. The ARBS is a composite measure of (1) physical behavioral symptoms directed at other people; (2) verbal behavioral symptoms directed at other people; (3) other behavioral symptoms not directed at other people; and (4) rejection of care. Variables used to establish construct validity included degree of cognitive impairment, use of medications for managing agitation and aggression, and co-occurring conditions associated with agitated and aggressive behaviors (eg, schizophrenia, depression, or delirium). RESULTS This report has 3 important findings: (1) the ARBS score has borderline-adequate internal consistency (α = .64-.71) in the national population NH residents with dementia; (2) only 18% of new admissions and 21% of long-stay residents with dementia evidence any agitated or aggressive behaviors in the last week, as rated in the MDS assessment; and (3) the ARBS demonstrates good construct validity; it increases with cognitive impairment, treatment with relevant medications, and co-occurring psychiatric conditions and symptoms. DISCUSSION Nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH residents with dementia. CONCLUSIONS AND IMPLICATIONS Researchers conducting pragmatic trials of non-pharmaceutical interventions to manage behaviors in NH residents with dementia should consider the likely underdetection of these behaviors in the available MDS data.
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Affiliation(s)
- Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
| | - Jessica A Ogarek
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; VA Medical Center, Providence, RI
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; VA Medical Center, Providence, RI
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163
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Cossette B, Bruneau MA, Couturier Y, Gilbert S, Boyer D, Ricard J, McDonald T, Labarre K, Déry V, Arcand M, Rodrigue C, Rhéaume AA, Moreault S, Allard C, Pépin MÉ, Beauchet O. Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) in Long-term Care Centers in Québec, Canada: A Strategy for Best Practices. J Am Med Dir Assoc 2019; 21:212-219. [PMID: 31669289 DOI: 10.1016/j.jamda.2019.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. DESIGN Prospective, closed cohort supplemented by a developmental evaluation. SETTING AND PARTICIPANTS Residents of designated wards in 24 LTC centers in Québec, Canada. METHODS Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP. RESULTS Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents. CONCLUSIONS AND IMPLICATIONS Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Québec.
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Affiliation(s)
- Benoit Cossette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada.
| | - Marie-Andrée Bruneau
- Faculty of Medicine, Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada; Institut universitaire de gériatrie de Montréal research centre, Integrated University Health and Social Services Centre of the Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, Quebec, Canada; Québec Knowledge Network in Integrated Primary Health Care, Longueuil, Quebec, Canada
| | - Suzanne Gilbert
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Diane Boyer
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada
| | - Jacques Ricard
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada; Ministry of Health and Social Services, Quebec, Quebec, Canada
| | - Tanya McDonald
- Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
| | | | - Véronique Déry
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marcel Arcand
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada
| | - Claudie Rodrigue
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada
| | - Andrée-Anne Rhéaume
- Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centre of the National Capital, Quebec, Quebec, Canada
| | - Sylvie Moreault
- Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada
| | - Catherine Allard
- Centre Hospitalier Universitaire de Sherbrooke Research centre, Sherbrooke, Québec, Canada
| | - Maude-Émilie Pépin
- Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Letters and Human Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis, Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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164
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Mainka T, Balint B, Gövert F, Kurvits L, van Riesen C, Kühn AA, Tijssen MAJ, Lees AJ, Müller-Vahl K, Bhatia KP, Ganos C. The spectrum of involuntary vocalizations in humans: A video atlas. Mov Disord 2019; 34:1774-1791. [PMID: 31651053 DOI: 10.1002/mds.27855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/22/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video-documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic-like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep-related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Bettina Balint
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Lille Kurvits
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph van Riesen
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL, Institute of Neurology, London, UK
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
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165
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Sampson EL, Stringer A, La Frenais F, Higgins S, Doyle MJ, Laybourne A, Livingston G, Leavey G. Agitation near the end of life with dementia: An ethnographic study of care. PLoS One 2019; 14:e0224043. [PMID: 31644549 PMCID: PMC6808497 DOI: 10.1371/journal.pone.0224043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Agitation is common in people living with dementia especially at the end of life. We examined how staff interpreted agitation behavior in people with dementia nearing end of life, how this may influence their responses and its impact on the quality of care. Research design Ethnographic study. Structured and semi-structured non-participant observations (referred to subsequently in this paper as “structured observations”) of people living with dementia nearing the end of life in hospital and care homes (south-east England) and in-depth interviews with staff, conducted August 2015-March 2017. Methods Three data sources: 1) detailed field notes, 2) observations using a structured tool and checklist for behaviors classed as agitation and staff and institutional responses, 3) staff semi-structured qualitative interviews. We calculated the time participants were agitated and described staff responses. Data sources were analyzed separately, developed continuously and relationally during the study and synthesized where appropriate. Results We identified two main ‘ideal types’ of staff explanatory models for agitation: In the first, staff attribute agitated behaviors to the person’s “moral judgement”, making them prone to rejecting or punitive responses. In the second staff adopt a more “needs-based” approach in which agitation behaviors are regarded as meaningful and managed with proactive and investigative approaches. These different approaches appear to have significant consequences for the timing, frequency and quality of staff response. While these models may overlap they tend to reflect distinct organizational resources and values. Conclusions Care worker knowledge about agitation is not enough, and staff need organizational support to care better for people living with dementia towards end of life. Positional theory may help to explain much of the cultural-structural context that produces staff disengagement from people with dementia, offering insights on how agitation behavior is reframed by some staff as dangerous. Such behavior may be associated with low-resource institutions with minimal staff training where the personhood of staff may be neglected.
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Affiliation(s)
- Elizabeth L. Sampson
- Marie Curie Palliative Care Research Unit, Division of Psychiatry, University College London, England, London, United Kingdom
- * E-mail:
| | - Aisling Stringer
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, England, London, United Kingdom
| | - Francesca La Frenais
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, England, London, United Kingdom
| | - Shanlee Higgins
- Camden and Islington NHS Foundation Trust, London, England, United Kingdom
| | - Mary-Jo Doyle
- Camden and Islington NHS Foundation Trust, London, England, United Kingdom
| | - Anne Laybourne
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, England, London, United Kingdom
| | - Gill Livingston
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, England, London, United Kingdom
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, School of Psychology, Ulster University, Coleraine, Northern Ireland, United Kingdom
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166
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Groot Kormelinck CM, van Teunenbroek CF, Kollen BJ, Reitsma M, Gerritsen DL, Smalbrugge M, Zuidema SU. Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial. BMC Psychiatry 2019; 19:298. [PMID: 31606036 PMCID: PMC6790012 DOI: 10.1186/s12888-019-2291-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation. METHODS We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews. DISCUSSION We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation. TRIAL REGISTRATION NTR5872 , registered on July 2, 2016.
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Affiliation(s)
- Claudia M. Groot Kormelinck
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Charlotte F. van Teunenbroek
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Boudewijn J. Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
| | - Margreet Reitsma
- Vilans, (Center of Expertise for Long-term Care), PO Box 8228, 3503 RE Utrecht, The Netherlands
| | - Debby L. Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, location VUmc/Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 253, 9700 AD Groningen, The Netherlands
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167
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Ye B, Khan SS, Chikhaoui B, Iaboni A, Martin LS, Newman K, Wang A, Mihailidis A. Challenges in Collecting Big Data in A Clinical Environment with Vulnerable Population: Lessons Learned from A Study Using A Multi-modal Sensors Platform. SCIENCE AND ENGINEERING ETHICS 2019; 25:1447-1466. [PMID: 30357559 DOI: 10.1007/s11948-018-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Agitation is one of the most common behavioural and psychological symptoms in people living with dementia (PLwD). This behaviour can cause tremendous stress and anxiety on family caregivers and healthcare providers. Direct observation of PLwD is the traditional way to measure episodes of agitation. However, this method is subjective, bias-prone and timeconsuming. Importantly, it does not predict the onset of the agitation. Therefore, there is a need to develop a continuous monitoring system that can detect and/or predict the onset of agitation. In this study, a multi-modal sensor platform with video cameras, motion and door sensors, wristbands and pressure mats were set up in a hospital-based dementia behavioural care unit to develop a predictive system to identify the onset of agitation. The research team faced several barriers in the development and initiation of the study, namely addressing concerns about the study ethics, logistics and costs of study activities, device design for PLwD and limitations of its use in the hospital. In this paper, the strategies and methodologies that were implemented to address these challenges are discussed for consideration by future researchers who will conduct similar studies in a hospital setting.
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Affiliation(s)
- Bing Ye
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada.
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
| | - Shehroz S Khan
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | - Belkacem Chikhaoui
- TELUQ University, 455 Rue du Parvis, Ville De Québec, QC, G1K 9H6, Canada
| | - Andrea Iaboni
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | | | - Kristine Newman
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Angel Wang
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Alex Mihailidis
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
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168
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McCreedy EM, Yang X, Baier RR, Rudolph JL, Thomas KS, Mor V. Measuring Effects of Nondrug Interventions on Behaviors: Music & Memory Pilot Study. J Am Geriatr Soc 2019; 67:2134-2138. [PMID: 31301191 PMCID: PMC6822268 DOI: 10.1111/jgs.16069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Most people with Alzheimer disease and related dementias will experience agitated and/or aggressive behaviors during the later stages of the disease. These behaviors cause significant stress for people living with dementia and their caregivers, including nursing home (NH) staff. Addressing these behaviors without the use of chemical restraints is a growing focus of policy makers and professional organizations. Unfortunately, evidence for nonpharmacological strategies for addressing dementia-related behaviors is lacking. DESIGN Six-month, preintervention-postintervention pilot study. SETTING US NHs (n = 4). PARTICIPANTS Residents with advanced dementia (n = 45). INTERVENTION Music & Memory, an individualized music program in which the music a resident preferred when she/he was young is delivered at early signs of agitation, using a personal music player. MEASUREMENTS Dementia-related behaviors for the same residents were measured three ways: (1) observationally using the Agitation Behavior Mapping Instrument (ABMI); (2) staff report using the Cohen-Mansfield Agitation Inventory (CMAI); and (3) administratively using the Minimum Data Set-Aggressive Behavior Scale (MDS-ABS). RESULTS ABMI score was 4.1 (SD = 3.0) preintervention while not listening to the music, 4.4 (SD = 2.3) postintervention while not listening to the music, and 1.6 (SD = 1.5) postintervention while listening to music (P < .01). CMAI score was 61.2 (SD = 16.3) preintervention and 51.2 (SD = 16.1) postintervention (P < .01). MDS-ABS score was 0.8 (SD = 1.6) preintervention and 0.7 (SD = 1.4) postintervention (P = .59). CONCLUSION Direct observations were most likely to capture behavioral responses, followed by staff interviews. Nursing-home based, pragmatic trials that rely solely on available administrative data may fail to detect effects of nonpharmaceutical interventions on behaviors. Findings are relevant to evaluations of nonpharmaceutical strategies for addressing behaviors in NHs, and will inform a large, National Institute on Aging-funded pragmatic trial beginning spring 2019. J Am Geriatr Soc 67:2134-2138, 2019.
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Affiliation(s)
- Ellen M. McCreedy
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Xiaofei Yang
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Rosa R. Baier
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - James L. Rudolph
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs (VA) Medical Center, Providence, Rhode Island
| | - Kali S. Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs (VA) Medical Center, Providence, Rhode Island
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs (VA) Medical Center, Providence, Rhode Island
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169
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Weise L, Töpfer NF, Deux J, Wilz G. Feasibility and effects of individualized recorded music for people with dementia: A pilot RCT study. NORDIC JOURNAL OF MUSIC THERAPY 2019. [DOI: 10.1080/08098131.2019.1661507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lisette Weise
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Nils F. Töpfer
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Juliane Deux
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Friedrich Schiller University of Jena, Jena, Germany
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170
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Li HC, Chen KM, Hsu HF. Modelling factors of urinary incontinence in institutional older adults with dementia. J Clin Nurs 2019; 28:4504-4512. [PMID: 31429131 DOI: 10.1111/jocn.15039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/04/2019] [Accepted: 08/03/2019] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). BACKGROUND A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. DESIGN Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. METHODS In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. RESULTS Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. CONCLUSION Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. RELEVANCE TO CLINICAL PRACTICE The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.
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Affiliation(s)
- Hui-Chi Li
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fen Hsu
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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171
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Yuen I, Kwok T. Effectiveness of DementiAbility Methods: The Montessori Way on agitation in long-term care home residents with dementia in Hong Kong. Int J Geriatr Psychiatry 2019; 34:1352-1358. [PMID: 30697810 DOI: 10.1002/gps.5063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/25/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the effect of the DementiAbility Methods: The Montessori Way (DMMW) on agitation in long-term care home residents with dementia. The activities using the DMMW are hypothesized to reduce agitation in terms of its frequency and disruptiveness to greater extent than structured social activities as control. METHODS Forty-six long-term care home residents with dementia were randomly allocated to receive the DMMW (n = 23) or structured social activities as control (n = 23). Each participant received six intervention sessions of 45 minutes each within 2 weeks, at long-term care home. Agitation in terms of frequency and disruptiveness before and after the intervention were compared. RESULTS The results showed that the DMMW resulted in significant reduction in overall frequency and disruptiveness of agitation. The DMMW group had significant reduction in frequency and disruptiveness of verbal aggressive, physical nonaggressive, and physical aggressive behaviors after the intervention. CONCLUSIONS The present findings support the potential of the DMMW as a safe and efficacious therapeutic intervention for addressing agitation in long-term care home residents with dementia, relevant to Hong Kong culture.
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Affiliation(s)
- Ivo Yuen
- Ching Chung Taoist Association of Hong Kong Limited, Ching Chung Care and Attention Home for the Aged, Yuen Long, Hong Kong
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
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172
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Francis ER, Smith JG, Qayyum M, Lee J, Woodgate P, Lawrence RM. Biographical films as a person-centered approach to reduce neuropsychiatric symptoms of dementia in residential care: A feasibility study. J Clin Psychol 2019; 76:137-145. [PMID: 31468533 DOI: 10.1002/jclp.22853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/11/2019] [Accepted: 08/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms are a major component of dementia irrespective of severity or subtype. We aimed to determine the feasibility of biographical films to reduce neuropsychiatric symptoms in people with moderate to severe dementia over a 32-week period. METHOD A total of 11 people with dementia situated in a residential care home took part in this mixed-method feasibility study. Carers reported neuropsychiatric symptoms of residents at three time-points, and their experience of the study was obtained at a feedback session. RESULTS There was a significant reduction in neuropsychiatric symptoms in residents with neuropsychiatric impairment from baseline to the end of study (p = .042; d = .98). Thematic analysis identified three major themes: Triggered memories, knowledge gained to support care, and perceived changes in the resident. CONCLUSION The findings suggest that it is feasible to use biographical films long-term to reduce neuropsychiatric symptoms of dementia, alongside routine care.
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Affiliation(s)
- Emma R Francis
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Jared G Smith
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom.,Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Mustabshira Qayyum
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Jessica Lee
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Philip Woodgate
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Robert M Lawrence
- Clinical Research Unit of the Psychiatry of Old Age and Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, United Kingdom.,Population Health Research Institute, St George's, University of London, London, United Kingdom
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173
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Gillis K, Lahaye H, Dom S, Lips D, Arnouts H, Van Bogaert P. A person-centred team approach targeting agitated and aggressive behaviour amongst nursing home residents with dementia using the Senses Framework. Int J Older People Nurs 2019; 14:e12269. [PMID: 31469240 DOI: 10.1111/opn.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/25/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The increase in agitated or aggressive behaviour amongst nursing home residents with dementia is a challenging problem. Such behaviour causes stress for both resident and caregiver. Many non-pharmacological interventions have been studied, but these interventions disregard the resident's unfulfilled needs and are executed by a single, designated caregiver. This study tests a non-pharmacological intervention, applied by the entire team and based on the resident's underlying needs. DESIGN A pretest and post-test interventional study design was used, in which 65 residents with dementia who expressed agitated or aggressive behaviour. Data were collected from December 2016 until March 2017. METHODS The ABC method and the Senses Framework were used to assign residents to either therapeutic touch, group music sessions or a meaningful individual activity. All staff members applied the interventions. Data were collected by use of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) and the Cohen-Mansfield Agitation Inventory (CMAI). RESULTS The frequency of aggression, loss of decorum, depression and the severity of aggression decreased for all three interventions. However, the overall severity of fear also increased. The overall prevalence of agitated of residents decreased for the therapeutic touch, group music sessions and individual activities. CONCLUSIONS This study shows the possibilities of designing individualised interventions on the Senses Framework and the ABC method for addressing agitated and aggressive behaviour amongst nursing home residents with dementia. The framework presented in this study should be further explored. IMPLICATIONS FOR PRACTICE A team-based approach is effective to reduce agitated or aggressive behaviour amongst nursing home residents.
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Affiliation(s)
- Katrin Gillis
- Odisee University College, Sint-Niklaas, Belgium.,Curando VZW, Ruiselede, Belgium
| | - Hilde Lahaye
- Odisee University College, Sint-Niklaas, Belgium.,VZW Woonzorg Samen Ouder, Sint-Niklaas, Belgium
| | - Stijn Dom
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
| | | | - Heidi Arnouts
- Odisee University College, Sint-Niklaas, Belgium.,Department of Engineering Management, Antwerp University, Antwerp, Belgium
| | - Peter Van Bogaert
- Faculty of Medicine and Healthcare, Antwerp University, Antwerp, Belgium
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174
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Griffioen C, Husebo BS, Flo E, Caljouw MAA, Achterberg WP. Opioid Prescription Use in Nursing Home Residents with Advanced Dementia. PAIN MEDICINE 2019; 20:50-57. [PMID: 29136228 DOI: 10.1093/pm/pnx268] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/04/2017] [Indexed: 11/14/2022]
Abstract
Background Although proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia. Objective To investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes. Design Cross-sectional study. Setting and Subjects Eighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated. Methods Potential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale ≥ 3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis. Results The prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N = 63) were prescribed opioids, and of these, 79.4% (N = 50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12 mcg/h) or buprenorphine (5 or 10 mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42), total number of pain-related diagnoses (OR = 1.47, 95% CI = 1.14-1.90), and depression and anxiety (OR = 1.05, 95% CI = 1.01-1.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR = 0.43, 95% CI = 0.19-0.99). Conclusions Strong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.
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Affiliation(s)
- Charlotte Griffioen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Novicare, Elderly Care, Best, the Netherlands
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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175
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Goodall G, Ciobanu I, Taraldsen K, Sørgaard J, Marin A, Draghici R, Zamfir MV, Berteanu M, Maetzler W, Serrano JA. The Use of Virtual and Immersive Technology in Creating Personalized Multisensory Spaces for People Living With Dementia (SENSE-GARDEN): Protocol for a Multisite Before-After Trial. JMIR Res Protoc 2019; 8:e14096. [PMID: 31538942 PMCID: PMC6786690 DOI: 10.2196/14096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background The number of people living with dementia is rapidly increasing. With dementia’s impact on memory, communication, and self-identity, it is important to identify ways of meeting individual needs of diagnosed individuals and their caregivers. This study will test a new intervention, SENSE-GARDEN, that integrates autobiographical music, films, pictures, and scents with innovative technology to create an immersive environment tailored specifically for the individual. Objective The SENSE-GARDEN study is an Active Assisted Living Program–funded multicenter project. The primary objective of the study is to assess whether a personalized, innovative technology-based intervention can improve the well-being of older adults living with moderate to severe dementia. The study will also assess whether the intervention can improve coping and reduce burden in caregivers. Methods A controlled before-after study design will be used. There will be 3 sites in 3 trial countries: Belgium, Norway, and Portugal. A total of 55 people with dementia (PWDs) will be recruited. All eligible participants for the study will be randomized into the intervention or control group. For the first three months of the study, all participants will receive the SENSE-GARDEN intervention. For the final month of the study, the intervention group will continue visits to the SENSE-GARDEN, and the control group will discontinue visits. A mixed-methods approach will be used, including the use of standardized outcome measures, quantitative physiological data, and qualitative interview data. Results The trials commenced recruitment in August 2019, and all data are expected to be collected by the end of May 2020. A user-centered design process is underway, with results from the first phase of user interviews indicating that people with mild cognitive impairment, family caregivers, and professional caregivers consider the SENSE-GARDEN to be a potentially valuable tool in providing numerous benefits to dementia care. Feasibility testing of the SENSE-GARDEN has been completed and results are expected to be published in October 2019. Conclusions Findings from the SENSE-GARDEN trials will provide insights into the use of technology for personalizing interventions to the PWD. This will have potential implications on not only dementia research, but it may also have influences on care practice. International Registered Report Identifier (IRRID) DERR1-10.2196/14096
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Affiliation(s)
- Gemma Goodall
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ileana Ciobanu
- University of Medicine and Pharmacy Carol Davlia, Bucharest, Romania.,ELIAS University Hospital, Bucharest, Romania
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Sørgaard
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreea Marin
- University of Medicine and Pharmacy Carol Davlia, Bucharest, Romania.,ELIAS University Hospital, Bucharest, Romania
| | - Rozeta Draghici
- University of Medicine and Pharmacy Carol Davlia, Bucharest, Romania.,ELIAS University Hospital, Bucharest, Romania
| | - Mihai-Viorel Zamfir
- University of Medicine and Pharmacy Carol Davlia, Bucharest, Romania.,ELIAS University Hospital, Bucharest, Romania
| | - Mihai Berteanu
- University of Medicine and Pharmacy Carol Davlia, Bucharest, Romania.,ELIAS University Hospital, Bucharest, Romania
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - J Artur Serrano
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromsø, Norway
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176
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Current Agents in Development for Treating Behavioral and Psychological Symptoms Associated with Dementia. Drugs Aging 2019; 36:589-605. [PMID: 30957198 DOI: 10.1007/s40266-019-00668-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behavioral and psychological symptoms associated with dementia are highly prevalent and are associated with an increased risk of institutionalization and mortality. Current pharmacological treatments for these symptoms include cholinesterase inhibitors, antipsychotics, and selective serotonin reuptake inhibitors. When used for treating behavioral and psychological symptoms associated with dementia, they are associated with limited efficacy and/or serious adverse events. As such, there has been extensive research into novel agents with varying mechanisms of action targeting behavioral and psychological symptoms associated with dementia. In this article, we present the results of a comprehensive literature search and review that evaluates current agents that have completed or are currently in clinical trials for treating behavioral and psychological symptoms associated with dementia as a primary outcome. We highlight novel agents from miscellaneous drug classes, such as dextromethorphan/quinidine, bupropion/dextromethorphan, lumateperone, deudextromethorphan/quinidine, methylphenidate and scyllo-inositol, and drugs from various therapeutic classes (including atypical antipsychotics, selective serotonin reuptake inhibitors, and cannabinoids) that have demonstrated promising results and were generally well tolerated. Future research with large appropriately powered studies using validated outcome measures for behavioral and psychological symptoms associated with dementia should be conducted to further establish the clinical utility of these agents.
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177
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Abstract
PURPOSE OF REVIEW This article reviews the treatment of aggression and agitation in dementia. Both nonpharmacologic and pharmacologic approaches to responsive behaviors are discussed. Practical treatment strategies are applied to common behavioral symptoms. RECENT FINDINGS Aggressive and agitated behavior is common in dementia. Behavioral symptoms lead to reduced quality of life and distress for both patients and caregivers. They can also lead to poor outcomes and are associated with significant financial implications for the individual and health care system. A wide range of difficult behaviors exists, with limited evidence for deciding on treatment. Clinicians should integrate the available evidence with practical and commonsense strategies to target these difficult-to-treat behaviors. SUMMARY Treating aggression and agitation in dementia is challenging. Viewing behaviors as a response to either internal or external stimuli can help guide treatment. Treatment should emphasize nonpharmacologic approaches as an initial step, using practical and commonsense strategies. Caregivers and family should be actively involved in the planning and implementation of behavioral plans. It is essential to minimize both medical and nonmedical factors that may be contributing to behaviors. When pharmacologic options are required, it is important to choose medications that will target specific behavioral goals, having both practical consideration and the best evidence in mind.
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178
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Yazdanpanah M, Plejert C, Samuelsson C, Jansson G. An interactional perspective on sound prolongation in multilingual encounters in residential care. CLINICAL LINGUISTICS & PHONETICS 2019; 33:1103-1124. [PMID: 31385544 DOI: 10.1080/02699206.2019.1584914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 06/10/2023]
Abstract
Elderspeak refers to adapting one's language to a perceived language decline of an older interlocutor. Earlier studies have explored different features of elderspeak; some of these studies attribute positive outcomes to using elderspeak that facilitates communication, but other studies consider elderspeak a negative way of communicating that should be avoided. The aim of this study is to investigate a largely unexplored feature of elderspeak, namely sound prolongation in a multilingual context. There are five participants in this study: three carers and two care recipients in a residential care unit. The carers and care recipients have limited access to a shared spoken language. The data consist of video- and audio recordings of interaction between the participants. The recordings have been transcribed and analysed in accordance with Conversation Analytical methodology. The analysis shows that the carers use sound prolongation as part of their interactional repertoire in order to manage situations of distress. We conclude that in some distressful situations carers' use of sound prolongation may help mitigating the care recipient's emotional concerns since the source of agitations has been addressed properly. In other situations, the use of sound prolongation may lead to an escalation in distress, if the source of agitation is not addressed adequately. Our results bring to the fore that an interactional practice, such as the use of sound prolongation in the context of expressed distress must be interpreted in relation to the complexity of each and every situation participants find themselves in, their level of understanding, and the task/activity at hand.
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Affiliation(s)
- Maziar Yazdanpanah
- Department of Culture and Communication, University of Linköping , Linköping , Sweden
| | - Charlotta Plejert
- Department of Culture and Communication, University of Linköping , Linköping , Sweden
| | - Christina Samuelsson
- Department of Culture and Communication, University of Linköping , Linköping , Sweden
| | - Gunilla Jansson
- Department of Swedish Language and Multilingualism, Stockholm University , Stockholm , Sweden
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179
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Knuff A, Leung RH, Seitz DP, Pallaveshi L, Burhan AM. Use of Actigraphy to Measure Symptoms of Agitation in Dementia. Am J Geriatr Psychiatry 2019; 27:865-869. [PMID: 30952608 DOI: 10.1016/j.jagp.2019.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and validity of actigraphy as a measurement of agitation in dementia. METHODS Participants aged 65 and older, diagnosed with dementia, residing in a geriatric psychiatry inpatient unit or long-term care facility were included in a cross-sectional study. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). Actigraphy was measured over seven days and compared across groups categorized as low or high agitation based on a CMAI cutoff score of 50. RESULTS Twenty participants were enrolled (mean age = 74.3 years, standard deviation [SD] = 8.69). The 24-hour mean motor activity as measured with actigraphy was significantly different between the low and high agitation groups (180.23, SD = 86.34 versus 81.51, SD = 30.29, Z = 2.29; p = 0.02). Most actigraph variables had significant correlations with CMAI and NPI scores. CONCLUSION Actigraphy was highly correlated with informant-based methods for measuring agitation in individuals with dementia and actigraphy may be useful tool for measuring agitation.
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Affiliation(s)
- Amber Knuff
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Hamilton Health Sciences Centre (AK), Hamilton
| | - Roxanne H Leung
- Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston
| | - Dallas P Seitz
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston.
| | - Luljeta Pallaveshi
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Amer M Burhan
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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180
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Hsu FY, Yang YP, Lee FP, Wang CJ, Wang JJ. Effects of Group Reminiscence Therapy on Agitated Behavior and Quality of Life in Taiwanese Older Adults With Dementia. J Psychosoc Nurs Ment Health Serv 2019; 57:30-36. [DOI: 10.3928/02793695-20190315-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/25/2019] [Indexed: 11/20/2022]
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181
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Bromundt V, Wirz-Justice A, Boutellier M, Winter S, Haberstroh M, Terman M, Münch M. Effects of a dawn-dusk simulation on circadian rest-activity cycles, sleep, mood and well-being in dementia patients. Exp Gerontol 2019; 124:110641. [PMID: 31252161 DOI: 10.1016/j.exger.2019.110641] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Abstract
Light is the most powerful "zeitgeber" signal to synchronize circadian sleep-wake cycles. In dementia, these rhythms are often fragmented - probably due to loss of neuronal function of the suprachiasmatic nuclei (the biological "master clock" in the brain) and/or weakness of external zeitgebers. We investigated the effects of a prototype dawn-dusk simulator (DDS) on circadian rest-activity cycles, sleep, mood and well-being in a balanced crossover design during fall and winter in 20 institutionalized patients with dementia (86 ± 6 y, 17 f). All participants had one baseline week followed by exposure to individually timed DDS over their beds for 7-8 weeks. They spent 8 weeks without DDS as a control. Mood, self-reliant daily activity, social behavior, agitation, and quality of life were assessed by standardized questionnaires and visual analogue scales, regularly rated by trained caregivers. Circadian and sleep characteristics of their rest-activity cycles were analyzed by actimetry over 17 weeks. DDS exposure led to significantly better mood in the morning hours after waking. The effects were most pronounced in the second 4 weeks with DDS, indicating that positive effects emerged gradually. Differences in circadian rest-activity cycles and sleep were mainly age-dependent. We found statistically significant correlations between measures of higher quality of life and better mood, greater alertness and circadian rhythm stability. We conclude that continuous, long-term application of dawn-dusk simulation at the sleep-wake transitions appears to increase external zeitgeber strength in institutionalized patients with dementia. The DDS may provide an effective, non-invasive tool to improve mood and ameliorate patients' quality of life.
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Affiliation(s)
- Vivien Bromundt
- Sleep-Wake-Epilepsy-Center, Dept. of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Anna Wirz-Justice
- Centre for Chronobiology, Transfaculty Research Platform Molecular and Cognitive Neurosciences, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | | | | | | | | | - Mirjam Münch
- Charité, University Medicine Berlin, Institute of Physiology and Institute of Medical Immunology, Berlin, Germany.
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182
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Bayram S, Usta E, Altınbaş-Akkaş Ö, Şık T. [The Determination of Agitation Behaviors among the Elderly People Receiving Long-Term Institutional Care and the Influencing Factors]. Florence Nightingale Hemsire Derg 2019; 27:173-187. [PMID: 34267972 PMCID: PMC8127599 DOI: 10.26650/fnjn18075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/25/2019] [Indexed: 11/20/2022] Open
Abstract
AIM Agitation is common among elderly people staying at nursing homes. It is a significant problem particularly for patients with dementia. This study aims to determine the agitation behaviors of elderly people receiving long-term institutional care in a city and influencing factors. METHOD The population of this descriptive and analytical study consisted of elderly individuals in three institutional care centers. 178 elderly individuals aged 60 and above were taken into the sample group. Approval was taken from them and their relatives. The study data were collected between September-November 2018 using the socio-demographic question form, the Cohen-Mansfield Agitation Inventory (CMAI), the Mini-Cog Brief Cognitive Assessment Form, the Barthel Index for Activities of Daily Living (ADL) and the Lawton&Brody Instrumental Activities of Daily Living Scale (IADL). RESULTS The mean age of the participants was 75.58±8.77 and 56.7% were males. The duration of stay at the institution was 23.48±24.46 months. Although 50.6% of the participants had psychiatric diagnoses. The mean score for the CMAI for the patients with dementia was 46.26±15.10, which was significantly higher than those without dementia (Z=-2.132, p=0.033). CONCLUSIONS The results show agitation is high among patients with dementia and cognitive impairment affects agitation significantly.
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Affiliation(s)
- Serap Bayram
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
| | - Esra Usta
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
| | | | - Tuğçe Şık
- Düzce Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Düzce, Türkiye
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183
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Nguyen N, Thalhammer R, Beutner K, Saal S, Servaty R, Klingshirn H, Icks A, Freyberg K, Vomhof M, Mansmann U, Le L, Müller M, Meyer G. Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]. Trials 2019; 20:305. [PMID: 31142350 PMCID: PMC6542100 DOI: 10.1186/s13063-019-3384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.
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Affiliation(s)
- Natalie Nguyen
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Kristina Freyberg
- Department of Medical Controlling, University Hospital Bonn, Bonn, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
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184
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Eikelboom WS, Singleton E, van den Berg E, Coesmans M, Mattace Raso F, van Bruchem RL, Goudzwaard JA, de Jong FJ, Koopmanschap M, den Heijer T, Driesen JJM, Vroegindeweij LJHM, Thomeer EC, Hoogers SE, Dijkstra AA, Zuidema SU, Pijnenburg YAL, Scheltens P, van Swieten JC, Ossenkoppele R, Papma JM. Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer's disease: protocol of the BEAT-IT study. Alzheimers Res Ther 2019; 11:48. [PMID: 31122267 PMCID: PMC6533693 DOI: 10.1186/s13195-019-0503-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are very common in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia and are associated with various disadvantageous clinical outcomes including a negative impact on quality of life, caregiver burden, and accelerated disease progression. Despite growing evidence of the efficacy of (non)pharmacological interventions to reduce these symptoms, NPS remain underrecognized and undertreated in memory clinics. The BEhavioural symptoms in Alzheimer's disease Towards early Identification and Treatment (BEAT-IT) study is developed to (1) investigate the neurobiological etiology of NPS in AD and (2) study the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) approach to structure and standardize the current care of NPS in AD. By means of the DICE method, we aim to improve the quality of life of AD patients with NPS and their caregivers who visit the memory clinic. This paper describes the protocol for the intervention study that incorporates the latter aim. METHODS We aim to enroll a total of 150 community-dwelling patients with MCI or AD and their caregivers in two waves. First, we will recruit a control group who will receive care as usual. Next, the second wave of participants will undergo the DICE method. This approach consists of the following steps: (1) describe the context in which NPS occur, (2) investigate the possible causes, (3) create and implement a treatment plan, and (4) evaluate whether these interventions are effective. Primary outcomes are the quality of life of patients and their caregivers. Secondary outcomes include NPS change, caregiver burden, caregivers' confidence managing NPS, psychotropic medication use, the experiences of patients and caregivers who underwent the DICE method, and the cost-effectiveness of the intervention. CONCLUSIONS This paper describes the protocol of an intervention study that is part of the BEAT-IT study and aims to improve current recognition and treatment of NPS in AD by structuring and standardizing the detection and treatment of NPS in AD using the DICE approach. TRIAL REGISTRATION The trial was registered on the Netherlands Trial Registry ( NTR7459 ); registered 6 September 2018.
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Affiliation(s)
- Willem S. Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ellen Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Francesco Mattace Raso
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rozemarijn L. van Bruchem
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jeannette A. Goudzwaard
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, the Netherlands
| | - Jan J. M. Driesen
- Department of Neurology, Franciscus Vlietland, PO Box 215, 3100 AE Schiedam, the Netherlands
| | | | - Elsbeth C. Thomeer
- Department of Neurology, Maasstad Hospital, PO Box 9100, 3007 AC Rotterdam, the Netherlands
| | - Susanne E. Hoogers
- Department of Neurology, Spijkenisse Medical Center, PO Box 777, 3200 GA Spijkenisse, the Netherlands
| | - Anke A. Dijkstra
- Department of Anatomy and Neurosciences, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 30,001, 9700 RB Groningen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - John C. van Swieten
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, 212 24 Malmö, Sweden
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
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185
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Benjamin S, Williams JW, Cotton C, Tung J, An H, Sanger S, Ho JMW. Anticonvulsants for behavioral and psychological symptoms in dementia: protocol for a systematic review. Syst Rev 2019; 8:118. [PMID: 31103045 PMCID: PMC6525967 DOI: 10.1186/s13643-019-1025-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are present in a majority of patients with dementia contributing to increased morbidity, health care costs, and caregiver burden. While there are no United States Food and Drug Administration (FDA)-approved medications for these symptoms, off-label use of medications such as antipsychotics have been shown to have significant adverse effects including increased mortality. The goal of this review is to examine the efficacy and safety of anticonvulsants in the treatment of BPSD. METHODS We will systematically search for randomized trials of anticonvulsants compared to placebo or other treatments such as antidepressants and antipsychotics from the following sources: The Cochrane Library, MEDLINE (OVID SP) in Process and Other Non-Indexed Citations (latest version), EMBASE, clinicalTrials.gov , and the WHO Clinical Trials Registry. The studies will be limited to those published in English but the study location can be worldwide. We will include studies pertaining to individuals with dementia and symptoms of BPSD. The primary outcomes will be behavioral change as measured by validated scales and secondary outcomes will include caregiver burden, quality of life, placement in long term care facility, serious adverse effects, and treatment discontinuation due to adverse effects. Two sets of reviewers will independently screen select and extract data. We will narratively describe the major findings and conclusions from individual studies. Patients who are prescribed antiepileptic drugs (AEDs) for other indications, including seizures, will be excluded. Outcomes of interest will include a change in a validated scale that measures BPSD, serious adverse events, and caregiver quality of life outcomes. If the data are found to be appropriate for a meta-analysis, we will use a random effects model to compute summary estimates of treatment effects. DISCUSSION This is a protocol for a systematic review addressing the anticonvulsant group of medications as a whole, and as such, our results will inform current clinical practice in the use of anticonvulsants for BPSD. It will also help clinicians and policy makers compare the efficacy of anticonvulsants compared to antidepressants and antipsychotics as well as identify areas which will need further study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017079826.
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Affiliation(s)
- Sophiya Benjamin
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, 10b Victoria St S, Kitchener, ON, N2G 1C5, Canada.
| | - John W Williams
- Duke University and the Durham Veteran Affairs Medical Center, Durham, NC, USA
| | | | | | - Howard An
- Toxicology, Trillium Health Partners - Credit Valley Hospital, Mississauga, ON, Canada
| | | | - Joanne Man-Wai Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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186
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Herr K, Sefcik JS, Neradilek MB, Hilgeman MM, Nash P, Ersek M. Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes. Pain Manag Nurs 2019; 20:253-260. [PMID: 31085096 DOI: 10.1016/j.pmn.2018.11.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/19/2018] [Accepted: 11/28/2018] [Indexed: 10/26/2022]
Abstract
PURPOSE The Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US. DESIGN Cross-sectional study. SETTINGS Sixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama. PARTICIPANTS One hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment. METHODS Validity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician's pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach's alpha. RESULTS MOBID overall scores were significantly associated with expert clinician's rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83). CONCLUSIONS AND CLINICAL IMPLICATIONS Result of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.
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Affiliation(s)
- Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Justine S Sefcik
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama; The University of Alabama Alabama Research Institute on Aging & Department of Psychology, Tuscaloosa, Alabama; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
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187
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Resnick B, Boltz M, Galik E, Holmes S, Vigne E, Fix S, Zhu S. Pain Assessment, Management, and Impact Among Older Adults in Assisted Living. Pain Manag Nurs 2019; 20:192-197. [PMID: 31080144 DOI: 10.1016/j.pmn.2019.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/14/2018] [Accepted: 02/23/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the incidence, pharmacologic management, and impact of pain on function, agitation, and resistiveness to care among assisted living residents. DESIGN This was a descriptive study. DATA SOURCES Baseline data from 260 residents in the second cohort of the study Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle. REVIEW/ANALYSIS METHODS Descriptive analyses for the Pain Assessment in Advanced Dementia (PAINAD), Visual Descriptor Scale (VDS), and use of medication for pain management and hypothesis testing using linear regression analyses were performed. RESULTS The majority of the sample was female (71%) and white (96%) with a mean age of 87 (standard deviation = 7). Fifty-two out of the 260 residents (20%) reported pain based on either the PAINAD or the VDS. Out of the total 260 residents, 75 (29%) received pain medication. Twenty-two out of the 52 individuals (42%) reporting pain were not getting pain medication. Controlling for age, gender, and cognition, the PAINAD was significantly associated with agitation, function, and resistiveness to care and the VDS was only associated with function. CONCLUSIONS The incidence of pain was low among participants based on the PAINAD or the VDS. Pain measured by the PAINAD was significantly associated with function, agitation, and resistiveness to care.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, Pennsylvania
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Sarah Holmes
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Erin Vigne
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Steven Fix
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland
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188
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Habiger TF, Achterberg WP, Flo E, Husebo BS. Psychosis symptoms in nursing home residents with and without dementia-Cross-sectional analyses from the COSMOS study. Int J Geriatr Psychiatry 2019; 34:683-691. [PMID: 30706561 DOI: 10.1002/gps.5067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 01/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the characteristics of nursing home residents with psychosis and the association with potential underlying factors, such as pain, sleep disturbances, and antipsychotic medication. METHOD Five hundred forty-five residents with and without dementia from 67 Norwegian nursing home units were included in the cross-sectional analyses. Psychosis was the main outcome measure in our study; other outcome measures include quality of life (QoL), activities of daily living (ADL) function, cognitive function, pain, and antipsychotic medication. RESULTS One hundred twelve residents had one or more symptoms of psychosis, and compared with residents without psychosis, they had lower QoL (p < 0.001), ADL function (p = 0.003), and cognitive functioning (p = 0.001). Adjusted logistic regression analyses showed that psychosis was associated with the prevalence of pain (OR: 3.19; 95% CI, 1.94-5.24), sleep disturbances (OR: 4.51; 95% CI, 2.91-6.99), and total number of medication (OR: 1.10; 95% CI, 1.03-1.17). Residents with psychosis but without antipsychotic medication had better QoL (p = 0.005) compared with residents receiving any antipsychotics. CONCLUSION Psychosis in NH residents is associated with pain, sleep disturbances, and number of medications. Residents with psychosis have poor QoL, although better QoL was observed among those who did not use antipsychotic medication.
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Affiliation(s)
- Torstein F Habiger
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Wilco P Achterberg
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, Netherlands
| | - Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
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189
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Richter C, Berg A, Langner H, Meyer G, Köpke S, Balzer K, Wolschon EM, Silies K, Sönnichsen A, Löscher S, Haastert B, Icks A, Wolf U, Fleischer S. Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial. Age Ageing 2019; 48:419-425. [PMID: 30806453 PMCID: PMC6503937 DOI: 10.1093/ageing/afz016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/18/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions. OBJECTIVE we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions. DESIGN a 2-armed 12-month cluster-randomised controlled trial. SETTING nursing homes in East, North and West Germany. METHODS all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation. RESULTS the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532). CONCLUSIONS the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes. TRIAL REGISTRATION ClinicalTrials.gov NCT02295462.
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Affiliation(s)
- Christin Richter
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Henriette Langner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Eva-Maria Wolschon
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Katharina Silies
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Löscher
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ursula Wolf
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- University Hospital Halle (Saale), Halle (Saale), Germany
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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190
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Na R, Yang JH, Yeom Y, Kim YJ, Byun S, Kim K, Kim KW. A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia. Psychiatry Investig 2019; 16:325-335. [PMID: 31132836 PMCID: PMC6539264 DOI: 10.30773/pi.2019.02.11.2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/11/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. METHODS A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020). RESULTS Ten randomized controlled trials met the inclusion criteria of the current meta-analysis. NPI were effective in improving ADL [SMD=0.28, 95% confidence interval (CI)=0.11-0.45] and reducing depression (SMD=-0.44, 95% CI=-0.70- -0.19). However, NPI were not effective in reducing agitation, anxiety, or overall, or improving cognitive function. In a subgroup analysis, music therapy was effective in reducing overall BPSD (SMD=-0.52, 95% CI=-0.90- -0.13). CONCLUSION Albeit the number of studies was limited, NPI improved ADL and depression in PWMSD.
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Affiliation(s)
- Riyoung Na
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Ji-Hye Yang
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Yusung Yeom
- National Institute of Dementia, Seongnam, Republic of Korea
| | - You Joung Kim
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Seonjeong Byun
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kiwon Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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191
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Kromhout MA, Rius Ottenheim N, Giltay E, Numans ME, Achterberg WP. Caffeine and neuropsychiatric symptoms in patients with dementia: A systematic review. Exp Gerontol 2019; 122:85-91. [PMID: 31051199 DOI: 10.1016/j.exger.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The consumption of caffeine has well known effects on the behavior and sleep of healthy adults. Behavioral symptoms and sleeping difficulties are common in patients with dementia which may be affected by caffeine consumption. This systematic review examines the association between caffeine intake and neuropsychiatric symptoms in patients with dementia. METHODS In January 2019 an extensive search was conducted in Medline (PubMed), Embase, Emcare, Cochrane, PsychInfo, Web of Science and gray literature. Studies were included when they: i) investigated patients diagnosed with dementia, ii) reported neuropsychiatric symptoms, iii) used caffeine or coffee consumption as an intervention, and iv) reported associations between caffeine or coffee consumption and neuropsychiatric symptoms. Studies were excluded when they also included participants without a diagnosis of dementia, or presented a review or expert opinion. Two reviewers independently rated the studies and reached consensus on the appraisal. RESULTS Of the seven studies eligible for this review, four reported on sleeping difficulties and five on behavioral symptoms. There was no consistent effect of caffeine administration on neuropsychiatric symptoms: e.g., both high caffeine consumption and eliminating caffeine were associated with less apathy, the total Neuropsychiatric Inventory (Nursing Home) decreased after both coffee therapy and after eliminating caffeine, and both caffeine consumption and eliminating caffeine improved sleep. CONCLUSION These findings suggest that caffeine can either induce or reduce neuropsychiatric symptoms in individual patients with dementia. Therefore, in these patients, caffeine consumption requires a prudent individualized approach and further research on the effects of caffeine on individual neuropsychiatric symptoms is required.
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Affiliation(s)
- M A Kromhout
- Leiden University Medical Centre, department of Public Health and Primary Care, V0-P, Postbus 9600, 2300 RC Leiden, the Netherlands.
| | - N Rius Ottenheim
- Leiden University Medical Centre, department of Psychiatry, B1-P, Postbus 9600, 2300 RC, Leiden, the Netherlands
| | - E Giltay
- Leiden University Medical Centre, department of Psychiatry, B1-P, Postbus 9600, 2300 RC, Leiden, the Netherlands
| | - M E Numans
- Leiden University Medical Centre, department of Public Health and Primary Care, V0-P, Postbus 9600, 2300 RC Leiden, the Netherlands
| | - W P Achterberg
- Leiden University Medical Centre, department of Public Health and Primary Care, V0-P, Postbus 9600, 2300 RC Leiden, the Netherlands
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Soobiah C, Tadrous M, Knowles S, Blondal E, Ashoor HM, Ghassemi M, Khan PA, Ho J, Tricco AC, Straus SE. Variability in the validity and reliability of outcome measures identified in a systematic review to assess treatment efficacy of cognitive enhancers for Alzheimer's Dementia. PLoS One 2019; 14:e0215225. [PMID: 30998774 PMCID: PMC6472754 DOI: 10.1371/journal.pone.0215225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Selection of optimal outcome measures is a critical step in a systematic review; inclusion of uncommon or non-validated outcome measures can impact the uptake of systematic review findings. Our goals were to identify the validity and reliability of outcome measures used in primary studies to assess cognition, function, behaviour and global status; and, to use these data to select outcomes for a systematic review (SR) on treatment efficacy of cognitive enhancers for Alzheimer's Dementia (AD). METHODS Articles fulfilling the eligibility criteria of the SR were included in a charting exercise to catalogue outcome measures reported. Outcome measures were then assessed for validity and reliability. Two independent reviewers abstracted data on outcome measures and validity and reliability reported for cognition, function, behaviour and global status. RESULTS 129 studies were included in the charting exercise; 57 outcome measures were identified for cognition, 21 for function, 13 for behaviour and 10 for global status. A total of 35 (61%) cognition measures, 10 (48%) functional measures, 8 (61%) behavioural measures and four (40%) of global status measures were only used once in the literature. Validity and reliability information was found for 51% of cognition measures, 90% of function and global status measures and 100% of behavioural measures. CONCLUSIONS While a large number of outcome measures were used in primary studies, many of these were used only once. Reporting of validity and reliability varied in AD studies of cognitive enhancers. Core outcome sets should be used when available; when they are not available researchers need to balance frequency of reported outcome measures, their respective validity and reliability, and preferences of knowledge users. SYSTEMATIC REVIEW REGISTRATION CRD#42012001948.
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Affiliation(s)
- Charlene Soobiah
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada
| | - Sandra Knowles
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Canada
- Clinical Pharmacology & Toxicology, Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| | - Erik Blondal
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
| | - Huda M. Ashoor
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
| | - Marco Ghassemi
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
| | - Joanne Ho
- Schlegel Research Institute for Aging, Waterloo, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Andrea C. Tricco
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Sharon E. Straus
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Suite RFE 3–805, Toronto, Ontario Canada
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Volicer L. Review of Programs for Persons Facing Death with Dementia. Healthcare (Basel) 2019; 7:E62. [PMID: 30991668 PMCID: PMC6628090 DOI: 10.3390/healthcare7020062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persons with advanced dementia cannot initiate activities because of the executive dysfunction. The lack of activities was identified as one of the most important factors contributing to behavioral problems of these persons. The unmet needs were boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activities. There is a need for activities designed specifically for residents with advanced dementia. OBJECTIVE A description of patient's needs and of programs that intend to maintain quality of life for people with dementia and facing death. DATA SOURCES A literature review of programs used for persons with advanced dementia and residing in long-term facilities, using the PubMed data base and collateral sources. RESULTS Since palliative care is appropriate for persons with advanced dementia, attention has to be paid to three following important aspects of care: Medical issues, behavioral symptoms, and meaningful activities. Medical interventions should be limited to those which have more benefits than burdens, behavioral symptoms should be distinguished according to the context in which they occur, and treated by non-pharmacological interventions that involve meaningful activities. This review describes four programs that may promote the quality of life in persons with advanced dementia and facing death. They are designed for persons with advanced dementia, taking into account their functional impairments. Most of these programs involve short infrequent sessions. In contrast, Namaste Care is a daily extended program of enhanced nursing care that can provide quality of life until the last breath. CONCLUSIONS It is possible to maintain quality life for people with advanced dementia if a special program of activities is available.
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Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL 34639, USA.
- The 3rd Medical Faculty, Charles University, 11000 Prague, Czech Republic.
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Abraham J, Kupfer R, Behncke A, Berger-Höger B, Icks A, Haastert B, Meyer G, Köpke S, Möhler R. Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A pragmatic cluster randomized controlled trial. Int J Nurs Stud 2019; 96:27-34. [PMID: 31014546 DOI: 10.1016/j.ijnurstu.2019.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite clear evidence for the lack of effectiveness and safety, physical restraints are frequently applied in nursing homes. Multicomponent interventions addressing nurses' attitudes and organizational culture have been effective in reducing physical restraints. OBJECTIVE To evaluate the effectiveness of two versions of a guideline and theory-based multicomponent intervention to reduce physical restraints in nursing homes. DESIGN Pragmatic cluster randomized controlled trial. SETTING The study was conducted in 120 nursing homes in four regions in Germany. PARTICIPANTS All residents living in the participating nursing home during follow-up, newly admitted residents were also included. A total of 12,245 residents included in the primary analysis (4126 and 3547 residents in intervention group 1 and 2 and 4572 residents in the control group). METHODS Intervention group 1 received an updated version of a successfully tested guideline-based multicomponent intervention (comprising brief education for the nursing staff, intensive training of nominated key nurses in each cluster, introduction of a least-restraint policy and supportive material), intervention group 2 received a concise version of the original program and the control group received optimized usual care (i.e. supportive materials only). Primary outcome was physical restraint prevalence at twelve months, assessed through direct observation by blinded investigators. Intervention and control groups were compared using baseline-adjusted linear regression on cluster level, Bonferroni-adjusted for double testing. Secondary outcomes included falls, fall-related fractures, and quality of life. We also described intervention costs and performed a comprehensive process analysis. RESULTS At baseline, mean physical restraint prevalence was 17.4% and 19.6% in intervention groups 1 and 2, and 18.8% in the control group. After twelve months, mean prevalence was 14.6%, 15.7%, and 17.6%. Baseline-adjusted differences between mean prevalences were 2.0% (97.5% CI, -5.8 to 1.9) lower in intervention group 1 and 2.5% (97.5% CI, -6.4 to 1.4) lower in intervention group 2 compared to controls. Physical restraint prevalence showed a pronounced variation between the different clusters in all study groups. We found no significant differences in the secondary outcomes. According to the process evaluation, the intervention was mainly implemented as planned, but the expected change towards a least restraint culture of care was not achieved in all clusters. CONCLUSIONS Neither intervention showed a clear advantage compared to control. The pronounced center variation in physical restraint prevalence indicates that other approaches like governmental policies are needed to sustainably change physical restraint practice and reduce center variations in nursing homes. TRIAL REGISTRATION ClinicalTrials.gov : NCT02341898.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Ramona Kupfer
- Health Sciences, MIN Faculty, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
| | - Anja Behncke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | | | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Str. 12, 58453 Witten, Germany.
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Ottoboni G, Amici S, Iannizzi P, Di Pucchio A, Vanacore N, Chattat R. Italian revised memory and behavior problems checklist (It-RMBPC): validation and psychometric properties in Alzheimer's disease caregivers. Aging Clin Exp Res 2019; 31:527-537. [PMID: 30066051 DOI: 10.1007/s40520-018-0995-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
Behavioral and psychiatric symptoms (BPSD), common in persons with Alzheimer's disease (AD), are known to be associated with caregiver burdening. Therefore, early recognition of BPSD is necessary to protect these caregivers. The aim of this validation study was to test the internal consistency, test-retest reliability and concurrent validity of an Italian translation of the revised memory and behavior problems checklist (RMBPC), as it demonstrated high plasticity in timely measuring the day-to-day BPSD changes that challenge caregivers. A cohort of 355 dyads composed of AD subjects and their principal caregivers were assessed with the Italian version of RMPBC capitalizing on the information provided by the latter ones. The results were compared with the ones from other predictors (i.e., the Zarit Burben Interview, the Hospital Anxiety and Depression Scale, the EurQuality of Life, the neuropsychiatric symptoms). The validity and stability of the It-RMBPC resulted being solid and concurrent reliability resulted having higher correlations with principal caregiver anxiety level. Future studies on the role of BPSD in fostering anxiety in AD principal caregivers are merited.
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196
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Livingston G, Barber J, Marston L, Stringer A, Panca M, Hunter R, Cooper C, Laybourne A, La Frenais F, Reeves S, Manela M, Lambe K, Banerjee S, Rapaport P. Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial. Lancet Psychiatry 2019; 6:293-304. [PMID: 30872010 DOI: 10.1016/s2215-0366(19)30045-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Many people with dementia living in care homes have distressing and costly agitation symptoms. Interventions should be efficacious, scalable, and feasible. METHODS We did a parallel-group, cluster-randomised controlled trial in 20 care homes across England. Care homes were eligible if they had 17 residents or more with dementia, agreed to mandatory training for all eligible staff and the implementation of plans, and more than 60% of eligible staff agreed to participate. Staff were eligible if they worked during the day providing face-to-face care for residents with dementia. Residents were eligible if they had a known dementia diagnosis or scored positive on screening with the Noticeable Problems Checklist. A statistician independent of the study randomised care homes (1:1) to the Managing Agitation and Raising Quality of Life (MARQUE) intervention or treatment as usual (TAU) using computer-generated randomisation in blocks of two, stratified by type of home (residential or nursing). Care home staff were not masked to the intervention but were asked not to inform assessors. Residents with dementia, family carers, outcome assessors, statisticians, and health economists were masked to allocation until the data were analysed. MARQUE is an evidence-based manualised intervention, delivered by supervised graduate psychologists to staff in six interactive sessions. The primary outcome was agitation score at 8 months, measured using the Cohen-Mansfield Agitation Inventory (CMAI). Analysis of the primary outcome was done in the modified intention-to-treat population, which included all randomly assigned residents for whom CMAI data was available at 8 months. Mortality was assessed in all randomly assigned residents. This study is registered with the ISRCTN registry, number ISRCTN96745365. FINDINGS Between June 14, 2016, and July 4, 2017, we randomised ten care homes (189 residents) to the MARQUE intervention and ten care homes (215 residents) to TAU. At 8 months, primary outcome data were available for 155 residents in the MARQUE group and 163 residents in the TAU group. At 8 months, no significant differences in mean CMAI scores were identified between the MARQUE and TAU groups (adjusted difference -0·40 [95% CI -3·89 to 3·09; p=0·8226]). In the intervention care homes, 84% of all eligible staff completed all sessions. The mean difference in cost between the MARQUE and TAU groups was £204 (-215 to 623; p=0·320) and mean difference in quality-adjusted life-years was 0·015 (95% CI -0·004 to 0·034; p=0·127). At 8 months, 27 (14%) of 189 residents in the MARQUE group and 41 (19%) of 215 residents in the TAU group had died. The prescription of antipsychotic drugs was not significantly different between the MARQUE group and the TAU group (odds ratio 0·66; 95% CI 0·26 to 1·69, p=0·3880). INTERPRETATION The MARQUE intervention was not efficacious for agitation although feasible and cost-effective in terms of quality of life. Addressing agitation in care homes might require resourcing for delivery by professional staff of a more intensive intervention, implementing social and activity times, and a longer time to implement change. FUNDING UK Economic and Social Research Council and the National Institute of Health Research.
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Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
| | - Julie Barber
- UCL Statistical Science and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Monica Panca
- Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Anne Laybourne
- Division of Psychiatry, University College London, London, UK
| | | | - Suzanne Reeves
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Katie Lambe
- Division of Psychiatry, University College London, London, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School and Sussex Partnership, NHS Foundation Trust, Brighton, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
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197
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Identification of Sexual Disinhibition in Dementia by Family Caregivers. Alzheimer Dis Assoc Disord 2019; 33:154-159. [DOI: 10.1097/wad.0000000000000302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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198
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McShane R, Westby MJ, Roberts E, Minakaran N, Schneider L, Farrimond LE, Maayan N, Ware J, Debarros J. Memantine for dementia. Cochrane Database Syst Rev 2019; 3:CD003154. [PMID: 30891742 PMCID: PMC6425228 DOI: 10.1002/14651858.cd003154.pub6] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Memantine is a moderate affinity uncompetitive antagonist of glutamate NMDA receptors. It is licensed for use in moderate and severe Alzheimer's disease (AD); in the USA, it is also widely used off-label for mild AD. OBJECTIVES To determine efficacy and safety of memantine for people with dementia. To assess whether memantine adds benefit for people already taking cholinesterase inhibitors (ChEIs). SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register of trials (http://www.medicine.ox.ac.uk/alois/) up to 25 March 2018. We examined clinical trials registries, press releases and posters of memantine manufacturers; and the web sites of the FDA, EMEA and NICE. We contacted authors and companies for missing information. SELECTION CRITERIA Double-blind, parallel group, placebo-controlled, randomised trials of memantine in people with dementia. DATA COLLECTION AND ANALYSIS We pooled and analysed data from four clinical domains across different aetiologies and severities of dementia and for AD with agitation. We assessed the impact of study duration, severity and concomitant use of ChEIs. Consequently, we restricted analyses to the licensed dose (20 mg/day or 28 mg extended release) and data at six to seven months duration of follow-up, and analysed separately results for mild and moderate-to-severe AD.We transformed results for efficacy outcomes into the difference in points on particular outcome scales. MAIN RESULTS Across all types of dementia, data were available from almost 10,000 participants in 44 included trials, most of which were at low or unclear risk of bias. For nearly half the studies, relevant data were obtained from unpublished sources. The majority of trials (29 in 7885 participants) were conducted in people with AD.1. Moderate-to-severe AD (with or without concomitant ChEIs). High-certainty evidence from up to 14 studies in around 3700 participants consistently shows a small clinical benefit for memantine versus placebo: clinical global rating (CGR): 0.21 CIBIC+ points (95% confidence interval (CI) 0.14 to 0.30); cognitive function (CF): 3.11 Severe Impairment Battery (SIB) points (95% CI 2.42 to 3.92); performance on activities of daily living (ADL): 1.09 ADL19 points (95% CI 0.62 to 1.64); and behaviour and mood (BM): 1.84 Neuropsychiatric Inventory (NPI) points (95% CI 1.05 to 2.76). There may be no difference in the number of people discontinuing memantine compared to placebo: risk ratio (RR) 0.93 (95% CI 0.83 to 1.04) corresponding to 13 fewer people per 1000 (95% CI 31 fewer to 7 more). Although there is moderate-certainty evidence that fewer people taking memantine experience agitation as an adverse event: RR 0.81 (95% CI 0.66 to 0.99) (25 fewer people per 1000, 95% CI 1 to 44 fewer), there is also moderate-certainty evidence, from three additional studies, suggesting that memantine is not beneficial as a treatment for agitation (e.g. Cohen Mansfield Agitation Inventory: clinical benefit of 0.50 CMAI points, 95% CI -3.71 to 4.71) .The presence of concomitant ChEI does not impact on the difference between memantine and placebo, with the possible exceptions of the BM outcome (larger effect in people taking ChEIs) and the CF outcome (smaller effect).2. Mild AD (Mini Mental State Examination (MMSE) 20 to 23): mainly moderate-certainty evidence based on post-hoc subgroups from up to four studies in around 600 participants suggests there is probably no difference between memantine and placebo for CF: 0.21 ADAS-Cog points (95% CI -0.95 to 1.38); performance on ADL: -0.07 ADL 23 points (95% CI -1.80 to 1.66); and BM: -0.29 NPI points (95% CI -2.16 to 1.58). There is less certainty in the CGR evidence, which also suggests there may be no difference: 0.09 CIBIC+ points (95% CI -0.12 to 0.30). Memantine (compared with placebo) may increase the numbers of people discontinuing treatment because of adverse events (RR 2.12, 95% CI 1.03 to 4.39).3. Mild-to-moderate vascular dementia. Moderate- and low-certainty evidence from two studies in around 750 participants indicates there is probably a small clinical benefit for CF: 2.15 ADAS-Cog points (95% CI 1.05 to 3.25); there may be a small clinical benefit for BM: 0.47 NOSGER disturbing behaviour points (95% CI 0.07 to 0.87); there is probably no difference in CGR: 0.03 CIBIC+ points (95% CI -0.28 to 0.34); and there may be no difference in ADL: 0.11 NOSGER II self-care subscale points (95% CI -0.35 to 0.54) or in the numbers of people discontinuing treatment: RR 1.05 (95% CI 0.83 to 1.34).There is limited, mainly low- or very low-certainty efficacy evidence for other types of dementia (Parkinson's disease and dementia Lewy bodies (for which CGR may show a small clinical benefit; four studies in 319 people); frontotemporal dementia (two studies in 133 people); and AIDS-related Dementia Complex (one study in 140 people)).There is high-certainty evidence showing no difference between memantine and placebo in the proportion experiencing at least one adverse event: RR 1.03 (95% CI 1.00 to 1.06); the RR does not differ between aetiologies or severities of dementia. Combining available data from all trials, there is moderate-certainty evidence that memantine is 1.6 times more likely than placebo to result in dizziness (6.1% versus 3.9%), low-certainty evidence of a 1.3-fold increased risk of headache (5.5% versus 4.3%), but high-certainty evidence of no difference in falls. AUTHORS' CONCLUSIONS We found important differences in the efficacy of memantine in mild AD compared to that in moderate-to-severe AD. There is a small clinical benefit of memantine in people with moderate-to-severe AD, which occurs irrespective of whether they are also taking a ChEI, but no benefit in people with mild AD.Clinical heterogeneity in AD makes it unlikely that any single drug will have a large effect size, and means that the optimal drug treatment may involve multiple drugs, each having an effect size that may be less than the minimum clinically important difference.A definitive long-duration trial in mild AD is needed to establish whether starting memantine earlier would be beneficial over the long term and safe: at present the evidence is against this, despite it being common practice. A long-duration trial in moderate-to-severe AD is needed to establish whether the benefit persists beyond six months.
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Affiliation(s)
- Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Emmert Roberts
- King's College LondonDepartment of Psychological Medicine and National Addiction CentreWeston Education CentreLondonLondonUKSE5 9RJ
| | - Neda Minakaran
- Moorfields Eye Hospital NHS Foundation TrustDepartment of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Lon Schneider
- Keck School of Medicine of the University of Southern California1540 Alcazar Street, CHP 216Los AngelesCAUSA90033
| | - Lucy E Farrimond
- Oxford University Hospitals NHS Foundation TrustNeurosciences DepartmentJohn Radcliffe HospitalOxfordUKOX3 9DU
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Jennifer Ware
- University of OxfordCochrane Dementia and Cognitive Improvement GroupOxfordUKOX3 9DU
| | - Jean Debarros
- University of OxfordNuffield Department of Clinical Neurosciences (NDCN)Level 6, West Wing, John Radcliffe HospitalOxfordUKOX3 9DU
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Sharp CA, Schulz Moore JS, McLaws ML. Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? JOURNAL OF BIOETHICAL INQUIRY 2019; 16:17-34. [PMID: 30671872 PMCID: PMC6474851 DOI: 10.1007/s11673-018-9892-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.
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Affiliation(s)
- Catherine A Sharp
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia
| | | | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia.
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Healthcare resource utilisation and costs of agitation in people with dementia living in care homes in England - The Managing Agitation and Raising QUality of LifE in Dementia (MARQUE) study. PLoS One 2019; 14:e0211953. [PMID: 30807569 PMCID: PMC6391021 DOI: 10.1371/journal.pone.0211953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background People with dementia living in care homes often experience clinically significant agitation; however, little is known about its economic impact. Objective To calculate the cost of agitation in people with dementia living in care homes. Methods We used the baseline data from 1,424 residents with dementia living in care homes (part of Managing Agitation and Raising QUality of lifE in dementia (MARQUE) study) that had Cohen-Mansfield Agitation Inventory (CMAI) scores recorded. We investigated the relationship between residents’ health and social care costs and severity of agitation based on the CMAI total score. In addition, we assessed resource utilisation and compared costs of residents with and without clinically significant symptoms of agitation using the CMAI over and above the cost of the care home. Results Agitation defined by the CMAI was a significant predictor of costs. On average, a one-point increase in the CMAI will lead to a 0.5 percentage points (cost ratio 1.005, 95%CI 1.001 to 1.010) increase in the annual costs. The excess annual cost associated with agitation per resident with dementia was £1,125.35. This suggests that, on average, agitation accounts for 44% of the annual health and social care costs of dementia in people living in care homes. Conclusion Agitation in people with dementia living in care homes contributes significantly to the overall costs increasing as the level of agitation increases. Residents with the highest level of agitation cost nearly twice as much as those with the lowest levels of agitation, suggesting that effective strategies to reduce agitation are likely to be cost-effective in this setting.
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