Dementia care research: The key role of nurses and nursing

Effects of training Community Health Agents on dementia: a quasi-experimental study

OBJECTIVES

to evaluate the knowledge of Community Health Agents about dementia before and after the training workshop for detecting signs of the disease.

METHODS

a quasi-experimental study with 33 community agents, in which sociodemographic information and knowledge about dementia were collected and assessed using the Alzheimer's Disease Knowledge Scale before and after the workshop. There were 10 weekly, online, synchronous meetings. The Student's t-test for related samples was used, and the effect size was calculated.

RESULTS

while the average score on the initial assessment, using the measurement instrument, was 16.3, it was 21.24 in the final assessment. An increase in the scale score was observed after participating in the workshop, with a value of 4.94.

CONCLUSIONS

it is urgent to invest in the ongoing education of these professionals for greater awareness in the timely detection of dementia cases in primary care and awareness of potentially modifiable factors.

Translating 'dementia friends' programme to undergraduate medical and nursing practice: a qualitative exploration

INTRODUCTION

Dementia awareness is a key priority of medical and nursing pre-registration education. The 'dementia friends' programme is an internationally recognised and accredited dementia awareness workshop that is led by a trained facilitator. While this programme has been associated with positive outcomes, few studies have examined how medical and nursing students apply their learning in practice after the workshop. The aim of his study was to explore how nursing and medical students apply the dementia friend's programme into practice when caring for people living with dementia.

METHODS

Seven focus-group interviews were conducted with 36 nursing students and 14 medical students at one university in Northern Ireland (n = 50), following 'the dementia friends programme. Interview guides were co-designed alongside people living with dementia. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Ethical approval was granted for this study.

RESULTS

Four themes emerged: 'reframing dementia', which highlighted how the education had enabled students to actively empower and support people living with dementia in practice; 'dementia friendly design', which focused on how students had modified their clinical environments when providing care for people living with dementia, 'creative communication', which considered how students had used their education to adapt their verbal and non-verbal communication with people living with dementia and 'realities of advanced dementia' which contemplated how students believed their dementia education could be improved within their current curriculum.

DISCUSSION

The Dementia Friends programme has actively supported nursing and medical students to improve the lives of people with dementia in their care through environmental adaptions and creative approaches to communication. This study provides an evidence base that supports the provision of 'a dementia friends programme to healthcare professional students. The study also highlights how this education can actively influence how nursing and medical students support people living with dementia in their practice in the months and years after education.

Effects of oral health intervention strategies on cognition and microbiota alterations in patients with mild Alzheimer's disease: A randomized controlled trial

We explored the effects of an oral health intervention on the oral microbiome and cognitive function of patients with mild Alzheimer's disease (AD) and determined the influence on disease progression. Sixty-six patients with mild AD were randomly assigned to intervention or control groups and received a 24-week oral health intervention and routine care, respectively. Data were collected at baseline and week 24. 16 S rRNA sequencing was used to analyze oral microbiota. After 24 weeks of oral health intervention, Kayser-Jones Brief Oral Health Status Examination (BOHSE), Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Nursing Home Adjustment Scale (NHAS), and Alzheimer's Disease Cooperative Study-ADL (ADCS-ADL) scores were different between groups (p < 0.05). Subgingival plaque in patients with AD showed significant differences in the diversity and abundance of oral microbiomes, with a higher abundance of normal oral flora in the intervention group. We found oral health intervention strategies are effective in modifying subgingival microbiota differences and slowing cognitive decline in mild AD patients.

Effects and influencing factors of Internet-based training on primary prevention of dementia among primary health care workers

BACKGROUND

Existing evidence-based guidelines and summaries on dementia prevention are not effectively disseminated and used by primary health care workers in developing countries. As such, the lack of knowledge and skills is a major obstacle to dementia prevention and has posed a need for relevant training.

OBJECTIVES

To evaluate the effects of an Internet-based dementia-related training program with the aim to improve the competence of primary health care workers to early detection of symptoms of memory disorder and dementia, and to provide effective guidance and consultation for residents.

DESIGN

A survey with 12 weeks follow-up.

SETTINGS

An Internet-based training program was conducted in four primary healthcare institutions in China between April and September 2020.

PARTICIPANTS

Primary health care workers, including doctors and nurses.

METHODS

A localized Internet-based training program on primary prevention of dementia for primary health care workers was built, based on existing guidelines. Self-made measures were used to evaluate the knowledge, self-efficacy, and behavioral intentions of primary health care workers. Data were collected before the training (T₀), after the training (T₁), and Week 12 after the training (T₂). Differences between the different time points were tested using a generalized estimation equation.

RESULTS

There were 268 study participants, 120 of whom completed the training and the questionnaire three times consecutively. At T₁ and T₂, the knowledge, self-efficacy, and behavioral intention scores were higher than those at T₀ (all B > 0, all p < 0.05. The knowledge scores were influenced by age, years of work, and occupation of participants. The self-efficacy and behavioral intention scores were influenced by age, dementia training history, and reception of complaints of memory loss. Eighty percent of the participants were satisfied with the training.

CONCLUSIONS

This study confirmed that Internet-based training on the primary prevention of dementia is highly accepted and improves the knowledge, self-efficacy, and behavioral intention of primary health care workers.

Sustainable nurse-led care for people with dementia including mild cognitive impairment and their family in an ambulatory care setting: A scoping review

AIMS

This review aimed to determine the characteristics of a nurse-led intervention for people with dementia including mild cognitive impairment and their family in an ambulatory care setting.

BACKGROUND

Enhancing the role of nurses in a multidisciplinary team of ambulatory care follow-up after a diagnosis of dementia is thought to lead to successful dementia care.

DESIGN

This is a scoping review.

DATA SOURCES

MEDLINE, CINAHL, EMBASE, Cochrane, JBI, Japan Medical Abstracts Society, PsycINFO and Web of Science were searched on 14 March 2019.

REVIEW METHODS

This scoping review was conducted using the Joanna Briggs Institute methodology, followed the PRISMA-ScR checklist and considered studies that included interventions conducted by nurses and included outcomes regarding dementia symptoms or family care burden.

RESULTS

Eleven studies were included. Of these, all interventions were multifactorial and reported effective results. Educational interventions were most common, and the content of education included the characteristics of dementia and how to interact with patients with dementia. The roles of nurses included caregiver education, assessment, care plan creation for continuous monitoring and team building.

CONCLUSION

This scoping review suggested that effective nurse-led interventions in the ambulatory care of people with dementia are continuous patient and family supports, primarily caregiver education within multidisciplinary teams.

A training program for primary health care nurses on timely diagnosis and management of dementia in general practice: An evaluation study

BACKGROUND

Primary health care nurses can play an important role in assisting the diagnosis and management of dementia. This study describes the evaluation outcome of a training program developed on the 'Four Steps to Building Dementia Practice in Primary Care'.

OBJECTIVE

To evaluate a training program for primary health care nurses by assessing change in current practice and future intention; and their knowledge, confidence, and perceived importance about dementia diagnosis and management.

DESIGN

A longitudinal survey. Participants were surveyed at three time points: pre-training, immediately post-training and six months (+/- 3 months) following their training.

SETTING

All states and territories in Australia.

PARTICIPANTS

Primary health care nurses (n = 1,290).

METHODS

A face-to-face and online training program on timely diagnosis and management of dementia was offered to primary health care nurses. A questionnaire was administered face-to-face and online to assess whether certain processes and services were 'currently in practice', 'working towards', or 'not in current practice' in their primary care facility. Three 10-point Likert scales were created to assess self-perceived levels of importance, knowledge and confidence about the diagnosis and management of dementia. A paired t-test was used to examine the differences between (a) post and pre-scores, and (b) follow-up and post scores. Linear regressions were used to identify the significant factors associated with pre-training scores for importance, confidence and knowledge.

RESULTS

Of 1290 primary health care nurses who participated in the training, 471 attended face-to-face and 819 participated online. Participants demonstrated improvements in all items in all four steps of the survey, with considerably higher improvement in the face-to-face mode. The average post-training score was significantly higher than the pre-training score for perceived importance, knowledge and confidence. The average follow-up score was significantly higher than the post-training score for perceived knowledge and confidence but not for perceived importance. Primary health care nurses who had 20 or more years of experience reported significantly more knowledge in attending patients with dementia than those with less than five years of experience (0.56, 95% CI: 0.11-1.01).

CONCLUSIONS

With a growing ageing population, the demand for dementia care is rising. Primary health care nurses can lead practice change and promote the timely diagnosis and management of dementia in general practice. Training programs of this kind that build knowledge, confidence, awareness and skills should be made available to the primary care nursing workforce. Further research is recommended to examine the translation of this training outcome into practice.