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Hwang JJ, Donnelly TT, Raffin Bouchal S, Davidson S. Factors influencing access to nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia: An integrative review. J Psychiatr Ment Health Nurs 2023; 30:1054-1081. [PMID: 37203563 DOI: 10.1111/jpm.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/06/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. WHAT ARE THE IMPLICATIONS FOR PRACTICE The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. ABSTRACT INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions. AIM The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia. METHOD An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. RESULTS The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. DISCUSSION The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. IMPLICATIONS FOR PRACTICE The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.
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Affiliation(s)
| | | | | | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Mountain G, Wright J, Cooper CL, Lee E, Sprange K, Beresford-Dent J, Young T, Walters S, Berry K, Dening T, Loban A, Turton E, Thomas BD, Young EL, Thompson BJ, Crawford B, Craig C, Bowie P, Moniz-Cook E, Foster A. An intervention to promote self-management, independence and self-efficacy in people with early-stage dementia: the Journeying through Dementia RCT. Health Technol Assess 2022; 26:1-152. [PMID: 35536231 DOI: 10.3310/khha0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few effective interventions for dementia. AIM To determine the clinical effectiveness and cost-effectiveness of an intervention to promote self-management, independence and self-efficacy in people with early-stage dementia. OBJECTIVES To undertake a randomised controlled trial of the Journeying through Dementia intervention compared with usual care, conduct an internal pilot testing feasibility, assess intervention delivery fidelity and undertake a qualitative exploration of participants' experiences. DESIGN A pragmatic two-arm individually randomised trial analysed by intention to treat. PARTICIPANTS A total of 480 people diagnosed with mild dementia, with capacity to make informed decisions, living in the community and not participating in other studies, and 350 supporters whom they identified, from 13 locations in England, took part. INTERVENTION Those randomised to the Journeying through Dementia intervention (n = 241) were invited to take part in 12 weekly facilitated groups and four one-to-one sessions delivered in the community by secondary care staff, in addition to their usual care. The control group (n = 239) received usual care. Usual care included drug treatment, needs assessment and referral to appropriate services. Usual care at each site was recorded. MAIN OUTCOME MEASURES The primary outcome was Dementia-Related Quality of Life score at 8 months post randomisation, with higher scores representing higher quality of life. Secondary outcomes included resource use, psychological well-being, self-management, instrumental activities of daily living and health-related quality of life. RANDOMISATION AND BLINDING Participants were randomised in a 1 : 1 ratio. Staff conducting outcome assessments were blinded. DATA SOURCES Outcome measures were administered in participants' homes at baseline and at 8 and 12 months post randomisation. Interviews were conducted with participants, participating carers and interventionalists. RESULTS The mean Dementia-Related Quality of Life score at 8 months was 93.3 (standard deviation 13.0) in the intervention arm (n = 191) and 91.9 (standard deviation 14.6) in the control arm (n = 197), with a difference in means of 0.9 (95% confidence interval -1.2 to 3.0; p = 0.380) after adjustment for covariates. This effect size (0.9) was less than the 4 points defined as clinically meaningful. For other outcomes, a difference was found only for Diener's Flourishing Scale (adjusted mean difference 1.2, 95% confidence interval 0.1 to 2.3), in favour of the intervention (i.e. in a positive direction). The Journeying through Dementia intervention cost £608 more than usual care (95% confidence interval £105 to £1179) and had negligible difference in quality-adjusted life-years (-0.003, 95% confidence interval -0.044 to 0.038). Therefore, the Journeying through Dementia intervention had a mean incremental cost per quality-adjusted life-year of -£202,857 (95% confidence interval -£534,733 to £483,739); however, there is considerable uncertainty around this. Assessed fidelity was good. Interviewed participants described receiving some benefit and a minority benefited greatly. However, negative aspects were also raised by a minority. Seventeen per cent of participants in the intervention arm and 15% of participants in the control arm experienced at least one serious adverse event. None of the serious adverse events were classified as related to the intervention. LIMITATIONS Study limitations include recruitment of an active population, delivery challenges and limitations of existing outcome measures. CONCLUSIONS The Journeying through Dementia programme is not clinically effective, is unlikely to be cost-effective and cannot be recommended in its existing format. FUTURE WORK Research should focus on the creation of new outcome measures to assess well-being in dementia and on using elements of the intervention, such as enabling enactment in the community. TRIAL REGISTRATION This trial is registered as ISRCTN17993825. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, University of Nottingham, Nottingham, UK
| | | | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Berry
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Loban
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emily Turton
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin D Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma L Young
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin J Thompson
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bethany Crawford
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Craig
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Peter Bowie
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Michelet M, Selbaek G, Strand BH, Lund A, Engedal K, Bieber A, Gonçalves-Pereira M, Hopper L, Irving K, Jelley H, Marques MJ, Orrell M, Portolani DM, Sjölund BM, Sköldunger A, Stephan A, Verhey F, de Vugt M, Wolfs C, Woods B, Zanetti O, Bergh S. Associations between unmet needs for daytime activities and company and scores on the Neuropsychiatric Inventory-Questionnaire in people with dementia: a longitudinal study. Aging Ment Health 2022; 26:725-734. [PMID: 33860718 DOI: 10.1080/13607863.2021.1910792] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine prospectively the association between unmet needs for daytime activities and company and behavioural and psychological symptoms of dementia. METHODS We included 451 people with mild or moderate dementia, from eight European countries, who were assessed three times over 12 months. Unmet needs were measured with the Camberwell Assessment of Need for the Elderly. Three sub-syndromes of the Neuropsychiatric Inventory-Questionnaire were regressed, one-by-one, against unmet needs for daytime activities and company, adjusting for demographic and clinical-functional covariates. RESULTS Unmet needs for daytime activities were associated with more affective symptoms at baseline, six and twelve months, mean 0.74 (p < 0.001), 0.76 (p < 0.001) and 0.78 (p = 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.39 points, p = 0.007) and at six months follow-up (mean 0.31 points, p = 0.006). Unmet needs for company were associated with more affective symptoms at baseline, six and twelve months, mean 0.44 (p = 0.033), 0.67 (p < 0.001) and 0.91 (p < 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.40 points, p = 0.005) and at six months (mean 0.35 points, p = 0.002) follow-up. CONCLUSION Interventions to reduce unmet needs for daytime activities and company could reduce affective and psychotic symptoms in people with dementia.
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Affiliation(s)
- Mona Michelet
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lund
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anja Bieber
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Manuel Gonçalves-Pereira
- Comprehensive Health Research Centre (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Hannah Jelley
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Maria J Marques
- Comprehensive Health Research Centre (CHRC), CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Martin Orrell
- Institute of Mental Health, Nottingham University, Nottingham, UK
| | - Daniel M Portolani
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Britt-Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Faculty of Health and Occupational Studies, Department Caring Sciences, University of Gävle, Gävle, Sweden
| | - Anders Sköldunger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Astrid Stephan
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claire Wolfs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Orazio Zanetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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4
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Mountain GA, Cooper CL, Wright J, Walters SJ, Lee E, Craig C, Berry K, Sprange K, Young T, Moniz-Cook E, Dening T, Loban A, Turton E, Beresford-Dent J, Thomas BD, Thompson BJ, Young EL. The Journeying through Dementia psychosocial intervention versus usual care study: a single-blind, parallel group, phase 3 trial. THE LANCET. HEALTHY LONGEVITY 2022; 3:e276-e285. [PMID: 36098301 DOI: 10.1016/s2666-7568(22)00059-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is an urgent clinical need for evidence-based psychosocial interventions for people with mild dementia. We aimed to determine the clinical benefits and cost-effectiveness of Journeying through Dementia (JtD), an intervention designed to promote wellbeing and independence in people with mild dementia. METHODS We did a single-blind, parallel group, individually randomised, phase 3 trial at 13 National Health Service sites across England. People with mild dementia (Mini-Mental State Examination score of ≥18) who lived in the community were eligible for inclusion. Patients were centrally randomly assigned (1:1) to receive the JtD intervention plus standard care (JtD group) or standard care only (standard care group). Randomisation was stratified by study site. The JtD intervention included 12 group and four one-to-one sessions, delivered in the community at each site. The primary endpoint was Dementia Related Quality of Life (DEMQOL) 8 months after randomisation, assessed according to the intention-to-treat principle. Only outcome assessors were masked to group assignment. A cost-effectiveness analysis reported cost per quality-adjusted life-year (QALY) from a UK NHS and social care perspective. The study is registered with ISRCTN, ISRCTN17993825. FINDINGS Between Nov 30, 2016, and Aug 31, 2018, 1183 patients were screened for inclusion, of whom 480 (41%) participants were randomly assigned: 241 (50%) to the JtD group and 239 (50%) to the standard care group. Intervention adherence was very good: 165 (68%) of 241 participants in the JtD group attended at least ten of the 16 sessions. Mean DEMQOL scores at 8 months were 93·3 (SD 13·0) for the JtD group and 91·9 (SD 14·6) for the control group. Difference in means was 0·9 (95% CI -1·2 to 3·0; p=0·38) after adjustment for covariates, lower than that identified as clinically meaningful. Incremental cost per QALY ranged from £88 000 to -£205 000, suggesting that JtD was not cost-effective. Unrelated serious adverse events were reported by 40 (17%) patients in the JtD group and 35 (15%) patients in the standard care group. INTERPRETATION In common with other studies, the JtD intervention was not proven effective. However, this complex trial successfully recruited and retained people with dementia without necessarily involving carers. Additionally, people with dementia were actively involved as participants and study advisers throughout. More research into methods of measuring small, meaningful changes in this population is needed. Questions remain regarding how services can match the complex, diverse, and individual needs of people with mild dementia, and how interventions to meet such needs can be delivered at scale. FUNDING UK National Institute of Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Gail A Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Cindy L Cooper
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
| | - Jessica Wright
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Claire Craig
- Art & Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Katherine Berry
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, The University of Hull, Hull, UK
| | - Tom Dening
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Loban
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Emily Turton
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Benjamin D Thomas
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Emma L Young
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
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5
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Peer support for the newly diagnosed: how people with dementia can co-produce meeting centre services. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This paper aims to contribute to the knowledge about open, co-produced meeting centres for people with dementia, from their own perspective. Services that support people who are newly diagnosed with dementia are often insufficient. Co-produced services have the potential to address the need of people with dementia to be useful and productive, while reducing the stigma. In this study, we applied a qualitative design. Data were collected at a meeting centre for people with newly diagnosed dementia, and consisted of fieldwork (13 days for about two hours at a time), written materials, and semi-structured interviews (mean length 30 minutes) with five attendees with dementia and two staff persons. The analysis was inspired by situational analysis. The findings showed that the meeting centre provided a place for human encounters, a break from everyday life, and a place to share knowledge and develop new skills. Further, challenges were described. Co-production consisted of the attendees being encouraged to take part in the planning of activities, learning from each other and providing mutual support. The study adds to previous knowledge about co-produced services for people with dementia. Future studies can clarify how co-production can be developed in services for people with newly diagnosed dementia in countries and regions where there is a dearth of this kind of support.
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Steele C, Berry K, Brown LJE. Healthcare professionals' experiences of using a biopsychosocial approach to understand behavioural and psychological symptoms of dementia: A qualitative interview study. Int J Older People Nurs 2021; 17:e12427. [PMID: 34561970 DOI: 10.1111/opn.12427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Biopsychosocial approaches to understanding behavioural and psychological (otherwise known as "non-cognitive" or "neuropsychiatric") symptoms of dementia tend to be conducted by specialist psychology professionals. To increase service users' access to these approaches, healthcare professionals from nursing and allied health disciplines are being trained to use them. However, little is known about healthcare professionals' experiences of implementing biopsychosocial approaches in everyday practice. OBJECTIVES To explore nursing and allied healthcare professionals' views of using the "Newcastle Model," which is a biopsychosocial approach to understanding behavioural and psychological symptoms of dementia. METHOD Thirteen community mental healthcare professionals from nursing, social work and occupational therapy backgrounds were interviewed about their views and experiences of using the Newcastle Model to understand and work with behavioural and psychological symptoms of dementia. Data were analysed using thematic analysis. RESULTS Five themes were identified. The first theme reflected the perceived positive value of taking a more psychosocial approach to understanding behavioural and psychological symptoms of dementia. The second theme reported participants' expressions of low confidence in using the approach, as well as their reported difficulties in prioritising it. The third theme highlighted the perceived time-consuming nature of the approach, and the adaptations that some staff made to increase its practicality. The fourth theme highlighted the importance of working in collaboration with those who provided direct care and support to the person with dementia. The final theme reflected participants' positive view of the effectiveness of the approach for delivering person-centred care CONCLUSION: Community healthcare professionals valued the integration of a biopsychosocial approach into their practice, although identified key implementation barriers. IMPLICATIONS FOR PRACTICE Formalising this approach within professional role descriptions; increasing collaborative working within multidisciplinary teams; and increasing carers' psychological understanding of dementia, are key ways in which this biopsychosocial approach could be implemented more effectively.
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Affiliation(s)
- Claire Steele
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Laura J E Brown
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Field B, Coates E, Mountain G. What influences uptake of psychosocial interventions by people living with early dementia? A qualitative study. DEMENTIA 2021; 20:2668-2688. [PMID: 33956547 PMCID: PMC8723173 DOI: 10.1177/14713012211007397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Health policy promotes post-diagnostic support for people affected by dementia.
Evidence suggests psychosocial interventions can effectively support people living with
dementia after diagnosis. Yet, what influences uptake of psychosocial interventions by
people with early dementia is poorly understood. This research aimed to identify
influences on uptake of psychosocial interventions by people with early dementia. Methods Sixteen face-to-face semi-structured interviews with people with early dementia, either
alone or with a family member(s), were completed. Twelve staff participated in
semi-structured interviews or a focus group. Thematic analysis and triangulation enabled
identification of overall themes across different participant groups and interview
types. Main Findings Four overarching themes influencing uptake were identified: (1) adjusting to a
diagnosis, (2) appeal of activities and perception of benefit, (3) service and societal
context, and (4) relationships and communication. Individual responses to diagnosis,
experiences of dementia and dementia services influenced uptake. Group interventions
were discussed the most by all participants. Group interventions offering social
contact, peer support, information, enjoyable activities and mental stimulation were
valued. However, group interventions specifically aimed at people with dementia did not
appeal to all. Ability to travel and convenience of locations were important. Continuing
with community activities not focused on dementia was valued. Stigma around dementia
appeared to discourage uptake. Emotional and practical support from family was key to
facilitating uptake as were the relationships between people with dementia and
staff. Conclusion A complex interplay of individual, service and societal influences affect uptake of
psychosocial interventions by people with early dementia. How interventions and which
services can enable people with early dementia remain engaged in their everyday lives
needs consideration. Further research examining uptake of specific interventions
commonly offered to people living with early dementia is needed. Involving people with
early dementia in designing interventions aiming to support them is paramount.
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Affiliation(s)
- Becky Field
- School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
| | - Elizabeth Coates
- School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
| | - Gail Mountain
- Centre for Applied Dementia Research, University of Bradford, UK; School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
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8
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Sprange K, Beresford-Dent J, Mountain G, Thomas B, Wright J, Mason C, Cooper CL. Journeying through Dementia Randomised Controlled Trial of a Psychosocial Intervention for People Living with Early Dementia: Embedded Qualitative Study with Participants, Carers and Interventionists. Clin Interv Aging 2021; 16:231-244. [PMID: 33574660 PMCID: PMC7872215 DOI: 10.2147/cia.s293921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify the barriers and facilitators to the implementation of a complex psychosocial intervention though a study exploring the experiences of participants, carers and interventionists during a trial. METHODS Individual semi-structured interviews were conducted with participants, their carers, and interventionists from a sample of recruiting sites that took part in the Journeying through Dementia randomized controlled trial (RCT). Interview data were transcribed and analysed using framework analysis. Co-researcher data analysis workshops were also conducted to explore researcher interpretations of the data through the lens of those with lived experience of dementia. Triangulation enabled comparison of findings from the interviews with findings from the co-researcher workshops. RESULTS Three main themes emerged from the interview data: being prepared; intervention engagement; and participation and outcomes from engagement. From these themes, a number of factors that can moderate delivery and receipt of the intervention as intended were identified. These were context and environment; readiness, training, skills and competencies of the workforce; identifying meaningful participation and relationships. CONCLUSION This study highlighted that the observed benefit of the intervention was nuanced for each individual. Mechanisms of change were influenced by a range of individual, social and contextual factors. Future research should therefore consider how best to identify and measure the multifaceted interplay of mechanisms of change in complex interventions. TRIAL REGISTRATION ISRCTN17993825.
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Affiliation(s)
- Kirsty Sprange
- Nottingham Clinical Trials Unit, Faculty of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Gail Mountain
- University of Bradford, Bradford West Yorkshire, BD7 1DP, UK
| | - Ben Thomas
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
| | - Jessica Wright
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
| | - Clare Mason
- University of Bradford, Bradford West Yorkshire, BD7 1DP, UK
| | - Cindy L Cooper
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
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Kleiman MJ, Barenholtz E, Galvin JE. Screening for Early-Stage Alzheimer's Disease Using Optimized Feature Sets and Machine Learning. J Alzheimers Dis 2021; 81:355-366. [PMID: 33780367 PMCID: PMC8324324 DOI: 10.3233/jad-201377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Detecting early-stage Alzheimer's disease in clinical practice is difficult due to a lack of efficient and easily administered cognitive assessments that are sensitive to very mild impairment, a likely contributor to the high rate of undetected dementia. OBJECTIVE We aim to identify groups of cognitive assessment features optimized for detecting mild impairment that may be used to improve routine screening. We also compare the efficacy of classifying impairment using either a two-class (impaired versus non-impaired) or three-class using the Clinical Dementia Rating (CDR 0 versus CDR 0.5 versus CDR 1) approach. METHODS Supervised feature selection methods generated groups of cognitive measurements targeting impairment defined at CDR 0.5 and above. Random forest classifiers then generated predictions of impairment for each group using highly stochastic cross-validation, with group outputs examined using general linear models. RESULTS The strategy of combining impairment levels for two-class classification resulted in significantly higher sensitivities and negative predictive values, two metrics useful in clinical screening, compared to the three-class approach. Four features (delayed WAIS Logical Memory, trail-making, patient and informant memory questions), totaling about 15 minutes of testing time (∼30 minutes with delay), enabled classification sensitivity of 94.53% (88.43% positive predictive value, PPV). The addition of four more features significantly increased sensitivity to 95.18% (88.77% PPV) when added to the model as a second classifier. CONCLUSION The high detection rate paired with the minimal assessment time of the four identified features may act as an effective starting point for developing screening protocols targeting cognitive impairment defined at CDR 0.5 and above.
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Affiliation(s)
- Michael J. Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elan Barenholtz
- Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, FL, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Rao GP, Sivakumar PT, Srivastava S, Sidana RC. Cognitive Therapy and Family Intervention for Patients with Dementia and Psychosis. Indian J Psychiatry 2020; 62:S183-S191. [PMID: 32055061 PMCID: PMC7001351 DOI: 10.4103/psychiatry.indianjpsychiatry_769_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Shrikant Srivastava
- Department of Geriatric Mental Health, K. G. Medical University, Lucknow, Uttar Pradesh, India
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