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Benge JF, Ali A, Chandna N, Rana N, Mis R, González DA, Kiselica AM, Scullin MK, Hilsabeck RC. Technology-based instrumental activities of daily living in persons with Alzheimer's disease and related disorders. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e70022. [PMID: 39391022 PMCID: PMC11465837 DOI: 10.1002/dad2.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 09/11/2024] [Accepted: 09/11/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Instrumental activities of daily living (iADLs) increasingly involve technology (e.g., making payments online, texting). The current study examined the applicability and diagnostic accuracy of technology-based iADLs in those evaluated for Alzheimer's disease and related dementias (ADRD). METHODS A total of 264 care partners of persons undergoing comprehensive interdisciplinary evaluations completed the Functional Activities Questionnaire and 11 technology-based iADL items. RESULTS Technology-based iADLs applied to more than 80% of patients. Average dependence on technology-based items was overall less than for traditional iADLs. The addition of technology-based items to traditional iADL items slightly improved the ability to identify individuals with dementia. When considered separately, technology-based iADL items demonstrated comparable ability to distinguish between diagnostic stages. DISCUSSION Technology use is common in older adults with ADRD for a range of daily activities. Accounting for technology use increases the content validity of existing iADL measures for the modern context and yields comparable diagnostic accuracy. Highlights Technology use is often integral to daily activity performance for individuals with Alzheimer's disease and related dementias (ADRD).Daily technologies, such as smartphones, were used frequently by those with ADRD.Many individuals were less dependent on technology activities than traditional activities.Adding technology questions slightly increased diagnostic accuracy for detecting dementia.
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Affiliation(s)
- Jared F. Benge
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
| | - Arsh Ali
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Neha Chandna
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Noor Rana
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
| | - Rachel Mis
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
| | - David A. González
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Andrew M. Kiselica
- Department of Health PsychologyUniversity of MissouriColumbiaMissouriUSA
| | | | - Robin C. Hilsabeck
- Department of NeurologyDell Medical SchoolUniversity of Texas at AustinAustinTexasUSA
- Mulva Clinic for the NeurosciencesUniversity of Texas at AustinAustinTexasUSA
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Benge JF, Aguirre A, Scullin MK, Kiselica A, Hilsabeck RC, Paydarfar D, Thomaz E, Douglas M. Digital Methods for Performing Daily Tasks Among Older Adults: An Initial Report of Frequency of Use and Perceived Utility. Exp Aging Res 2024; 50:133-154. [PMID: 36739553 PMCID: PMC11250545 DOI: 10.1080/0361073x.2023.2172950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/22/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Digital technologies permit new ways of performing instrumental activities of daily living (iADLs) for older adults, but these approaches are not usually considered in existing iADL measures. The current study investigated how a sample of older adults report using digital versus analog approaches for iADLs. METHOD 248 older adults completed the Digital and Analog Daily Activities Survey, a newly developed measure of how an individual performs financial, navigation, medication, and other iADLs. RESULTS The majority of participants reported regularly using digital methods for some iADLs, such as paying bills (67.7%) and using GPS (67.7%). Low digital adopters were older than high adopters (F(2, 245) = 12.24, p < .001), but otherwise the groups did not differ in terms of gender, years of education, or history of neurological disorders. Participants who used digital methods relatively more than analog methods reported greater levels of satisfaction with their approach and fewer daily errors. CONCLUSIONS Many older adults have adopted digital technologies for supporting daily tasks, which suggests limitations to the validity of current iADL assessments. By capitalizing on existing habits and enriching environments with new technologies, there are opportunities to promote technological reserve in older adults in a manner that sustains daily functioning.
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Affiliation(s)
- Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
| | - Alyssa Aguirre
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
| | - Michael K Scullin
- Department of Psychology and Neurosciences, Baylor University, Waco, TX, USA
| | - Andrew Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
| | - David Paydarfar
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX, USA
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Benge JF, Aguirre A, Scullin MK, Kiselica AM, Hilsabeck RC, Paydarfar D, Douglas M. Internet-Enabled Behaviors in Older Adults During the Pandemic: Patterns of Use, Psychosocial Impacts, and Plans for Continued Utilization. WORK, AGING AND RETIREMENT 2024; 10:6-13. [PMID: 38196827 PMCID: PMC10772966 DOI: 10.1093/workar/waac026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In response to social distancing measures during the COVID-19 pandemic, there was a need to increase the frequency of internet enabled behaviors (IEBs). To date, little is known about how the pandemic impacted IEBs in older adults, a population that has historically been linked to lower digital literacy and utilization. We administered an online survey between April and July 2021 to 298 adults who were over age 50 (mean age = 73 years; 93.5% non-Hispanic white; 94% smart phone owners; 83.5% retired). Older adults self-reported IEBs for social, shopping, medical, and leisure activities during the pandemic, plans for continued use of these behaviors, and completed measures of psychosocial functioning. 66.8% of respondents reported an overall increase in IEBs during the pandemic, most notably for online meeting attendance. More frequent online meeting use was associated with less depression (r = -0.12, p = .04) and less loneliness (r = -0.14, p = .02). With regard to plans for continued use, 82.5% of the sample reported at least one IEB (M = 2.18, SD = 1.65) that they increased during the pandemic and planned to maintain over time (e.g., online shopping for household goods). Plans for continued use were more likely in participants who used IEBs more overall during the pandemic (r = 0.56, p < .001), and who frequently sought technical support on search engines (r = 0.22, p < .001), or online video sites (r = 0.16, p = .006). In summary, IEBs during the pandemic were associated with favorable psychosocial functioning and expectations for continued use in this sample of predominantly white older adults who had some baseline technological familiarity.
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Affiliation(s)
- Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Alyssa Aguirre
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Michael K Scullin
- Department of Psychology and Neurosciences, Baylor University, Waco, TX, United States
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - David Paydarfar
- Department of Neurology, University of Texas at Austin, Austin, TX, United States
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, United States
| | - Michael Douglas
- Georgetown Neuroscience Foundation, Georgetown, TX, United States
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Fredriksen-Goldsen KI, Jones BR, Hoy-Ellis C, Kim HJ, Emlet CA, La Fazia D, McKenzie G, Petros R, Teri L. Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA). Contemp Clin Trials Commun 2023; 35:101169. [PMID: 37638227 PMCID: PMC10448412 DOI: 10.1016/j.conctc.2023.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods This paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. Results The virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. Discussion The virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.
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Affiliation(s)
| | - Brittany R. Jones
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles Hoy-Ellis
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles A. Emlet
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - David La Fazia
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ryan Petros
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Linda Teri
- University of Washington, School of Nursing, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
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Stojanovic M, Waters AB, Kiselica AM, Benge JF. The impact of technology-based compensatory behaviors on subjective cognitive decline in older adults with a family history of dementia. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37647340 DOI: 10.1080/23279095.2023.2247109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The current study examined whether greater use of technology to help with daily tasks is associated with less subjective cognitive decline (SCD), especially in individuals with a family history of Alzheimer's disease (AD). Individuals over the age of 50 (n = 102; age range 50-85) completed surveys about their digital and analog approaches to daily tasks, physical activity, and SCD. Participants with and without family histories of AD were matched on age, education, sex, and family history of AD using the R package MatchIt. There was no main effect of technology-based behavioral strategies on SCD (p = 0.259). However, a family history of AD moderated the association between technology use and SCD even when controlling for another protective lifestyle factor, physical activity. In individuals with a family history of AD, more reliance on technology-based behavioral strategies was associated with less SCD (p = 0.018), but this relationship was not significant in individuals without family history of AD (p = 0.511). Our findings suggest that technology-based behavioral strategies are associated with less SCD in individuals with a family history of AD, independent of another protective lifestyle factor. Future recommendations provided by healthcare providers to address SCD in cognitively unimpaired older adults might include focusing on technological assistance.
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Affiliation(s)
- Marta Stojanovic
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, MO, USA
| | - Abigail B Waters
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychology, Suffolk University, Boston, MA, USA
| | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, USA
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Woods SP, Thompson JL, Benge JF. Computer use: a protective factor for cognition in aging and HIV disease? Aging Clin Exp Res 2023:10.1007/s40520-023-02449-0. [PMID: 37278938 DOI: 10.1007/s40520-023-02449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Modifiable lifestyle factors such as engagement with technology may be beneficial to cognition in older adults, but we know little about these relationships in older persons with chronic medical conditions. AIMS The current study examined the association between computer use frequency and cognition in younger and older adults with and without HIV disease. METHODS Participants included 110 older persons with HIV (pwHIV; age ≥ 50 years), 84 younger pwHIV (age ≤ 40 years), 76 older HIV-, and 66 younger HIV- adults who completed a comprehensive medical, psychiatric, and cognitive research assessment. Demographically adjusted scores were derived from a well-validated clinical battery of performance-based neuropsychological tests. Participants also completed self-reported measures of cognitive symptoms in daily life and the Brief Computer Use and Anxiety Questionnaire (BCUAQ). RESULTS Older age was associated with less frequent computer use among persons with and without HIV disease. More frequent computer use was strongly and independently related to better cognitive performance, particularly in higher order domains (e.g., episodic memory and executive functions) and among the older seronegative adults. A small, univariable correlation between more frequent computer use and fewer cognitive symptoms in daily life was observed in the full sample, but that relationship was better explained by computer-related anxiety and HIV/age study group. DISCUSSION These findings add to the existing literature that suggests regular engagement with digital technologies may have a beneficial impact on cognitive functioning, consistent with the technological reserve hypothesis.
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Affiliation(s)
- Steven Paul Woods
- Department of Psychology, University of Houston, 3595 Cullen Blvd., 126 Heyne Bldg., Ste. 239d, Houston, TX, 77204, USA
| | - Jennifer L Thompson
- Department of Psychology, University of Houston, 3595 Cullen Blvd., 126 Heyne Bldg., Ste. 239d, Houston, TX, 77204, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Trinity St Bldg B, Austin, TX, 78712, USA.
- Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX, 78712, USA.
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Benge JF, Kiselica AM, Aguirre A, Hilsabeck RC, Douglas M, Paydarfar D, Scullin MK. Technology use and subjective cognitive concerns in older adults. Arch Gerontol Geriatr 2023; 106:104877. [PMID: 36459914 PMCID: PMC9868079 DOI: 10.1016/j.archger.2022.104877] [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: 08/02/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES How technology impacts the day to day cognitive functioning of older adults is a matter of some debate. On the one hand, the use of technologies such as smartphones and social media, may lead to more subjective cognitive concerns (SCC) by promoting distractibility and reliance on devices to perform memory tasks. However, continued digital engagement in older adults may also be related to better cognitive functioning. Given these competing viewpoints, our study evaluated if frequency of digital device use was associated with greater or less subjective cognitive concerns. METHOD Participants were 219 adults over the age of 65 (mean age =75 years) who had internet access. Measures assessing frequency of digital device use along with SCC were administered. Hierarchical multiple regression was used to gage association between frequency of device use and SCC, controlling for relevant demographic and lifestyle factors. RESULTS Increased frequency of digital device use was associated with less SCC, over and above the influence of demographic factors, across cognitive (but especially in executive) domains. This effect was observed for general device usage, with no statistically significant associations were observed between texting/video call, social media use and SCC. DISCUSSION Results were broadly consistent with the technological reserve hypothesis in that digital engagement was associated with better experienced cognitive functioning in older adults. While device use may contribute to distractibility in certain cases, the current results add to a burgeoning literature that digital engagement may be a protective factor for cognitive changes with age.
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Affiliation(s)
- Jared F Benge
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA.
| | | | - Alyssa Aguirre
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA; Steve Hick's School of Social Work, University of Texas at Austin, Austin TX USA
| | - Robin C Hilsabeck
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA
| | | | - David Paydarfar
- Department of Neurology, University of Texas at Austin, Austin, TX USA; Mulva Clinic for the Neurosciences, University of Texas at Austin, Austin, TX USA
| | - Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco TX USA
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Scullin MK, Jones WE, Phenis R, Beevers S, Rosen S, Dinh K, Kiselica A, Keefe FJ, Benge JF. Using smartphone technology to improve prospective memory functioning: A randomized controlled trial. J Am Geriatr Soc 2022; 70:459-469. [PMID: 34786698 PMCID: PMC8821124 DOI: 10.1111/jgs.17551] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND A decline in the ability to perform daily intentions-known as prospective memory-is a key driver of everyday functional impairment in dementia. In the absence of effective pharmacological treatments, there is a need for developing, testing, and optimizing behavioral interventions that can bolster daily prospective memory functioning. We investigated the feasibility and efficacy of smartphone-based strategies for prospective memory in persons with cognitive impairment. METHODS Fifty-two older adults (74.79 ± 7.20 years) meeting diagnostic criteria for mild cognitive impairment or mild dementia were enrolled in a 4-week randomized controlled trial. Participants were trained to use a digital voice recorder app or a reminder app to off-load prospective memory intentions. Prospective memory was assessed using experimenter-assigned tasks (e.g., call the laboratory on assigned days), standardized questionnaires, and structured interviews. Secondary dependent measures included days of phone and app usage, acceptability ratings, quality of life, and independent activities of daily living. RESULTS Participant ratings indicated that the intervention was acceptable and feasible. Furthermore, after the four-week intervention, participants reported improvements in daily prospective memory functioning on standardized questionnaires (p < 0.001, ηp2 = 0.285) and the structured interview (p < 0.001, d = 1.75). Participants performed relatively well on experimenter-assigned prospective memory tasks (51.7% ± 27.8%), with performance levels favoring the reminder app in Week 1, but reversing to favor the digital recorder app in Week 4 (p = 0.010, ηp2 = 0.079). Correlational analyses indicated that greater usage of the digital recorder or reminder app was associated with better prospective memory performance and greater improvements in instrumental activities of daily living (completed by care partners), even when controlling for condition, age, baseline cognitive functioning, and baseline smartphone experience. CONCLUSIONS Older adults with cognitive disorders can learn smartphone-based memory strategies and doing so benefits prospective memory functioning and independence.
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Affiliation(s)
- Michael K. Scullin
- Baylor University, Department of Psychology and Neuroscience,Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center,Corresponding author: Michael K. Scullin, Ph.D., Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX 76798, Phone: 254-710-2241, or . Twitter: @BaylorSleep
| | | | - Richard Phenis
- Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center
| | - Samantha Beevers
- Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center
| | - Sabra Rosen
- Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center
| | - Kara Dinh
- Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center
| | | | - Francis J. Keefe
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - Jared F. Benge
- Baylor University, Department of Psychology and Neuroscience,Baylor Scott and White Health, Department of Neurology and Plummer Movement Disorders Center,University of Texas in Austin, Department of Neurology
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Wolff JL, Benge JF, Cassel CK, Monin JK, Reuben DB. Emerging topics in dementia care and services. J Am Geriatr Soc 2021; 69:1763-1773. [PMID: 34245585 DOI: 10.1111/jgs.17341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The National Institute on Aging (NIA), in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act (NAPA), convened a 2020 Dementia Care, Caregiving, and Services Research Summit Virtual Meeting Series. This review article summarizes three areas of emerging science that are likely to grow in importance given advances in measurement, technologies, and diagnostic tests that were presented at the Summit. RESULTS Dr. Cassel discussed novel ethical considerations that have resulted from scientific advances that have enabled early diagnosis of pre-clinical dementia. Dr. Monin then summarized issues regarding emotional experiences in persons with dementia and their caregivers and care partners, including the protective impact of positive emotion and heterogeneity of differences in emotion by dementia type and individual characteristics that affect emotional processes with disease progression. Finally, Dr. Jared Benge provided an overview of the role of technologies in buffering the impact of cognitive change on real-world functioning and their utility in safety and monitoring of function and treatment adherence, facilitating communication and transportation, and increasing access to specialists in underserved or remote areas. CONCLUSIONS National policy initiatives, supported by strong advocacy and increased federal investments, have accelerated the pace of scientific inquiry and innovation related to dementia care and services but have raised some new concerns regarding ethics, disparities, and attending to individual needs, capabilities, and preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Christine K Cassel
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David B Reuben
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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