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Di Lorito C, van der Wardt V, Pollock K, Howe L, Booth V, Logan P, Gladman J, Masud T, das Nair R, Goldberg S, Vedhara K, O’Brien R, Adams E, Cowley A, Bosco A, Hancox J, Burgon C, Bajwa R, Lock J, Long A, Godfrey M, Dunlop M, Harwood RH. The facilitators and barriers to improving functional activity and wellbeing in people with dementia: a qualitative study from the process evaluation of Promoting Activity, Independence and Stability in Early Dementia (PrAISED). Age Ageing 2023; 52:afad166. [PMID: 37603841 PMCID: PMC10442073 DOI: 10.1093/ageing/afad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The PRomoting Activity, Independence and Stability in Early Dementia (PrAISED) study delivered an exercise and functional activity programme to participants living with dementia. A Randomised Controlled Trial showed no measurable benefits in activities of daily living, physical activity or quality of life. OBJECTIVE To explore participants' responses to PrAISED and explain why an intervention that might be expected to have produced measurable health gains did not do so. METHODS A process evaluation using qualitative methods, comprising interviews and researcher notes. SETTING Data were collected in participants' homes or remotely by telephone or videoconferencing. SAMPLE A total of 88 interviews were conducted with 44 participants living with dementia (n = 32 intervention group; n = 12 control group) and 39 caregivers. A total of 69 interviews were conducted with 26 therapists. RESULTS Participants valued the intervention as proactively addressing health issues that were of concern to them, and as a source of social contact, interaction, information and advice. Facilitators to achieving positive outcomes included perceiving progress towards desired goals, positive expectations, therapists' skills and rapport with participants, and caregiver support. Barriers included: cognitive impairment, which prevented independent engagement and carry-over between sessions; chronic physical health problems and intercurrent acute illness and injury; 'tapering' (progressively infrequent supervision intended to help develop habits and independent activity); and the COVID-19 pandemic. CONCLUSIONS Self-directed interventions may not be appropriate in the context of dementia, even in the mild stages of the condition. Dementia-specific factors affected outcomes including caregiver support, rapport with therapists, availability of supervision, motivational factors and the limitations of remote delivery. The effects of cognitive impairment, multimorbidity and frailty overwhelmed any positive impact of the intervention. Maintenance of functional ability is valued, but in the face of inevitable progression of disease, other less tangible outcomes become important, challenging how we frame 'health gain' and trial outcomes.
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Affiliation(s)
- Claudio Di Lorito
- Division of Primary Care and Population Health, University College London, UK
| | | | | | - Louise Howe
- School of Medicine, University of Nottingham, UK
| | - Vicky Booth
- School of Medicine, University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, UK
| | - John Gladman
- School of Medicine, University of Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, UK
| | | | | | | | | | - Emma Adams
- School of Medicine, University of Nottingham, UK
| | - Alison Cowley
- School of Medicine, University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, UK
| | | | - Jennie Hancox
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Clare Burgon
- School of Health Sciences, University of Nottingham, UK
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Reichhart T, Pitschel-Walz G, Kissling W, Bäuml J, Schuster T, Rummel-Kluge C. Gender differences in patient and caregiver psychoeducation for schizophrenia. Eur Psychiatry 2020; 25:39-46. [DOI: 10.1016/j.eurpsy.2009.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 06/15/2009] [Accepted: 08/08/2009] [Indexed: 11/17/2022] Open
Abstract
AbstractObjective:The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation.Methods:Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge.Results:The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers.Conclusion:Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.
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Phan SV, Osae S, Morgan JC, Inyang M, Fagan SC. Neuropsychiatric Symptoms in Dementia: Considerations for Pharmacotherapy in the USA. Drugs R D 2019; 19:93-115. [PMID: 31098864 PMCID: PMC6544588 DOI: 10.1007/s40268-019-0272-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dementia affects all domains of cognition. The relentless progression of the disease after diagnosis is associated with a 98% incidence of neuropsychiatric symptoms (NPS) at some point in the disease, including depression, psychosis, agitation, aggression, apathy, sleep disturbances, and disinhibition. These symptoms can be severe and lead to excess morbidity and mortality. The purpose of this article was to describe current literature on the medication management of NPS of dementia and highlight approaches to and concerns about the pharmacological treatment of NPS in the USA. Guidelines and expert opinion favor nonpharmacologic management of NPS as first-line management. Unfortunately, lack of adequate caregiver training and a high failure rate eventually result in the use of psychotropic agents in patients with dementia. Various psychotropic medications have been studied, although how they should be used in the management of NPS remains unclear. A systematic approach to evaluation, treatment, and monitoring, along with careful documentation and evidenced-based agent and dose selection, is likely to reduce risk and improve patient outcomes. Considerations should be given to the NPS presentation, including type, frequency, and severity, when weighing the risks and benefits of initiating, continuing, or discontinuing psychotropic management. Use of antidepressants, sedative/hypnotics, antipsychotics, and antiepileptic agents should include a clear and documented analysis of risk and benefit in a given patient with dementia.
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Affiliation(s)
- Stephanie V Phan
- Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Southwest Georgia Clinical Campus, Albany, GA, USA.
| | - Sharmon Osae
- Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Southwest Georgia Clinical Campus, Albany, GA, USA
| | - John C Morgan
- Memory Disorders Program, Department of Neurology, Augusta University, Augusta, GA, USA
| | - Mfon Inyang
- Phoebe Putney Memorial Hospital, Albany, GA, USA
| | - Susan C Fagan
- Memory Disorders Program, Department of Neurology, Augusta University, Augusta, GA, USA.,Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA.,Program in Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, USA
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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5
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Garlinghouse A, Rud S, Johnson K, Plocher T, Klassen D, Havey T, Gaugler JE. Creating objects with 3D printers to stimulate reminiscence in memory loss: A mixed-method feasibility study. Inform Health Soc Care 2017; 43:362-378. [PMID: 28786714 DOI: 10.1080/17538157.2017.1290640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of the current project was to determine the feasibility of using 3D printed technology to facilitate reminiscence-related activities for persons with memory loss (PWMLs). METHODS A parallel convergent mixed methods design was used. Fifteen PWMLs, 13 family members, and six staff from two residential long-term care facilities participated. Participants were observed and interviewed initially, during a 2-week reminiscence session, and again during a 1-month reminiscence session. Staff participants also completed a 1-month focus group, and staff and family members were administered a 3D printing review checklist at 1-month. RESULTS The integrated qualitative and quantitative data strongly suggested that PWMLs enjoyed using the 3D objects, were engaged while doing so and appeared to value the objects due to their personalized nature. The use of 3D printed objects also appeared to encourage family involvement as well as family and staff interactions with PWMLs. Barriers to use included memory impairment and behavioral issues. CONCLUSIONS The use of 3D printed objects could provide an easy-to-use, well-received, person-centered approach that augments current reminiscence strategies for PWMLs.
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Affiliation(s)
- Allison Garlinghouse
- a School of Nursing , University of Minnesota-Twin Cities , Minneapolis , MN , USA
| | - Shaina Rud
- a School of Nursing , University of Minnesota-Twin Cities , Minneapolis , MN , USA
| | - Kari Johnson
- b Moai Technologies, LLC , Minneapolis , MN , USA
| | - Tom Plocher
- b Moai Technologies, LLC , Minneapolis , MN , USA
| | | | - Thomas Havey
- b Moai Technologies, LLC , Minneapolis , MN , USA
| | - Joseph E Gaugler
- a School of Nursing , University of Minnesota-Twin Cities , Minneapolis , MN , USA
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6
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Breitve MH, Hynninen MJ, Brønnick K, Chwiszczuk LJ, Auestad BH, Aarsland D, Rongve A. A longitudinal study of anxiety and cognitive decline in dementia with Lewy bodies and Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2016; 8:3. [PMID: 26812908 PMCID: PMC4729131 DOI: 10.1186/s13195-016-0171-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/03/2015] [Indexed: 11/12/2022]
Abstract
Background Anxiety in dementia is common but not well studied. We studied the associations of anxiety longitudinally in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Methods In total, 194 patients with a first-time diagnosis of dementia were included (n = 122 patients with AD, n = 72 patients with DLB). Caregivers rated the patients’ anxiety using the Neuropsychiatric Inventory, and self-reported anxiety was assessed with the anxiety and tension items on the Montgomery–Åsberg Depression Rating Scale. The Mini Mental State Examination was used to assess cognitive outcome, and the Clinical Dementia Rating (CDR)-Global and CDR boxes were used for dementia severity. Linear mixed effects models were used for longitudinal analysis. Results Neither in the total sample nor in AD or DLB was caregiver-rated anxiety significantly associated with cognitive decline or dementia severity over a 4-year period. However, in patients with DLB, self-reported anxiety was associated with a slower cognitive decline than in patients with AD. No support was found for patients with DLB with clinical anxiety having a faster decline than patients with DLB without clinical anxiety. Over the course of 4 years, the level of anxiety declined in DLB and increased in AD. Conclusions Anxiety does not seem to be an important factor for the rate of cognitive decline or dementia severity over time in patients with a first-time diagnosis of dementia. Further research into anxiety in dementia is needed.
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Affiliation(s)
- Monica H Breitve
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway. .,Old Age Department, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway. .,Faculty of Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
| | - Minna J Hynninen
- Department of Clinical Psychology, University of Bergen, Christies Gate 12, 5015, Bergen, Norway. .,NKS Olaviken Psychogeriatric Hospital, Ulriksdal 8, 5009, Bergen, Norway.
| | - Kolbjørn Brønnick
- TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, 4011, Stavanger, Norway. .,Network for Medical Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Luiza J Chwiszczuk
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway. .,Faculty of Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway. .,Neurological Department, Clinic of Medicine, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway.
| | - Bjørn H Auestad
- Research Department, Stavanger University Hospital, Stavanger, Norway. .,Department of Mathematics and Natural Sciences, University of Stavanger, 4011, Stavanger, Norway.
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Armauer Hansensvei 20, 4011, Stavanger, Norway. .,Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Centre for Alzheimer Research, Karolinska Institutet, 141 57, Huddinge, Sweden.
| | - Arvid Rongve
- Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway. .,Old Age Department, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Postbox 2170, 5504, Haugesund, Norway. .,Faculty of Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
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7
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Moebs I, Gee S, Miyahara M, Paton H, Croucher M. Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study. DEMENTIA 2015; 16:513-522. [DOI: 10.1177/1471301215609738] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.
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Affiliation(s)
- Isabelle Moebs
- Dunedin Public Hospital, Southern District Health Board, New Zealand
| | - Susan Gee
- Princess Margaret Hospital, Canterbury District Health Board, New Zealand
| | - Motohide Miyahara
- Movement Development Clinic, School of Physical Education, Sport and Exercise Sciences, University of Otago, New Zealand
| | - Helen Paton
- Dunedin Public Hospital, Southern District Health Board, New Zealand
| | - Matthew Croucher
- Princess Margaret Hospital, Canterbury District Health Board, New Zealand
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8
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Reducing Aβ load and tau phosphorylation: Emerging perspective for treating Alzheimer's disease. Eur J Pharmacol 2015. [DOI: 10.1016/j.ejphar.2015.07.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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9
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Abstract
BACKGROUND Anxiety in persons with dementia has received little attention despite its severe consequences. In this observational cross-sectional study, we investigated the frequency of anxiety and associations between anxiety and socio-demographic and clinical variables in an outpatient sample with first-time diagnosed mild dementia. METHODS The study sample (n = 169) comprised participants recruited from clinics in geriatric medicine and old age psychiatry for a longitudinal dementia study. Symptoms of anxiety were rated by a caregiver on the Neuropsychiatric Inventory (NPI) and by the patient on the anxiety tension item on the Montgomery and Åsberg Depression Rating Scale. Measures of caregiver stress, dementia-related impairment (Clinical Dementia Rating (CDR) scale), and cognitive functioning were also included. RESULTS According to caregiver reports, 19.5% had clinically significant anxiety and an additional 22.5% had subclinical anxiety. Half of the patients reported experiencing anxiety from time to time. Patients with Lewy-body dementia reported anxiety more often compared to patients with Alzheimer's disease. Anxiety was associated with depression, higher caregiver stress, and more dementia-related impairment, but not with cognitive test performance. Caregiver stress and higher CDR score increased the odds for anxiety significantly, even when controlling for depression. CONCLUSION Anxiety is common in patients with mild dementia, and seems to be associated not so much with cognitive test performance than with caregiver distress and the patient's ability to function in daily life. Anxiety should be taken into account when assessing dementia, as well as screened for when examining patients with known dementia.
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10
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Davis LL. Caring for frail older adults: a theoretical and methodological agenda. Res Gerontol Nurs 2012; 5:231-2. [PMID: 23075134 DOI: 10.3928/19404921-20120906-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The study is carried out as an action research to investigate the effect of nursing interventions during home visits to early- and mid-stage Alzheimer's patients problems and the anxiety and depression levels. The study was realized as one initial visit, six weekly visits and another visit 1 month later in 40 early- and mid-stage Alzheimer's patients who met the study criterion and accepted to join the study presenting at a Turkish university hospital. The data were collected using the Alzheimer's Patient Data Collection Form, Cornell Scale for Depression in Dementia and Spielberg's State-Trait Anxiety Inventory. We found a statistically significant decrease in patient problems compared to the initial with nursing interventions administered during home visits during the study (P < 0.05). However, the follow-up visit 1 month after the weekly visits did not show persistence of this decrease in problems and some problems were found to have increased. There was a statistically significant decrease in the mean depression and situational and continuous anxiety scores of the patients at the end of the follow-up compared to the initial period with the nursing interventions administered during the follow-ups (P < 0.05). According to these results, it is recommended that continuous programmes for home care should be developed for Alzheimer's patients in Turkey.
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Affiliation(s)
- G Taşdemır
- Department of Nursing, Pamukkale University, Denizli School of Health, Denizli, Turkey.
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12
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Robinson CM, Paukert A, Kraus-Schuman CA, Snow AL, Kunik ME, Wilson NL, Teri L, Stanley MA. The involvement of multiple caregivers in cognitive-behavior therapy for anxiety in persons with dementia. Aging Ment Health 2011; 15:291-8. [PMID: 21491216 PMCID: PMC3086554 DOI: 10.1080/13607860903493374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Peaceful Mind, a cognitive-behavioral therapy for treating anxiety in persons with dementia, is a promising new treatment currently under investigation. This article reports results of our examination of a modification of the treatment protocol in two cases that included multiple caregivers in treating two persons with dementia. METHOD Two case presentations of the benefits and challenges of including multiple caregivers in treatment are discussed. Treatment outcome data for these cases were collected as part of a larger investigation of Peaceful Mind. RESULTS The involvement of multiple collaterals resulted in several benefits, including increased family communication, as well as increased opportunities for the practice of new skills. These cases have also presented unique challenges requiring alterations in therapy structure and attention to issues of family conflict. CONCLUSIONS Including multiple collaterals in cognitive-behavioral therapy for treating anxiety in persons with dementia is feasible and may be beneficial in maximizing treatment gains and increasing the family's investment in therapy.
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Affiliation(s)
| | | | | | - A. Lynn Snow
- University of Alabama; Tuscaloosa VA Medical Center, Tuscaloosa, AL,
VA South Central Mental Illness Research, Education and Clinical Center
| | - Mark E. Kunik
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX,
VA South Central Mental Illness Research, Education and Clinical Center,
VA HSR&D Center of Excellence,
Baylor College of Medicine
| | | | | | - Melinda A. Stanley
- VA South Central Mental Illness Research, Education and Clinical Center,
VA HSR&D Center of Excellence,
Baylor College of Medicine,
Corresponding author:
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Slaughter S, Bankes J. The Functional Transitions Model: Maximizing Ability in the Context of Progressive Disability Associated with Alzheimer's Disease. Can J Aging 2010; 26:39-47. [PMID: 17430803 DOI: 10.3138/q62v-1558-4653-p0hx] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ABSTRACTThe Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of attempting to minimize excess disability while anticipating the progressive functional decline associated with AD. It is suggested that times of functional transition are times of decision making and opportunities for interdisciplinary collaboration to identify and minimize excess disability, for revision of goals and expectations, and for provision of support to patients and caregivers. The model also is applicable as a conceptual framework for education and research.
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Affiliation(s)
- Susan Slaughter
- Primary Care Research and Development Group, Department of Family Medicine, University of Calgary, Calgary, AB.
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Seignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M. Anxiety in dementia: a critical review. Clin Psychol Rev 2008; 28:1071-82. [PMID: 18555569 PMCID: PMC2575801 DOI: 10.1016/j.cpr.2008.02.008] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 11/13/2007] [Accepted: 02/28/2008] [Indexed: 12/01/2022]
Abstract
Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer's Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed.
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Affiliation(s)
- Paul J Seignourel
- Department of Psychiatry and Behavioral Sciences, University of Houston, 1300 Moursund St., Houston, TX 77030, United States.
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Rapp MA, Decker A, Klein U, Duch T, Treusch Y, Majic T, Petermann A, Hildebrand C, Heinz A, Gutzmann H. Verhaltenssymptome bei Demenz in Pflegeeinrichtungen. ACTA ACUST UNITED AC 2008. [DOI: 10.1024/1011-6877.21.3.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In fortgeschrittenen Stadien von Demenzerkrankungen treten neben Depression vermehrt Verhaltenssymptome auf, zu denen Unruhe, Aggressivität und Halluzinationen zählen. In Pflegeeinrichtungen betrifft dies bis zu drei Viertel aller Bewohner. Diese Symptome sind für Pflegende belastend, ziehen erhöhte Versorgungskosten, eine vermehrte Verschreibung von Psychopharmaka, sowie häufigere Krankenhausaufenthalte nach sich. Im Jahr 2003 haben die Amerikanischen Gesellschaften für Gerontopsychiatrie und Geriatrie Leitlinien zur Behandlung von Depressionen und Verhaltenssymptomen in Pflegeeinrichtungen vorgestellt. Vergleichbare Leitlinien der deutschen Fachgesellschaften liegen bislang nicht vor. Die amerikanischen Leitlinien geben neben einem standardisierten Assessment Therapiealgorhythmen vor. In unserem Projekt werden diese Leitlinien in acht Pflegeinrichtungen in Berlin eingeführt und die Ausprägung von Verhaltenssymptomen, die Verschreibung von Psychopharmaka, die Anzahl der Krankenhauseinweisungen und die Belastung der Pflegenden mit einer Kontrollstichprobe von acht vergleichbaren Pflegeeinrichtungen ohne Leitlinienbehandlung über einen Zeitraum von 12 Monaten verglichen. Wir erwarten eine Verminderung der Ausprägung von Verhaltenssymptomen, sowie der Psychopharmakaverschreibungen, der Hospitalisierungsrate und der subjektiven Belastung für Pflegende.
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Affiliation(s)
- Michael A. Rapp
- Klinik für Psychiatrie und Psychotherapie, Charite Campus Mitte, Berlin
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - A. Decker
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | | | - T. Duch
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - Y. Treusch
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - T. Majic
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | | | | | - A. Heinz
- Klinik für Psychiatrie und Psychotherapie, Charite Campus Mitte, Berlin
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
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Abstract
The advent of new immunostains have improved the ability to detect limbic and cortical Lewy bodies, and it is evident that dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, after Alzheimer's disease (AD). Distinguishing DLB from AD has important implications for treatment, in terms of substances that may worsen symptoms and those that may improve them. Neurocognitive patterns, psychiatric features, extrapyramidal signs, and sleep disturbance are helpful in differentiating DLB from AD early in the disease course. Differences in the severity of cholinergic depletion and type/distribution of neuropathology contribute to these clinical differences.
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Sasaki M, Arai Y, Kumamoto K, Abe K, Arai A, Mizuno Y. Factors related to potentially harmful behaviors towards disabled older people by family caregivers in Japan. Int J Geriatr Psychiatry 2007; 22:250-7. [PMID: 16998783 DOI: 10.1002/gps.1670] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of the present study was to examine factors related to potentially harmful behaviors (PHB) by family caregivers towards their older family members. METHODS Four hundred and twelve pairs of disabled older adults and their family caregivers participated in the study. All of these disabled older adults were users of visiting nursing services under the public Long-Term Care insurance system, who resided in one of the eight catchment areas of visiting nursing services in Kyoto Prefecture, Japan. The caregivers were asked to complete questionnaires in relation to their PHB towards their older family members, caregiver burden, patient-caregiver kinship, behavioral disturbances of their older adult, age and sex. Visiting nurses obtained the following information regarding the older adults: the severity of dementia; the severity of physical impairment; age and sex. RESULTS More than 30% of the caregivers admitted PHB towards their older family members. The most frequently reported PHB included verbal aggression (16.8%) and ignoring (13.6%). A logistic regression analysis revealed that adult children (OR = 2.69, 95%CI = 1.23-5.89, p = 0.013) and caregivers of disabled older people with behavioral disturbances (OR = 3.61, 95%CI = 1.65-7.90, p < 0.01) were more likely to show PHB. CONCLUSIONS In the present study, PHB towards the older people by family caregivers was associated with patients' behavioral disturbances and patient-caregiver kinship, i.e. an adult child as a caregiver. These findings should be taken into account when planning strategies to prevent PHB by family members.
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Affiliation(s)
- Megumi Sasaki
- Department of Gerontological Policy, National Institute for Longevity Sciences (NILS), National Center for Geriatrics and Gerontology (NCGG), Obu-shi, Aichi, Japan
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Draper B, Brodaty H, Low LF. A tiered model of psychogeriatric service delivery: an evidence-based approach. Int J Geriatr Psychiatry 2006; 21:645-53. [PMID: 16802279 DOI: 10.1002/gps.1541] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous models of mental health care for older persons have not considered the full spectrum of mental disorders. AIM To describe a tiered model for comprehensive evidence-based planning of service delivery for mental disorders in late life. METHOD The model depicts tiers of mental disorders in ascending order of severity and consequent interventions required. RESULTS Interventions aim both to avert individuals from moving up tiers (prevention) and to move individuals down tiers (treatment). Individuals in the lower tiers have no mental disorders and prevention strategies are targeted at known risk factors. In the middle tiers, individuals with mild-moderate mental disorders will mainly be treated in primary care, often in collaboration with specialist mental health services for older people. Individuals in the top tiers with severe mental disorders usually require institutional care. CONCLUSION The tiered model provides a basis for planning comprehensive service delivery.
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Affiliation(s)
- Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia.
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Berger G, Bernhardt T, Weimer E, Peters J, Kratzsch T, Frolich L. Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. J Geriatr Psychiatry Neurol 2005; 18:119-28. [PMID: 16100100 DOI: 10.1177/0891988704273375] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The objective was to evaluate the course and severity of dementia-related symptoms and their relationship to caregivers' subjective burden and depression over time. Forty-five patients with dementia and their caregivers were followed over a period of 2 years. Patients' cognition, function, and behavioral/psychological symptoms were assessed by the Mini Mental State Examination, Syndrome Kurz Test, Geriatric Depression Screening scale, Instrumental Activities of Daily Living Scale, Physical Self Maintenance Scale, Behavioral Abnormalities in Alzheimer's Disease Rating Scale, and Nurses Observation Scale for Geriatric Patients. Caregivers' depression and subjective burden were evaluated by the Geriatric Depression Screening scale or Beck Depression Inventory and the Caregiver Burden Interview. Global dementia severity, functional impairment, and behavioral disturbances increased significantly over the 2-year observation period. Caregivers' burden remained stable, and severe depression decreased over time. There were significant associations between burden and dementia-related symptoms. For deficits in activities of daily living as well as behavioral disturbances, these associations became stronger over time. It was concluded that stage of dementia, functional deficits, and behavioral disturbances are important factors when evaluating the relationship between patients' symptoms and caregivers' well-being.
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Affiliation(s)
- Gabriele Berger
- Department of Psychiatry and Psychotherapy, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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Brodaty H, Draper BM, Low LF. Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. Med J Aust 2003; 178:231-4. [PMID: 12603188 DOI: 10.5694/j.1326-5377.2003.tb05169.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2002] [Accepted: 11/18/2002] [Indexed: 11/17/2022]
Abstract
People with dementia usually experience behavioural and psychological symptoms of dementia (BPSD) during the course of their illness. Currently, in Australia, there is a lack of comprehensive planning for managing and preventing BPSD, and the resources required for optimal care are inadequate and unevenly distributed. We propose a seven-tiered model of service delivery based on severity and prevalence of BPSD, ranging from no dementia through tiers of increasingly severe behavioural disturbance to the propensity for extreme violence in a small number of individuals. Each tier is associated with a different model of intervention. People with dementia may move up or down between tiers depending on their condition, their care and the intervention provided. Lower-level interventions may prevent the need for the more intensive interventions needed when disturbance becomes more severe.
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Affiliation(s)
- Henry Brodaty
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Avoca Street, Randwick, NSW 2031, Australia.
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