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Dunn T, Howlett SE, Stanojevic S, Shehzad A, Stanley J, Rockwood K. Patterns of Symptom Tracking by Caregivers and Patients With Dementia and Mild Cognitive Impairment: Cross-sectional Study. J Med Internet Res 2022; 24:e29219. [PMID: 35084341 PMCID: PMC8832273 DOI: 10.2196/29219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/13/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Individuals with dementia and mild cognitive impairment (MCI) experience a wide variety of symptoms and challenges that trouble them. To address this heterogeneity, numerous standardized tests are used for diagnosis and prognosis. myGoalNav Dementia is a web-based tool that allows individuals with impairments and their caregivers to identify and track outcomes of greatest importance to them, which may be a less arbitrary and more sensitive way of capturing meaningful change. OBJECTIVE We aim to explore the most frequent and important symptoms and challenges reported by caregivers and people with dementia and MCI and how this varies according to disease severity. METHODS This cross-sectional study involved 3909 web-based myGoalNav users (mostly caregivers of people with dementia or MCI) who completed symptom profiles between 2006 and 2019. To make a symptom profile, users selected their most personally meaningful or troublesome dementia-related symptoms to track over time. Users were also asked to rank their chosen symptoms from least to most important, which we called the symptom potency. As the stage of disease for these web-based users was unknown, we applied a supervised staging algorithm, previously trained on clinician-derived data, to classify each profile into 1 of 4 stages: MCI and mild, moderate, and severe dementia. Across these stages, we compared symptom tracking frequency, symptom potency, and the relationship between frequency and potency. RESULTS Applying the staging algorithm to the 3909 user profiles resulted in 917 (23.46%) MCI, 1596 (40.83%) mild dementia, 514 (13.15%) moderate dementia, and 882 (22.56%) severe dementia profiles. We found that the most frequent symptoms in MCI and mild dementia profiles were similar and comprised early hallmarks of dementia (eg, recent memory and language difficulty). As the stage increased to moderate and severe, the most frequent symptoms were characteristic of loss of independent function (eg, incontinence) and behavioral problems (eg, aggression). The most potent symptoms were similar between stages and generally reflected disruptions in everyday life (eg, problems with hobbies or games, travel, and looking after grandchildren). Symptom frequency was negatively correlated with potency at all stages, and the strength of this relationship increased with increasing disease severity. CONCLUSIONS Our results emphasize the importance of patient-centricity in MCI and dementia studies and illustrate the valuable real-world evidence that can be collected with digital tools. Here, the most frequent symptoms across the stages reflected our understanding of the typical disease progression. However, the symptoms that were ranked as most personally important by users were generally among the least frequently selected. Through individualization, patient-centered instruments such as myGoalNav can complement standardized measures by capturing these infrequent but potent outcomes.
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Affiliation(s)
| | - Susan E Howlett
- Ardea Outcomes, Halifax, NS, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sanja Stanojevic
- Ardea Outcomes, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | | | - Kenneth Rockwood
- Ardea Outcomes, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- Geriatric Medicine Research Unit, Nova Scotia Health Authority, Halifax, NS, Canada
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Stanley J, Howlett SE, Dunn T, Rockwood K. The Clinician's Interview-Based Impression of Change (Plus caregiver input) and goal attainment in two dementia drug trials: Clinical meaningfulness and the initial treatment response. Alzheimers Dement 2021; 17:856-865. [PMID: 33928754 DOI: 10.1002/alz.12242] [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: 05/26/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The Clinician's Interview-Based Impression of Change Plus caregiver input (CIBIC-Plus) has been widely used in dementia drug trials to evaluate cognition, behavior, and function. New trials of symptomatic drugs forecast renewed interest in this measure. METHODS To test its clinical meaningfulness, we examined how CIBIC-Plus performed in two cholinesterase inhibitor trials compared to goal attainment scaling Scale (GAS) scores, a patient-reported outcome measure. RESULTS Net goal attainment was seen for all but one GAS domains in subjects who improved on the CIBIC-Plus. Subjects who improved initially on CIBIC-Plus scores were likely to remain improved across all other outcomes for each trial's duration, except for Disability Assessment for Dementia scores. DISCUSSION The initial response to treatment, as assessed by CIBIC-Plus, remained stable for most outcome measures. Even small CIBIC-Plus improvement changes are associated with clinically meaningful change as assessed by GAS. Other tests detect decline better than improvement.
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Affiliation(s)
| | - Susan E Howlett
- DGI Clinical Inc., Halifax, Nova Scotia, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Taylor Dunn
- DGI Clinical Inc., Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- DGI Clinical Inc., Halifax, Nova Scotia, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Sefcik JS, Ersek M, Cacchione PZ. Nursing home residents with advanced dementia and persistent vocalisations: Observations of surrounding context. Int J Older People Nurs 2020; 15:e12322. [PMID: 32383798 PMCID: PMC7648731 DOI: 10.1111/opn.12322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/05/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Persistent vocalisations are commonly exhibited by persons with dementia and are often characterised as agitation or aggression. There has been little focus on persistent vocalisations independent from other behavioural and psychological symptoms of dementia making it difficult to differentiate information about the context that surrounds the person with dementia, including the circumstances and events that precede and accompany the expression. Therefore, the aim of this study was to describe the context surrounding persistent vocalisations expressed by older adults residing in nursing homes (NH) with advanced dementia. DESIGN AND METHODS The need-driven dementia-compromised behaviour model informed this qualitative descriptive study. This naturalistic qualitative observational study involved direct observations of nine older adults diagnosed with dementia residing in four NHs and included informal interviews with formal caregivers. Field notes were taken and analysed using conventional content analysis. RESULTS Variability of exhibited persistent vocalisations was both observed by the investigator and explained by NH staff. Two themes emerged from the field notes; Routine of Staying in Room was identified for participants considered 'disruptive' to others, and Providing Care Without Communicating triggered persistent vocalisations. IMPLICATIONS The findings provide insight into the lack of therapeutic interactions between NH staff and persons with advanced dementia and persistent vocalisations residing in NHs. Ongoing, mandatory, evidence-based training on person-centred interventions and dementia care communication for all NH staff globally could have a significant impact on the delivery of holistic quality care for persons with dementia and persistent vocalisations.
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Affiliation(s)
- Justine S. Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Mary Ersek
- Department of Veterans Affairs, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Pamela Z. Cacchione
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Penn Presbyterian Medical Center, Philadelphia, PA, USA
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Walton H, Spector A, Roberts A, Williamson M, Bhatt J, Tombor I, Michie S. Developing strategies to improve fidelity of delivery of, and engagement with, a complex intervention to improve independence in dementia: a mixed methods study. BMC Med Res Methodol 2020; 20:153. [PMID: 32532216 PMCID: PMC7291463 DOI: 10.1186/s12874-020-01006-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is important to evaluate fidelity of delivery and engagement during feasibility trials. However, there is little guidance on how to systematically develop strategies to improve implementation if problems arise. We aimed to: 1) Assess fidelity of delivery and engagement, 2) Identify factors influencing fidelity of delivery and engagement, and 3) Develop strategies to improve fidelity of delivery of, and engagement with, a complex intervention to improve independence in dementia, within a feasibility trial. METHODS A mixed methods evaluation of an intervention that aimed to improve independence in dementia. To assess fidelity of delivery and engagement, observation and self-report methods were used: 60% of audio-recorded intervention sessions were transcribed and reliably rated for fidelity. Providers (n = 12) and people with dementia/supporters (n = 34) were asked to complete checklists after each session. Descriptive statistics were used to analyse the data. To identify factors influencing fidelity and engagement, one-to-one semi-structured interviews were conducted with providers (n = 8), people with dementia (n = 7) and supporters (n = 7). Thematic analysis and content analysis were used to analyse data. To develop strategies, we followed four steps proposed by the authors of the Behaviour Change Wheel (1. Understanding the behaviour, 2. Identifying intervention functions, 3. Specifying intervention content, 4. Identifying mode of delivery). RESULTS Researcher ratings indicated moderate fidelity and provider/participant ratings indicated high fidelity of delivery. Knowledge, providers' attributes, ease of adaptation of the intervention in relation to participants' needs and logistical considerations influenced fidelity. We developed four strategies to improve fidelity of delivery of PRIDE: 1) showing a video, 2) giving an instruction sheet, 3) giving time to practice and 4) providing continued support. Participants reported high levels of engagement. Participants' attributes, capability and opportunity influenced engagement. We developed four strategies to improve engagement with PRIDE: 1) a session summary document, 2) clear instructions, 3) time to practice activity and 4) providing regular compulsory telephone support. CONCLUSION Fidelity of delivery and engagement are complex behaviours. This manuscript provides an example of how the Behaviour Change Wheel can be used during a feasibility trial to systematically develop strategies to improve implementation of complex interventions.
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Affiliation(s)
- Holly Walton
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Morgan Williamson
- School of Social Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - Jem Bhatt
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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den Ouden M, Kuk NO, Zwakhalen SM, Bleijlevens MH, Meijers JM, Hamers JP. The role of nursing staff in the activities of daily living of nursing home residents. Geriatr Nurs 2017; 38:225-230. [DOI: 10.1016/j.gerinurse.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
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DiLauro M, Pereira A, Carr J, Chiu M, Wesson V. Spousal caregivers and persons with dementia: Increasing participation in shared leisure activities among hospital-based dementia support program participants. DEMENTIA 2016; 16:9-28. [DOI: 10.1177/1471301215570680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spousal caregivers of persons with dementia often have difficulty engaging persons with dementia in leisure activities. This qualitative descriptive study identifies how caregivers perceive their spouses’ participation in leisure activities since dementia onset and the professional guidance caregivers require to increase persons with dementia participation in shared leisure activities. Nine spousal caregivers from a hospital-based caregiver intervention attended one of three focus groups. Using symbolic interactionism and selective optimization with compensation theory as guiding frameworks, thematic content analysis was performed. Three major themes were identified: Recognizing and acknowledging changes, Making sense of changes and conflicts, and Embracing changes and forging ahead. Findings can be used by healthcare providers to better understand caregivers’ needs for engaging persons with dementia in shared leisure activities, and inform development of feedback protocols to enhance caregiver interventions.
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Affiliation(s)
| | | | - Jennifer Carr
- Mount Sinai Hospital & University of Toronto (Status Only), Toronto, Canada
| | - Mary Chiu
- Mount Sinai Hospital & University of Toronto, Toronto, Canada
| | - Virginia Wesson
- Mount Sinai Hospital & University of Toronto, Toronto, Canada
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Smit D, de Lange J, Willemse B, Twisk J, Pot AM. Activity involvement and quality of life of people at different stages of dementia in long term care facilities. Aging Ment Health 2016; 20:100-9. [PMID: 26032736 DOI: 10.1080/13607863.2015.1049116] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. METHOD Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents' age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. RESULTS Despite resident's cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. CONCLUSION Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement.
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Affiliation(s)
- Dieneke Smit
- a Department of Clinical Psychology , Faculty of Psychology and Education , Vrije Universiteit , Amsterdam , The Netherlands.,b Program on Aging , Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands
| | - Jacomine de Lange
- c Research Centre Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , The Netherlands
| | - Bernadette Willemse
- a Department of Clinical Psychology , Faculty of Psychology and Education , Vrije Universiteit , Amsterdam , The Netherlands.,b Program on Aging , Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands
| | - Jos Twisk
- d Department of Methodology and Applied Biostatistics , Faculty of Earth and Life Sciences , Vrije Universiteit , Amsterdam , The Netherlands.,e EMGO+ Institute for Health and Care research , Amsterdam , The Netherlands
| | - Anne Margriet Pot
- a Department of Clinical Psychology , Faculty of Psychology and Education , Vrije Universiteit , Amsterdam , The Netherlands.,b Program on Aging , Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands.,e EMGO+ Institute for Health and Care research , Amsterdam , The Netherlands.,f School of Psychology , University of Queensland , Brisbane , Australia
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Han A, Radel J, McDowd JM, Sabata D. Perspectives of People with Dementia About Meaningful Activities: A Synthesis. Am J Alzheimers Dis Other Demen 2016; 31:115-23. [PMID: 26340962 PMCID: PMC10852553 DOI: 10.1177/1533317515598857] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Qualitative studies were synthesized to describe perspectives of people with dementia regarding meaningful activities. Themes of connectedness were identified using a meta-ethnography approach. The theme of being connected with self encompasses engagement for continuity, health promotion, and personal time. The theme of being connected with others includes being with others not to feel alone, doing an activity with others, and meaningful relationships. The theme of being connected with the environment encompasses being connected to one’s familiar environment, community, and nature. This synthesis suggests that connectedness is an important motivation for engagement in daily activities. Findings indicate that identifying the underlying motivation for an individual with dementia to engage in different activities is important for matching a person with activities that will be satisfying. This review may inform the development of interventions for engaging people with dementia in meaningful, daily activities and creating connectedness to self, others, and the environment.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeff Radel
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joan M. McDowd
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Dory Sabata
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
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Rockwood K, Mitnitski A, Richard M, Kurth M, Kesslak P, Abushakra S. Neuropsychiatric symptom clusters targeted for treatment at earlier versus later stages of dementia. Int J Geriatr Psychiatry 2015; 30:357-67. [PMID: 24798635 DOI: 10.1002/gps.4136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/02/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To characterize clusters of neuropsychiatric symptoms targeted for tracking the disease course in people with dementia, in relation to stage. METHODS Baseline symptoms from 2922 subjects from two datasets (one clinic based, one online) were aggregated. Common neuropsychiatric symptoms identified by patients/carers as targets of treatment using a dementia SymptomGuide™ were selected. The Global Deterioration Scale was used for clinic staging, and an artificial neural network algorithm, for staging online subjects. Symptom clusters were detected using multiple correspondence analysis and connectivity graph analysis based on relative risk (RR). In a connectivity graph, each pair of nodes (representing symptoms) is connected if their co-occurrence is statistically significant; direction is indicated as positive if RR > 1 and negative otherwise. RESULTS Neuropsychiatric symptoms were targeted for treatment in 1072 patients (37%). Agitation (37%) and sleep disturbances (28%) were most common symptoms. One cluster (in people with cognitive impairment, no dementia (CIND) or mild dementia) showed significant co-occurrence of anxiety and restlessness; decreased initiative was chiefly seen in isolation. A second cluster (in moderate/severe dementia) was defined by significant co-occurrence of delusions and hallucinations with sleep disturbances; in these subjects, decreased initiative was related to aggression. CONCLUSIONS Two analytical methods identified neuropsychiatric symptom clusters targeted to track the disease course. In CIND/mild dementia, a profile of decreased initiative distinct from depression suggests possible executive dysfunction. In moderate/severe dementia, targets more reflected psychotic symptoms. Visual data displays allow the relationships between multiple symptoms to be considered simultaneously, which commonly is how they present in patients.
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Affiliation(s)
- Kenneth Rockwood
- DGI Clinical Inc., Halifax, NS, Canada; Dalhousie University, Halifax, NS, Canada; Institute of Brain and Behaviour and Mental Health, University of Manchester, Manchester, UK
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Tang Yan HS, Clemson LM, Jarvis F, Laver K. Goal setting with caregivers of adults in the community: a mixed methods systematic review. Disabil Rehabil 2014; 36:1943-63. [PMID: 24856636 DOI: 10.3109/09638288.2014.884173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine how goal setting is used with caregivers of community residing adults and the effect of goal setting practices in improving the outcomes. METHODS A mixed methods systematic review was conducted. The methodological rigour of included studies was critiqued using Cochrane Collaboration's risk of bias assessment tool, Downs and Black checklist and a framework for evaluating qualitative research. Narrative synthesis was created through tabulation and categorisation, visual mapping of the goal setting process, thematic analysis on common goal setting features and critical reflection on the accuracy and robustness of the synthesis. RESULTS Seventeen studies were included: 10 randomised trials, 5 other quantitative studies and two descriptive studies which incorporated qualitative methods. The trials demonstrated a relatively low risk of bias in contrast to the other studies that had varied methodological rigour. No studies isolated the effect of the goal setting process on outcomes and therefore the effectiveness of goal setting could not be evaluated. However, through a narrative synthesis six prominent features of collaborative goal setting were identified. CONCLUSIONS Despite the fact that goal setting is an important component of client-centred care, and the prominence of client-centred care in healthcare discourse, the review uncovered a surprisingly limited number of studies. Goal setting is an elusive process that is of therapeutic value and warrants further investigation. Implications for Rehabilitation The current body of empirical evidence suggests that there are six prominent features of collaborative goal setting with caregivers. The goals that are most important to caregivers are often different to those that are important to clinicians; it is important that caregivers and clinicians agree on goals to maximise adherence to treatment and goal attainment. The quality of evidence for goal setting with caregivers is limited although some intervention trials illustrate the usefulness of collaborative goal setting in contributing to improved outcomes.
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Affiliation(s)
- Heidi Shaunna Tang Yan
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney , Lidcombe, NSW , Australia and
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Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study. Int Psychogeriatr 2014; 26:69-80. [PMID: 24053758 DOI: 10.1017/s1041610213001397] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Occupation remains an unmet need in long-term dementia care. To increase residents' occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable. METHODS In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as "wellbeing-enhancing occupation." Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation. RESULTS Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program. CONCLUSIONS This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.
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Erder MH, Wilcox TK, Chen WH, O'Quinn S, Setyawan J, Saxton J. A new measure of caregiver burden in Alzheimer's disease: the caregiver-perceived burden questionnaire. Am J Alzheimers Dis Other Demen 2012; 27:474-82. [PMID: 22904030 PMCID: PMC10697400 DOI: 10.1177/1533317512456449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE To validate the Caregiver-Perceived Burden Questionnaire (CPBQ) and report its psychometric properties. METHODS The CPBQ was administered to caregivers of patients with moderate-to-severe AD in a double-blind randomized trial comparing extended-release memantine to placebo (n = 676). Measurement properties were analyzed using factor analysis, classical test theory, and Rasch analysis. RESULTS Two subscales were identified: the Caregivers' Assessment of the Patient (CAP) and the Caregivers' Assessment of Themselves (CAT). The reliability was .89 (CAP) and .83 (CAT). The CAP scores were significantly correlated (r > .3) with scores from the Severe Impairment Battery (SIB) and the Neuropsychiatric Inventory (NPI). The CAT scores were significantly correlated with NPI scores. The CAT discriminated among patients by clinician-rated severity and significantly differentiated between responders and nonresponders. CONCLUSION The CPBQ appears to be a reliable, valid, and responsive measure that enables linking caregiver's perceptions about burden and patient function in patients with moderate-to-severe AD.
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Cedervall Y, Kilander L, Aberg AC. Declining physical capacity but maintained aerobic activity in early Alzheimer's disease. Am J Alzheimers Dis Other Demen 2012; 27:180-7. [PMID: 22573284 PMCID: PMC10845600 DOI: 10.1177/1533317512442996] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The longitudinal influences on physical capacity and habitual aerobic activity level in the early stages of Alzheimer's disease (AD) are unclear. Therefore, changes in physical capacity and aerobic activity level were evaluated. Twenty-five individuals with AD were assessed annually for 2 years, by 10-m walk test, 6-minute walk test, and timed up-and-go (TUG) single/dual tasks. Habitual aerobic activity was assessed by diary registrations. The AD group showed a lower physical capacity than controls at baseline but comparable levels of aerobic activity. During the follow-up period, physical capacity declined in the AD group, but the aerobic activity levels changed only marginally. Our results show that in the early stages of AD, people are capable of maintaining health-promoting aerobic activity levels, despite a decline in their physical capacity. Additionally, it appears that cognitive dysfunction contributes to an impaired physical capacity. The TUG tasks might, therefore, be useful for detecting early signs of cognitive impairment.
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Affiliation(s)
- Ylva Cedervall
- Department of Public Health and Caring Science/Geriatrics, Uppsala University, Sweden.
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Seelye AM, Schmitter-Edgecombe M, Das B, Cook DJ. Application of cognitive rehabilitation theory to the development of smart prompting technologies. IEEE Rev Biomed Eng 2012; 5:29-44. [PMID: 23231987 PMCID: PMC8841061 DOI: 10.1109/rbme.2012.2196691] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Older adults with cognitive impairments often have difficulty performing instrumental activities of daily living (IADLs). Prompting technologies have gained popularity over the last decade and have the potential to assist these individuals with IADLs in order to live independently. Although prompting techniques are routinely used by caregivers and health care providers to aid individuals with cognitive impairment in maintaining their independence with everyday activities, there is no clear consensus or gold standard regarding prompt content, method of instruction, timing of delivery, or interface of prompt delivery in the gerontology or technology literatures. In this paper, we demonstrate how cognitive rehabilitation principles can inform and advance the development of more effective assistive prompting technologies that could be employed in smart environments. We first describe cognitive rehabilitation theory (CRT) and show how it provides a useful theoretical foundation for guiding the development of assistive technologies for IADL completion. We then use the CRT framework to critically review existing smart prompting technologies to answer questions that will be integral to advancing development of effective smart prompting technologies. Finally, we raise questions for future exploration as well as challenges and suggestions for future directions in this area of research.
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Affiliation(s)
- Adriana M Seelye
- Department of Psychology, Washington State University, Pullman, WA 99164, USA.
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Laudate TM, Neargarder S, Dunne TE, Sullivan KD, Joshi P, Gilmore GC, Riedel TM, Cronin-Golomb A. Bingo! Externally supported performance intervention for deficient visual search in normal aging, Parkinson's disease, and Alzheimer's disease. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2011; 19:102-21. [PMID: 22066941 PMCID: PMC3275685 DOI: 10.1080/13825585.2011.621930] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
External support may improve task performance regardless of an individual's ability to compensate for cognitive deficits through internally generated mechanisms. We investigated if performance of a complex, familiar visual search task (the game of bingo) could be enhanced in groups with suboptimal vision by providing external support through manipulation of task stimuli. Participants were 19 younger adults, 14 individuals with probable Alzheimer's disease (AD), 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson's disease (PD), and 20 PD-matched healthy adults. We varied stimulus contrast, size, and visual complexity during game play. The externally supported performance interventions of increased stimulus size and decreased complexity resulted in improvements in performance by all groups. AD also obtained benefit from increasing contrast, presumably by compensating for their contrast sensitivity deficit. The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance.
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Affiliation(s)
| | - Sandy Neargarder
- Department of Psychology, Boston University, Boston, MA, 02215 USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA, 02325 USA
| | - Tracy E. Dunne
- Department of Psychology, Boston University, Boston, MA, 02215 USA
| | | | - Pallavi Joshi
- Department of Psychology, Boston University, Boston, MA, 02215 USA
| | - Grover C. Gilmore
- Department of Psychology, Case Western Reserve University, Cleveland, OH, 44106 USA
| | - Tatiana M. Riedel
- Department of Psychology, Case Western Reserve University, Cleveland, OH, 44106 USA
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Kavanagh S, Gaudig M, Van Baelen B, Adami M, Delgado A, Guzman C, Jedenius E, Schäuble B. Galantamine and behavior in Alzheimer disease: analysis of four trials. Acta Neurol Scand 2011; 124:302-8. [PMID: 21615354 DOI: 10.1111/j.1600-0404.2011.01525.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Many individuals with Alzheimer's disease (AD) experience behavioral and neuropsychiatric symptoms, which may cause caregiver distress and lead to the institutionalization of the patient. This analysis characterized behavioral symptoms and caregiver distress in trials of galantamine and their response to treatment. MATERIALS AND METHODS Data were pooled from four randomized, placebo-controlled clinical trials of galantamine in patients with mild to moderate AD (three studies) or AD plus cerebrovascular disease (one study) (n = 2177). Behavior and associated caregiver distress were assessed in each study using the Neuropsychiatric Inventory (NPI) and NPI distress (NPI-D), respectively. RESULTS After 5/6 months, but not after 3 months, NPI score was significantly improved with galantamine vs placebo (P = 0.013). The benefit was particularly pronounced in patients categorized as having advanced moderate AD. At 5/6 months, there was a numerical benefit of galantamine over placebo in terms of caregiver distress; the difference was statistically significant in patients with moderate or advanced moderate AD. CONCLUSIONS Galantamine reduces behavioral symptoms in patients with mild to moderate AD, leading to reduced caregiver burden. The reductions were greatest in patients with moderate or advanced moderate disease.
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Affiliation(s)
- S Kavanagh
- Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
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Padilla R. Effectiveness of Interventions Designed to Modify the Activity Demands of the Occupations of Self-Care and Leisure for People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011; 65:523-31. [DOI: 10.5014/ajot.2011.002618] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
A systematic review of evidence for the effectiveness of modification of activity demands in the care of people with Alzheimer’s disease (AD) was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The review included 10 articles addressing occupations of self-care and leisure. No reports related to work and social participation were located. Results suggest that evidence for this intervention’s effectiveness is strong. Four practice principles were derived from this appraisal: (1) Occupational therapy programs should be individualized to elicit the person’s highest level of retained skill and interest, (2) cues used while assisting people with AD to complete tasks should be short and provide clear direction, (3) compensatory strategies in the form of environmental modifications and simple adaptive equipment should be specifically implemented on the basis of the unique needs of the person, and (4) caregiver training and involvement are essential in implementing individualized programs.
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Affiliation(s)
- René Padilla
- René Padilla, PhD, OTR/L, FAOTA, is Associate Dean for Academic and Student Affairs, Office of Academic and Student Affairs, Criss III Building, Suite 154, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178;
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