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Uceda-Portillo C, Aranda-Valero S, Moruno-Miralles P. Occupational Therapy Interventions to Improve the Quality of Life of Older Adults with Dementia Living in Nursing Homes: A Systematic Review. Healthcare (Basel) 2024; 12:896. [PMID: 38727453 PMCID: PMC11083416 DOI: 10.3390/healthcare12090896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The increase in older adults with dementia presents challenges in promoting research to improve the quality of life of this population. The objective of this study was to assess the scientific evidence on the effectiveness of occupational therapy interventions in improving the quality of life of older adults over 65 years old with dementia living in nursing homes. The databases used were PubMed, Web of Science, OTSeeker, clinicaltrials.gov, Dialnet, Scopus, Cochrane, and SciELO between 2013 and 2023. The studies were selected and evaluated according to the Cochrane guidelines. The review was carried out following the PRISMA 2020 Statement. Sixteen articles met the inclusion criteria and were categorized into four groups according to the focus of the intervention: "meaningful activities/occupations", "physical, cognitive and sensory functioning", "performance areas", and "physical and social environment and staff training". The strength of evidence was moderate, and the risk of bias was low. The findings revealed that occupational therapy interventions based on participation in recreational activities, reminiscence, performance-based activities and the physical and social environment, and specialized staff training, could improve the perceived quality of life of older adults with dementia living in nursing homes.
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Affiliation(s)
- Cristian Uceda-Portillo
- Department of Psychology, National University of Distance Education (UNED), Talavera de la Reina, 45600 Toledo, Spain
| | - Sandra Aranda-Valero
- Department of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain;
| | - Pedro Moruno-Miralles
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Talavera de la Reina, 45600 Toledo, Spain;
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Kejžar A, Turunen KM. The ecosystem of human capital in care homes. Front Public Health 2024; 12:1298833. [PMID: 38500729 PMCID: PMC10946669 DOI: 10.3389/fpubh.2024.1298833] [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: 10/03/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction This qualitative study addresses the essential yet often overlooked experiences of knowledge transfer within care homes (CH). Conducted in a Slovenian CH in 2020 and 2023, participants, including CH management, staff, and residents with their relatives, shared perceptions of knowledge transfer at various levels. The study aims to explore barriers and facilitators for knowledge transfer crucial for creating new knowledge, services, and enhancing care quality for older individuals. Methods Structured focus group interviews were conducted, and data were collected within the CH. The participants' insights into knowledge transfer were probed, covering various dimensions such as between individuals, groups, organizations, and the community. Transcriptions of recorded interviews were analyzed using content analysis. Results Knowledge transfer within the CH was facilitated through continuous training, diverse communication channels, and mentoring. Collaboration with relatives improved understanding of resident preferences, habits, and overall enhanced the quality of care. This collaborative effort allowed mutual learning and knowledge transfer from the CH to the broader community. Despite potential benefits, there is an underutilization of information and communication technology, e-care, and untapped potential for partnerships, partly due to the scarcity of care. Barriers were identified in the form of stereotypical attitudes towards aging and care, further reinforced by negative news coverage on older people's care. Conclusion The multidimensional nature of knowledge in CH centers on resident well-being, emphasizing three key aspects of knowledge transfer: between staff and residents, staff and residents' families, and between the CH and the community. In the context of age management, creating opportunities for knowledge transfer is crucial, emphasizing a transition from traditional institutional care to an approach prioritizing knowledge about quality care. and involving experts from experiences in care process.
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Affiliation(s)
- Anamarija Kejžar
- Chair of Long-Term Care, Faculty of Social Work, University of Ljubljana & MRRC UL SI-AHA, Ljubljana, Slovenia
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Mazzola P, Zanetti M, Ferraguzzi G, Villa ML, Sandrini MC, Fumagalli M, Volpi M, Caggiu G, Monzio Compagnoni M, Mecocci P, Bellelli G. Shifting the Paradigm of Nursing Home Care for People with Dementia: The Italian Experience of Il Paese Ritrovato and the Impact of SARS-CoV-2. J Alzheimers Dis 2024; 97:741-752. [PMID: 38143344 DOI: 10.3233/jad-230229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Il Paese Ritrovato is an Italian nursing home founded in 2018, it is based on the Alzheimer village model and admits people with mild-to-moderate dementia. OBJECTIVE Describe the impact of the SARS-CoV-2 pandemic on people living at Il Paese Ritrovato through a Comprehensive Geriatric Assessment (CGA) regularly administered prior to and during the pandemic. METHODS We explored the effects of a person-centered approach. We assessed 64 subjects (enrolled and followed between June 2018 and December 2020), who underwent at least 18 months of observation prior to the pandemic. Each subject was evaluated using a CGA on admission time (T0) and at defined time-points: T6, T12, T18. One last CGA evaluation was performed during the SARS-CoV-2 pandemic (TCovid-19). Temporal trends during T0-T18, and differences between T18 and TCovid-19 were calculated. RESULTS The mean age was 82 years with a prevalence for females (77.0%) and Alzheimer's disease diagnosis (60%). Psychiatric and behavioral disorders were the most common conditions (80%). We utilized a nonpharmacological approach aimed at promoting the residents' overall wellbeing and observed satisfactory performance during the first 18 months. In comparison with the pre-pandemic period, TCovid-19 enlightened +11.7% use of antidepressants and a decline of Mini-Mental State Examination mean values (not statistically significant), while engagement in activities dropped. CONCLUSIONS The pandemic may have disrupted the existing model of care, but at the same time, it confirmed that the Il Paese Ritrovato approach, which encompasses symptoms improvement and multicomponent support, is in fact beneficial.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
| | | | - Gaia Ferraguzzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | | | | | - Giulia Caggiu
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Matteo Monzio Compagnoni
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Patrizia Mecocci
- Department of Biomedical Sciences for Health, Università di Perugia, Perugia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
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Vaillant-Ciszewicz AJ, Lantermino L, Quin C, Cuni A, Guerin O. [Setting up, running and evaluating NMIs as part of the "ageing well" project]. SOINS. GERONTOLOGIE 2023; 28:13-23. [PMID: 37977760 DOI: 10.1016/j.sger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
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Affiliation(s)
| | | | - Cassandra Quin
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Alice Cuni
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Olivier Guerin
- Inserm U1081, IRCAN, CNRS UMR 7284, Université Côte-d'Azur, CHU de Nice, 4 avenue Reine-Victoria, 06000 Nice, Alpes-Maritimes, France
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Lühnen J, Richter T, Calo S, Meyer G, Köpke S, Möhler R. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2023; 8:CD008634. [PMID: 37650479 PMCID: PMC10471006 DOI: 10.1002/14651858.cd008634.pub3] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND Antipsychotic medications are regularly prescribed in care home residents for the management of behavioural and psychological symptoms of dementia (BPSD) despite questionable efficacy, important adverse effects, and available non-pharmacological interventions. Prescription rates are related to organisational factors, staff training and job satisfaction, patient characteristics, and specific interventions. Psychosocial intervention programmes aimed at reducing the prescription of antipsychotic drugs are available. These programmes may target care home residents (e.g. improving communication and interpersonal relationships) or target staff (e.g. by providing skills for caring for people with BPSD). Therefore, this review aimed to assess the effectiveness of these interventions, updating our earlier review published in 2012. OBJECTIVES To evaluate the benefits and harms of psychosocial interventions to reduce antipsychotic medication use in care home residents compared to regular care, optimised regular care, or a different psychosocial intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 14 July 2022. SELECTION CRITERIA We included individual or cluster-randomised controlled trials comparing a psychosocial intervention aimed primarily at reducing the use of antipsychotic medication with regular care, optimised regular care, or a different psychosocial intervention. Psychosocial interventions were defined as non-pharmacological intervention with psychosocial components. We excluded medication withdrawal or substitution interventions, interventions without direct interpersonal contact and communication, and interventions solely addressing policy changes or structural interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Critical appraisal of studies addressed risks of selection, performance, attrition and detection bias, as well as criteria related to cluster randomisation. We retrieved data on the complex interventions on the basis of the TIDieR (Template for Intervention Description and Replication) checklist. Our primary outcomes were 1. use of regularly prescribed antipsychotic medication and 2. ADVERSE EVENTS Our secondary outcomes were 3. mortality; 4. BPSD; 5. quality of life; 6. prescribing of regularly psychotropic medication; 7. regimen of regularly prescribed antipsychotic medication; 8. antipsychotic medication administered 'as needed'; 9. physical restraints; 10. cognitive status; 11. depression; 12. activities of daily living; and 13. COSTS We used GRADE to assess certainty of evidence. MAIN RESULTS We included five cluster-randomised controlled studies (120 clusters, 8342 participants). We found pronounced clinical heterogeneity and therefore decided to present study results narratively. All studies investigated complex interventions comprising, among other components, educational approaches. Because of the heterogeneity of the results, including the direction of effects, we are uncertain about the effects of psychosocial interventions on the prescription of antipsychotic medication. One study investigating an educational intervention for care home staff assessed the use of antipsychotic medication in days of use per 100 resident-days, and found this to be lower in the intervention group (mean difference 6.30 days, 95% confidence interval (CI) 6.05 to 6.66; 1152 participants). The other four studies reported the proportion of participants with a regular antipsychotic prescription. Of two studies implementing an intervention to promote person-centred care, one found a difference in favour of the intervention group (between-group difference 19.1%, 95% CI 0.5% to 37.7%; 338 participants), while the other found a difference in favour of the control group (between-group difference 11.4%, 95% CI 0.9% to 21.9%; 862 participants). One study investigating an educational programme described as "academic detailing" found no difference between groups (odds ratio 1.06, 95% CI 0.93 to 1.20; 5363 participants). The fifth study used a factorial design to compare different combinations of interventions to supplement person-centred care. Results showed a positive effect of medication review, and no clear effect of social interaction or exercise. We considered that, overall, the evidence about this outcome was of low certainty. We found high-certainty evidence that psychosocial interventions intended primarily to reduce antipsychotic use resulted in little to no difference in the number of falls, non-elective hospitalisations, or unplanned emergency department visits. Psychosocial interventions intended primarily to reduce antipsychotic use also resulted in little to no difference in quality of life (moderate-certainty evidence), and BPSD, regular prescribing of psychotropic medication, use of physical restraints, depression, or activities of daily living (all low-certainty evidence). We also found low-certainty evidence that, in the context of these interventions, social interaction and medication review may reduce mortality, but exercise does not. AUTHORS' CONCLUSIONS All included interventions were complex and the components of the interventions differed considerably between studies. Interventions and intervention components were mostly not described in sufficient detail. Two studies found evidence that the complex psychosocial interventions may reduce antipsychotic medication use. In addition, one study showed that medication review might have some impact on antipsychotic prescribing rates. There were no important adverse events. Overall, the available evidence does not allow for clear generalisable recommendations.
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Affiliation(s)
- Julia Lühnen
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Clinical Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Cano F, Alves E, João A, Oliveira H, Pinho LG, Fonseca C. A rapid literature review on the health-related outcomes of long-term person-centered care models in adults with chronic illness. Front Public Health 2023; 11:1213816. [PMID: 37670836 PMCID: PMC10477001 DOI: 10.3389/fpubh.2023.1213816] [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: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction The strong association between age and the increasing prevalence of chronic diseases, makes it imperative to promote self-care throughout life. Systematic knowledge on the health findings of person-centered care models may contribute to designing effective healthcare strategies to promote empowerment for self-care in long-term care. Objective To assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness. Methods A rapid review of the literature was performed following the Cochrane rapid review methodology. The electronic databases CINAHL, MedicLatina, MEDLINE, and Psychology and Behavioral Sciences Collection were searched for randomized experimental studies, published between 2017 and 2022, that implemented interventions based on person-centered models to promote self-care in adults aged ≥18 years with chronic diseases and needing long-term health care. Verification of the eligibility of the articles and the extraction of data were performed by two independent investigators. Quantitative data on the health-related variables assessed were collected and, through narrative synthesis, health outcomes were grouped into individual, institutional and societal levels. Results Eight studies, mostly conducted in European countries, were included. All satisfied more than 60% of the methodological quality score. A large variability among studies was found regarding the number of participants, the data collection period and duration of the intervention, the samples selected and the care model implemented. A high number of health-related outcomes (n = 17) were analyzed in the studies, using 52 different instruments. The main health-related outcomes were multidimensional, with implications at the individual, institutional and societal levels. The promotion of overall health and wellbeing (n = 4), the implementation of patient-centered care models (n = 1), the positive and more frequent interactions with health professionals (2), the decrease on staff psychosocial distress (n = 1), and the absence of added costs (n = 1), while improving family caregivers' skills (n = 1) were the main health-related outcomes described. Conclusion There is a need to develop robust experimental studies focused on the views and experiences of all stakeholders and conducted in different countries and cultures. Short-, medium- and long-term health outcomes should be measured using internationally accepted and validated scales for chronic patients.
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Affiliation(s)
- Fátima Cano
- Local Health Unit of Baixo Alentejo, Beja, Portugal
| | - Elisabete Alves
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - Ana João
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - Henrique Oliveira
- Instituto de Telecomunicações, Lisbon, Portugal
- Polytechnic Institute of Beja, Beja, Portugal
| | - Lara Guedes Pinho
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - César Fonseca
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
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Behrendt D, Spieker S, Sumngern C, Wendschuh V. Integrating social support into interventions among the elderly in nursing homes: a scoping review. BMJ Open 2023; 13:e071962. [PMID: 37085297 PMCID: PMC10124279 DOI: 10.1136/bmjopen-2023-071962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This study aimed to understand the evidence related to integration of social support into interventions, to identify literature gaps related to social support interventions, and to clarify dimensions of supportive functions, outcomes, and providers among the elderly in nursing homes. DESIGN This scoping review followed the approach by Arksey and O'Malley. The Mixed Methods Appraisal Tool V.2018 was used for quality assessment of the studies. DATA SOURCES Searches were conducted of the PubMed, ScienceDirect, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases for publications from 2010 to 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We searched for primary studies and heterogeneous study designs published in English. Eligible studies took place in nursing and care homes and had study populations of elderly adults (older adults, geriatrics, ageing, seniors, older people and those aged 60 years and older). DATA EXTRACTION AND SYNTHESIS A data extraction form based on Joanna Briggs Institute's recommendations for scoping reviews was used. Two reviewers independently extracted data and performed quality assessment of the studies. Then, extracted data and quality assessment reports were discussed by all authors. RESULTS Thirty-one eligible studies were included in this review. 54.8% of the studies provided interventions for cognitively impaired residents. The top-three outcomes were neuropsychiatric symptoms, physical function and quality of life, respectively. The interventions were performed by nursing home staff (83.9%), other persons with specific qualifications (58.1%) and health volunteers (6.5%). Most studies (90.3%) depicted the integration of emotional and instrumental supportive functions into interventions. CONCLUSION The appropriate dimensions of supportive function, mainly emotional and instrumental support, are important to integrate into the social care of elderly people living in nursing homes.
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Affiliation(s)
- Daniel Behrendt
- Nursing Department, Städtisches Klinikum Dessau, Dessau, Germany
| | - Sybille Spieker
- Departments of Neurology and Geriatrics, Städtisches Klinikum Dessau, Dessau, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin and Brandenburg, Germany
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Möhler R, Calo S, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2023; 3:CD009812. [PMID: 36930048 PMCID: PMC10010156 DOI: 10.1002/14651858.cd009812.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. We wanted to know whether offering them activities which are tailored to their individual interests and preferences could improve their quality of life and reduce agitation. This review updates our earlier review published in 2018. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities. ∙ To describe the components of the interventions. ∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 15 June 2022. We also performed additional searches in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up-to-date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interest in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion, extracted data and assessed the risk of bias of included studies. Our primary efficacy outcomes were agitation and participant quality of life. Where possible, we pooled data across studies using a random effects model. MAIN RESULTS We identified three new studies, and therefore included 11 studies with 1071 participants in this review update. The mean age of participants was 78 to 88 years and most had moderate or severe dementia. Ten studies were RCTs (three studies randomised clusters to the study groups, six studies randomised individual participants, and one study randomised matched pairs of participants) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, five studies an active control group (activities which were not personally tailored) and one study included both types of control group. The duration of follow-up ranged from 10 days to nine months. In nine studies personally tailored activities were delivered directly to the participants. In one study nursing staff, and in another study family members, were trained to deliver the activities. The selection of activities was based on different theoretical models, but the activities delivered did not vary substantially. We judged the risk of selection bias to be high in five studies, the risk of performance bias to be high in five studies and the risk of detection bias to be high in four studies. We found low-certainty evidence that personally tailored activities may slightly reduce agitation (standardised mean difference -0.26, 95% CI -0.53 to 0.01; I² = 50%; 7 studies, 485 participants). We also found low-certainty evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). Two studies investigated quality of life by proxy-rating. We found low-certainty evidence that personally tailored activities may result in little to no difference in quality of life in comparison with usual care or an active control group (MD -0.83, 95% CI -3.97 to 2.30; I² = 51%; 2 studies, 177 participants). Self-rated quality of life was only available for a small number of participants from one study, and there was little or no difference between personally tailored activities and usual care on this outcome (MD 0.26, 95% CI -3.04 to 3.56; 42 participants; low-certainty evidence). Two studies assessed adverse effects, but no adverse effects were observed. We are very uncertain about the effects of personally tailored activities on mood and positive affect. For negative affect we found moderate-certainty evidence that there is probably little to no effect of personally tailored activities compared to usual care or activities which are not personalised (standardised mean difference -0.02, 95% CI -0.19 to 0.14; 6 studies, 632 participants). We were not able to undertake meta-analyses for engagement and sleep-related outcomes, and we are very uncertain whether personally tailored activities have any effect on these outcomes. Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects they found persisted only during the period of delivery of the activities. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly reduce agitation. Personally tailored activities may result in little to no difference in quality of life rated by proxies, but we acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities probably have little or no effect on negative affect, and we are uncertain whether they have any effect on positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one theoretical model rather than another. We included three new studies in this updated review, but two studies were pilot trials and included only a small number of participants. Certainty of evidence was predominately very low or low due to several methodological limitations of and inconsistencies between the included studies. Evidence is still limited, and we remain unable to describe optimal activity programmes. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
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Affiliation(s)
- Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Bartels C, Abdel-Hamid M, Wiltfang J, Schneider A, Belz M. Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data. J Alzheimers Dis 2022; 90:1725-1737. [PMID: 36336930 DOI: 10.3233/jad-220578] [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: 11/05/2022]
Abstract
BACKGROUND The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings. OBJECTIVE We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care. METHODS During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer's dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months). RESULTS Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen's d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033). CONCLUSION A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.
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Affiliation(s)
- Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR-Hospital Essen, Essen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.,Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Michael Belz
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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Strong JV, Plys E, Hartmann CW, Hinrichs KLM, McCullough M. Strategies for Implementing Group Mental Health Interventions in a VA Community Living Center. Clin Gerontol 2022; 45:1201-1213. [PMID: 32314668 DOI: 10.1080/07317115.2020.1756550] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Group mental health interventions are difficult to implement into rehabilitation facilities, but no one has studied the specific barriers. This mixed-methods project systematically examined the implementation of a mental health (MH) group intervention in a VA community living center (CLC) for residents on subacute rehabilitation units, using the Promoting Action on Research Implementation in Health Services (PARIHS) implementation framework.Methods: We implemented a group MH intervention, tracking team referrals, attendance rates, and reasons for declining to participate. We conducted qualitative interviews with attendees.Results: Individual barriers to attendance included acute illness (n = 67, 20%), attitudes toward MH (n = 50; 15%), and perceived busyness (n = 19; 6%). Facility barriers included competing appointments (n = 69; 21%). Interviews demonstrated challenges to implementation, including stigma toward mental health (Theme: Challenges and Supports to Implementation). Attendees found the group relatable, and noted that both positive and negative group dynamics contributed to their experience (Themes: Content Relevance and Group Dynamics).Conclusions: The results provide insight into implementing a group MH treatment into the CLC setting, with implications for the MH care of older adults residing in CLCs.Clinical Implications: 1) Group leaders should consider matching attendees for ability levels (physical or cognitive). 2) At the facility level, leaders may take steps to address stigma toward MH by adopting approaches (e.g., music) or framing MH issues (e.g., use of language) in a way that is approachable. 3) Modifiable barriers at the individual and facility level could be addressed to encourage ease of implementation.
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Affiliation(s)
- Jessica V Strong
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,New England GRECC, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan Plys
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Internal Medicine, University of Colorado Denver- Anschutz Medical Campus
| | - Christine W Hartmann
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kate L M Hinrichs
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McCullough
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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11
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Brimelow R, Beattie E, Byrne G, Dissanayaka N. Frequency of changed behaviours in residential aged care and common mitigation strategies - A retrospective review of behavioural report logs. J Clin Nurs 2022. [PMID: 36168200 DOI: 10.1111/jocn.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap. OBJECTIVE To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours. METHODS Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting. RESULTS There were 395 behaviours recorded in a two-month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24-h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness. CONCLUSION This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively. RELEVANCE TO CLINICAL PRACTICE This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short-term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met. PATIENT AND PUBLIC CONTRIBUTION A RACF participated in project design and review.
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Affiliation(s)
- Rachel Brimelow
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Gerard Byrne
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,Royal Brisbane Clinical Unit, Royal Brisbane & Woman's Hospital, Queensland, Australia
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,The University of Queensland School of Psychology, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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12
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Amor Gaviola M, Searles A, Dilworth S, Higgins I, Holliday E, Jill Inder K. Estimating the cost of an individualised music intervention for aged care residents with dementia. Nurs Older People 2022; 34:13-19. [PMID: 35673896 DOI: 10.7748/nop.2022.e1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people. AIM To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia. METHOD A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales. The analysis took into consideration the operating, training and delivery costs, as well as the costs of purchasing the music equipment and downloads. RESULTS The cost of delivering the individualised music intervention was found to be AU$6,623.76 per year - or AU$3.98 per resident per week, at 2017 values. At 2022 values, this equates to an annual cost of AU$7,130.07 (£4,031.85) for 32 residents and a weekly cost of AU$4.28 (£2.42) per resident per week. CONCLUSION The cost of implementing the individualised music intervention was relatively low compared with the overall cost of residential aged care for older people with dementia.
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Affiliation(s)
- Minah Amor Gaviola
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sophie Dilworth
- College of Health, Medicine and Wellbeing, The University of Newcastle, Wallsend, Australia
| | - Isabel Higgins
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia
| | | | - Kerry Jill Inder
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia
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13
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Mack M, Stojan R, Bock O, Voelcker-Rehage C. Cognitive-motor multitasking in older adults: a randomized controlled study on the effects of individual differences on training success. BMC Geriatr 2022; 22:581. [PMID: 35840893 PMCID: PMC9284902 DOI: 10.1186/s12877-022-03201-5] [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] [Received: 01/11/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness. Methods We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness, and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness. Discussion We expect that multitasking performance in participants with lower initial competence in either one or both domains (cognitive functioning, motor fitness) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking. Trial registration DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do
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Affiliation(s)
- Melanie Mack
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Wilhelm-Schickard-Straße 8, 48149, Muenster, Germany
| | - Robert Stojan
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Wilhelm-Schickard-Straße 8, 48149, Muenster, Germany.,Institute of Human Movement Science and Health, Chemnitz University of Technology, Thueringer Weg 11, 09126, Chemnitz, Germany
| | - Otmar Bock
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Thueringer Weg 11, 09126, Chemnitz, Germany.,Institute of Exercise Training and Sport Informatics, German Sport University, Am Sportpark Muengersdorf 6, 50927, Cologne, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Wilhelm-Schickard-Straße 8, 48149, Muenster, Germany. .,Institute of Human Movement Science and Health, Chemnitz University of Technology, Thueringer Weg 11, 09126, Chemnitz, Germany.
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14
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Poon E. A Systematic Review and Meta-Analysis of Dyadic Psychological Interventions for BPSD, Quality of Life and/or Caregiver Burden in Dementia or MCI. Clin Gerontol 2022; 45:777-797. [PMID: 31752633 DOI: 10.1080/07317115.2019.1694117] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This systematic review and meta-analysis assesses the effectiveness of psychological interventions that involve people with dementia or mild cognitive impairment (MCI) and their informal caregivers, and target improvements in the management of the behavioral and psychological symptoms of dementia (BPSD); quality of life; and/or burden reduction for people with either dementia or MCI and their informal caregivers.Methods: Studies were identified through database searches (Cochrane Library, CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO) and clinical trials registers (ClinicalTrials.gov and http://apps.who.int/trialsearch/). Data were pooled for meta-analysis.Results: Database and reference list searches identified 1,878 references, of which fourteen studies were included. Positive effects were found on the anxiety symptoms of people with dementia on the RAID scale; on the quality of life of people with dementia on the self-rated QoL-AD scale; and on informal caregiver burden on the Zarit Burden Interview.Conclusions: Psychological interventions involving whole dyads have some promise for both people with dementia and informal caregivers, but are still far from uniformly effective across BPSD, quality of life, and caregiver burden. Further research directions are discussed.Clinical Implications: The results suggest that clinicians should routinely involve both halves of the dyad when delivering psychological interventions targeting anxiety or quality of life for people with dementia, or burden for informal caregivers.
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Affiliation(s)
- Emma Poon
- Clinical Education Development and Research (CEDAR) Group, Psychology: College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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15
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McDermid J, Da Silva MV, Williams G, Khan Z, Corbett A, Ballard C. A Randomized Controlled Trial of a Digital Adaptation of the WHELD Person-Centered Nursing Home Training Program. J Am Med Dir Assoc 2022; 23:1166-1170. [DOI: 10.1016/j.jamda.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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16
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Zarei S, Colman S, Rostas A, Burhan AM, Chu L, Davies SJ, Derkach P, Elmi S, Hussain M, Gerretsen P, Graff-Guerrero A, Ismail Z, Kim D, Krisman L, Moghabghab R, Mulsant BH, Nair V, Pollock BG, Rej S, Simmons J, Van Bussel L, Rajji TK, Kumar S. The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial. J Alzheimers Dis 2022; 86:827-840. [PMID: 35147535 DOI: 10.3233/jad-215261] [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: 11/15/2022]
Abstract
BACKGROUND Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings. OBJECTIVE To describe the rationale and design of structured behavioral interventions in the StaN study. METHODS Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility. RESULTS The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and to integrate them with pharmacotherapy. CONCLUSION Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.
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Affiliation(s)
- Shadi Zarei
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Colman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Aviva Rostas
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Burhan
- Department of Psychiatry, Western University, London, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
| | - Li Chu
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Simon Jc Davies
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Derkach
- Ukrainian Canadian Care Centre, Toronto, Ontario, Canada
| | - Sarah Elmi
- Ontario Shores Centre for Mental Health Sciences, Toronto, Ontario, Canada
| | - Maria Hussain
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Donna Kim
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Linda Krisman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rola Moghabghab
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vasavan Nair
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Bruce G Pollock
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jyll Simmons
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa Van Bussel
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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17
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Behrendt D, Schirmer M, Wendschuh V, Sumngern C. Integrating social support into interventions among the elderly in nursing homes: a scoping review protocol. BMJ Open 2022; 12:e055692. [PMID: 35105592 PMCID: PMC8808442 DOI: 10.1136/bmjopen-2021-055692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The instituted elderly in nursing home need professional support targeting to maintain their daily activities and quality of life. Social support affects the health of elderly through its influence as a stress buffering or main effects on emotions, cognitions and behaviour that improve health outcomes. Understanding and identifying available interventions for the elderly in the literature related to integrating social support into interventions will be benefits to guide future practice, research and policy. METHODS AND ANALYSIS A scoping review designed by Arksey and O'Malley has been used in this study. Key words, inclusion and exclusion criteria were elaborated to search the primary articles that published in English from 2010 to 2021 mainly from PubMed, Science Direct, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases targeting to reach the selected articles and combined the results with reference lists and hand searches. The Mixed Methods Appraisal Tool version 2018 will be used to identify the quality of the studies. Authors developed the Data Extraction Form for data extraction and analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews tool will be employed for reporting guideline. ETHICS AND DISSEMINATION Authors forecast to obtain relevant studies reporting integrating specific dimensions of supportive functions into interventions for the elderly in nursing home. This finding will benefit in quality improvement of supportive interventions in nursing home and to continue the further experimental study. The findings will be disseminated via electronic and hard copy through peer-reviewed publications, conference presentations and internal organisation meeting.
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Affiliation(s)
- Daniel Behrendt
- Nursing Department, Städtisches Klinikum Dessau, Dessau, Germany
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18
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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19
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Lu S, Zhang AY, Liu T, Choy JCP, Ma MSL, Wong G, Lum T. Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis. BMJ Open 2021; 11:e048917. [PMID: 34845067 PMCID: PMC8634002 DOI: 10.1136/bmjopen-2021-048917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement. DESIGN Systematic review with meta-analysis. DATA SOURCES ProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020. ELIGIBILITY CRITERIA We included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups. DATA EXTRACTION AND SYNTHESIS Two researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest. RESULTS Thirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=-0.52, p<0.05), followed by medium (n=6; SMD=-0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=-0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation. CONCLUSIONS To develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances. PROSPERO REGISTRATION NUMBER CRD42020168556.
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Affiliation(s)
- Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, Hong Kong, Hong Kong
| | - Anna Y Zhang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Jacky C P Choy
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Maggie S L Ma
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Gloria Wong
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, Hong Kong
| | - Terry Lum
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
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20
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Plante-Lepage R, Voyer P, Carmichael PH, Kröger E. A nursing mentoring programme on non-pharmacological interventions against BPSD: Effectiveness and use of antipsychotics-A retrospective, before-after study. Nurs Open 2021; 9:181-188. [PMID: 34612586 PMCID: PMC8685876 DOI: 10.1002/nop2.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022] Open
Abstract
Behavioural and psychological symptoms of dementia (BPSD) are common and have significant implications for patients and caregivers. Non‐pharmacological interventions (NPI) have shown to be effective in the management of BPSD. However, the use of antipsychotics to treat BPSD remains ubiquitous. This retrospective, before–after study aimed to examine whether a nurse mentoring programme promoting NPI for BPSD management had a significant association with the use of antipsychotics in older adults with major neurocognitive disorders residing in different settings. Results obtained from the medical files of 134 older adults having benefitted from the mentoring programme demonstrate that this intervention significantly reduced BPSD. The effect on antipsychotics use was modest: a 10% reduction in the use of antipsychotics has been observed among patients for which the NPI were effective. However, the use of antipsychotics remained widespread despite the nursing recommendations of the mentoring team of the Center of Excellence on Aging in Quebec (CEVQ).
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Affiliation(s)
| | - Philippe Voyer
- Faculté des Sciences Infirmières, Université Laval, Laval, QC, Canada.,Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Edeltraut Kröger
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada.,Faculté de Pharmacie, Université Laval, Québec, QC, Canada
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21
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Luscombe N, Morgan-Trimmer S, Savage S, Allan L. Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review. Syst Rev 2021; 10:179. [PMID: 34148547 PMCID: PMC8214930 DOI: 10.1186/s13643-021-01715-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies. METHOD A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation. DISCUSSION Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.
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Affiliation(s)
- Nicholas Luscombe
- The Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter Medical School, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Sarah Morgan-Trimmer
- Institute of Health Research, College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sharon Savage
- School of Psychology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Louise Allan
- The Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter Medical School, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Habiger TF, Achterberg WP, Flo-Groeneboom E, Mannseth J, Husebo BS. Managing Pain and Psychosis Symptoms in Nursing Home Patients: Results from a Cluster-Randomized Controlled Trial (COSMOS). J Am Med Dir Assoc 2021; 22:1692-1698. [PMID: 34087225 DOI: 10.1016/j.jamda.2021.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In nursing homes (NHs), 30% to 60% of patients experience daily pain and >80% have dementia. This can lead to neuropsychiatric symptoms, including psychosis symptoms such as delusion. We investigated if there was a relationship between pain and psychosis symptoms over time. We also aimed to investigate the effect of a multicomponent intervention (COSMOS) on pain, psychosis symptoms, and analgesic prescription. DESIGN COSMOS is a cluster-randomized, single blinded, controlled trial. Each NH unit was defined as a cluster and randomized to either the COSMOS intervention or care as usual. The COSMOS intervention is a multicomponent intervention, consisting of staff training in communication, pain treatment, medication review, organization of activities, and safety. The intervention lasted for 4 months with a follow-up at month 9. SETTING AND PARTICIPANTS Sixty-seven units from 33 Norwegian NHs in 8 municipalities. The study included 723 patients aged ≥65 years, residing at the NH ≥2 weeks before inclusion. Patients with a life expectancy <6 months were excluded. MEASURES Pain was measured using the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale. Psychosis symptoms were measured using the Neuropsychiatric Inventory-NH version. Measurements were performed at baseline, and months 4 and 9. RESULTS Multilevel Mixed-Effect statistical analysis found that psychosis symptoms as a group (odds ratio [OR] 2.03, P = .009), and delusion (OR 2.12, P = .007) were associated with pain over time. No significant intervention effect on psychosis symptoms was observed. Compared with the control group, people with dementia in the intervention group experienced less musculoskeletal pain (β: -0.47, P = .047). Analgesic prescription was not affected by the intervention. CONCLUSION AND IMPLICATIONS Pain is associated with psychosis symptoms, and pain assessment should be done when making treatment decisions on psychosis symptoms in NH patients. The COSMOS intervention improved musculoskeletal pain in people with dementia, but not psychosis symptoms, and there is need for further studies on treatment of psychosis symptoms in NH patients.
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Affiliation(s)
- Torstein F Habiger
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Wilco P Achterberg
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, Leiden University Medical Centre, Netherlands
| | - Elisabeth Flo-Groeneboom
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Janne Mannseth
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Municipality of Bergen, Bergen, Norway
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23
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Wang G, Albayrak A, Kortuem G, van der Cammen TJ. A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study. JMIR Form Res 2021; 5:e25705. [PMID: 34047703 PMCID: PMC8196358 DOI: 10.2196/25705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/10/2021] [Accepted: 04/04/2021] [Indexed: 01/20/2023] Open
Abstract
Background Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into “client level,” “ward level,” and “team level.” The corresponding actions taken by the care team were classified into “investigation” and “implementation.” User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context.
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Affiliation(s)
- Gubing Wang
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Armagan Albayrak
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Gerd Kortuem
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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24
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Røsvik J, Mjørud M. 'We must have a new VIPS meeting soon!' Barriers and facilitators for implementing the VIPS practice model in primary health care. DEMENTIA 2021; 20:2649-2667. [PMID: 33870756 PMCID: PMC8670746 DOI: 10.1177/14713012211007409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Person-centred care is a philosophy of care rather than a method ready for implementation and utilisation in daily work. Internationally, few methods for the implementation of person-centred care have been widely adopted in clinical and care practice. In Norway, the VIPS practice model is a commonly used model for person-centred care implementation. Method Qualitative manifest content analysis was used. Managers and leaders in the municipalities, care institutions and domestic nursing care services were eligible for inclusion if their workplace had implemented the VIPS practice model and conducted the consensus meeting regularly for a minimum of 12 months. Seventeen respondents were included. Individual interviews were conducted either via FaceTime, Skype or telephone. Results Three global categories emerged describing the implementation process: (1) factors that impact the decision made at municipal level to implement person-centred care; (2) requirements for a good start at unit level and (3) factors that help to support the new routines in the unit. The categories were entwined; the results of one affected the results of the others. The informants from both domestic nursing care and institutions described the same factors as important for the implementation of the VIPS practice model. Conclusion To implement person-centred care by use of the VIPS practice model, the frontline staff need sufficient information about the rationale for implementing the model. The management’s vision and ethos of person-centred care must be followed by time set aside for staff training and regularly scheduled VIPS practice model consensus meetings. Head nurses are key to getting the new routines established and maintained and should be supported by the management.
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Affiliation(s)
- Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, 60512Vestfold Hospital Trust, Tonsberg, Norway, Department of Geriatric Medicine, 155272Oslo University Hospital, Oslo, Norway
| | - Marit Mjørud
- Norwegian National Advisory Unit on Ageing and Health, 60512Vestfold Hospital Trust, Tonsberg, Norway, Department of Geriatric Medicine, 155272Oslo University Hospital, Oslo, Norway
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25
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Karssemeijer EGA, de Klijn FH, Bossers WJR, Olde Rikkert MGM, van Heuvelen MJG. Ranking Barriers, Motivators, and Facilitators to Promote Physical Activity Participation of Persons With Dementia: An Explorative Study. J Geriatr Phys Ther 2021; 43:71-81. [PMID: 30095552 DOI: 10.1519/jpt.0000000000000210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Community-dwelling persons with dementia are inactive most of the day. The purpose of this study was to rank the barriers, motivators, and facilitators that hamper or promote physical activity (PA) participation for persons with dementia. This could provide knowledge that can be used to design effective interventions to promote PA participation for persons with dementia. METHODS Twenty community-dwelling persons with dementia, mean (SD) age = 79 (5.4) years, 25% female, mean (SD) Mini-Mental Status Examination score = 23 (3.5); their informal caregivers, N = 20, mean (SD) age = 70 (11.5) years, 85% female; and an expert group of physiotherapists, N = 15, mean (SD) age = 41 (12.4) years, 73% female, were asked to rank preselected barriers, motivators, and facilitators of PA participation for persons with dementia. These statements were categorized at the intrapersonal, interpersonal, and community levels. RESULTS AND DISCUSSION Persons with dementia and their informal caregivers selected only motivators and facilitators as being important for PA participation, with the motivator "beneficial health effects" considered the most important. The experts had a different perspective on PA participation; half of their ranked top 10 most important factors were barriers to PA participation for persons with dementia. This could be explained by the more critical role of a therapist, focusing on symptom control and treatment of disability; in this case, the elimination of barriers to maintain PA participation in their patients. Furthermore, all groups prioritized statements at the intrapersonal level. CONCLUSIONS The results of this study suggest a difference in perspective between the more optimistic view of persons with dementia and their informal caregivers and the more critical view of physiotherapy experts regarding the most important factors that influence PA participation. In addition, there was a strong focus on the individual characteristics that influence PA behavior that warrant personalized interventions to promote PA in persons with dementia.
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Affiliation(s)
- Esther G A Karssemeijer
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Fleur H de Klijn
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Willem J R Bossers
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marieke J G van Heuvelen
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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26
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Zubatsky M. Editorial: Virtual Groups to Address the Health of Homebound Adults During COVID-19: A Biopsychosocial Framework. J Nutr Health Aging 2021; 25:281-283. [PMID: 33575716 PMCID: PMC7794637 DOI: 10.1007/s12603-021-1584-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Affiliation(s)
- M Zubatsky
- Max Zubatsky, PhD, LMFT, Associate Professor, Program Director, Medical Family Therapy Program, School of Medicine, Saint Louis University, 3700 Lindell Boulevard, St. Louis, MO 63108, USA,
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27
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Miller HV, Ward K, Zimmerman S. Implementation effectiveness of psychosocial and environmental care practices in assisted living. Geriatr Nurs 2020; 42:295-302. [PMID: 33041084 DOI: 10.1016/j.gerinurse.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 02/08/2023]
Abstract
Psychosocial and environmental care practices are recommended to address behavioral expressions in persons with dementia, but their use has been limited partly because guidance is lacking regarding implementation. In response, we developed a simple "how-to" guide of evidence-based protocols for aromatherapy, natural light, familiar music, and robotic pets; trained staff in four assisted living (AL) communities to use the practices; provided materials; met with them regularly; and evaluated fidelity, facilitators and barriers to implementation, and staff knowledge, attitudes, and self-efficacy. After two months, staff reported more familiarity, confidence, and use; barriers such as difficulty locating supplies and task-focused staff with limited time; and staff "champion" facilitators. Notable differences were identified across communities, suggesting that just as care to individuals must be person-centered, practices embraced by communities must fit that community. Through strategic adoption, successful implementation is possible. The "how-to" guide is appropriate for AL, nursing homes, and persons' own homes.
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Affiliation(s)
- Hayley V Miller
- University of South Carolina Greenville School of Medicine, 607 Grove Rd., Greenville, SC, 29601, USA.
| | - Kimberly Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 M.L.K. Jr. Blvd., Chapel Hill, NC, 27516, USA.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 M.L.K. Jr. Blvd., Chapel Hill, NC, 27516, USA; School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St #3550, Chapel Hill, NC, 27516, USA.
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28
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Arai A, Khaltar A, Ozaki T, Katsumata Y. Influence of social interaction on behavioral and psychological symptoms of dementia over 1 year among long-term care facility residents. Geriatr Nurs 2020; 42:509-516. [PMID: 33039200 DOI: 10.1016/j.gerinurse.2020.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/29/2023]
Abstract
This study investigated the effect of social interaction including activity participation, relationships with residents, and communication with family/relatives and friends at baseline on the behavioral and psychological symptoms of dementia (BPSD) among long-term care facility residents over 1 year. This follow-up study was conducted among older adult residents with dementia or similar symptoms. Generalized linear mixed effect models were used to examine associations between social interaction and changes in the number and severity of BPSD symptoms over 1 year. Among 220 participants, rare participation in activities and poor relationships with other residents at baseline were associated with greater baseline BPSD. Less communication with family/relatives at baseline was associated with increased severity of BPSD over 1 year. Active interaction with family and relatives may prevent progression of BPSD severity among long-term care facility residents for at least 1 year.
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Affiliation(s)
- Asuna Arai
- Department of Health Care Policy, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Amartuvshin Khaltar
- Department of Health Care Policy, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan; General Hospital for State Special Servants of Mongolia, Ulaanbaatar, Mongolia.
| | | | - Yuriko Katsumata
- College of Public Health, University of Kentucky, Lexington, USA.
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29
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Ballard C, Orrell M, Moniz-Cook E, Woods R, Whitaker R, Corbett A, Aarsland D, Murray J, Lawrence V, Testad I, Knapp M, Romeo R, Zala D, Stafford J, Hoare Z, Garrod L, Sun Y, McLaughlin E, Woodward-Carlton B, Williams G, Fossey J. Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.
Objective
The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.
Design
This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.
Setting
This programme was carried out in care homes in the UK.
Participants
Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.
Results
Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities.
Limitations
Residents with dementia were not involved in the qualitative work.
Conclusions
The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual.
Future work
It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation.
Trial registration
Current Controlled Trials ISRCTN40313497 and ISRCTN62237498.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, Centre of Psychological Care and Ageing, University of Hull, Hull, UK
| | - Robert Woods
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- Centre for Age-related Medicine, Stavanger University Hospital, University of Stavanger, Stavanger, Norway
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Renee Romeo
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darshan Zala
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health & Social Care, Institute of Medical & Social Care Research, Bangor University, Bangor, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Yongzhong Sun
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | | | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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Inamura K, Shinagawa S, Tsuneizumi Y, Nagata T, Tagai K, Nukariya K, Shigeta M. Sex differences in the severity of neuropsychiatric symptoms and their relationship with clinico-demographic and psychosocial factors in patients with amnestic mild cognitive impairment and mild Alzheimer's disease. Aging Ment Health 2020; 24:431-438. [PMID: 30588827 DOI: 10.1080/13607863.2018.1539834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: We examined differences in the severity of neuropsychiatric symptoms (NPS) according to sex and identified NPS-related clinico-demographic and psychosocial factors among community-living patients with amnestic-mild cognitive impairment (a-MCI) or mild Alzheimer's disease (AD).Method: Overall, 111 patients (44 males, 67 females) with mild a-MCI (n = 64) or mild AD (n = 47) were included. We divided the patients according to sex and compared their clinico-demographic and psychosocial factors, explored the severity of NPS using the subscales from the Neuropsychiatric Inventory-Questionnaire (NPI-Q), and further identified variables related to NPS.Results: Significant differences in several clinico-demographic and psychosocial characteristics were observed between the sexes. The severity of delusions was higher among females (mean, 0.48; SD, 1.60) than males (mean, 0.23; SD, 1.07; p = .02), while the severity of irritability was higher among males (mean, 0.97; SD, 1.92) than females (mean, 0.49; SD, 1.40; p = .03). The severity of delusions among females was related to the duration of cognitive decline (B = 0.37, p = .03), while the severity of irritability among males was related to general cognition (B = -0.40, p = .003).Conclusion: The severity of NPS among patients with a-MCI or mild AD differed according to sex. We identified NPS-related clinico-demographic factors among these patients. Sex differences should be considered when determining the need for NPS interventions.
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Affiliation(s)
- Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Yuri Tsuneizumi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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Félix SB, Ribeiro O, Maia H. Personalized Cognitive Stimulation through Personhood: A Case Report on Dementia Diagnosis Acceptance and Therapeutic Engagement. Clin Gerontol 2020; 43:233-239. [PMID: 31394982 DOI: 10.1080/07317115.2019.1648349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Dementia related cognitive impairment, as forgetting recent memories, brings several emotional challenges to patients and their families. This paper reports a case of a non-collaborative high-education level patient. who recurrently refused a set of conventional cognitive stimulation exercises, as he also was in refusal of his cognitive impairment. The aim of this report is to show the benefits of a personalized cognitive stimulation (PCS) program.Methods: A24-sessions PCS program was conceived within a person-centered care approach and in active co-creation between the therapist and the patient.Results: The results evidence the patient's increasing therapeutic engagement in the proposed activities, along with mild cognitive improvement. This procedure also promoted a diagnosis acceptance and the patient's mood stabilization. Two illustrative materials used in this tailored intervention are available as supplemental material.Conclusions: Cognitive stimulating programs benefit from tailoring and personalization. Personalization indeed helped the patient feeling engaged and increased his participation in the activities. Furthermore, his mood stabilized, and the patient accepted his cognitive impairments. Thus, PCS is a way of reaching person-centered care.Clinical implications: PCS may be used to improve patient's engagement in the stimulating activities. Also, PCS promoted the dementia diagnosis acceptance..
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Affiliation(s)
| | - Oscar Ribeiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
| | - Humbertina Maia
- Psychogeriatrics Service, Hospital de Magalhães Lemos, Porto, Portugal
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Peisah C, Jessop T, Breen J. A missed opportunity to improve practice around the use of restraints and consent in residential aged care: Limitations of the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019. Australas J Ageing 2019; 39:292-296. [PMID: 31808267 PMCID: PMC7687132 DOI: 10.1111/ajag.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022]
Abstract
Objective To explore the meaning and potential role of new Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019, (Principles) which amend Quality of Care Principles 2014 in improving practice around physical and chemical restraint. Methods We examined both Principles and accompanying Explanatory Statement in light of best practices around consent and use of chemical and physical restraint. Results The chemical restraint definition is problematic by exclusion of medications for treating mental disorders, physical illness or physical conditions, which is not considered restraint. Inexplicably, physical restraint requirements are more rigorous than chemical restraint requirements, where assessment is optional, and consent sometimes obtained, after use, and from the person's “representative,” rather than the person first, followed by their proxy decision‐maker. Conclusions Although a start in promoting best practice around physical restraint, the Principles do not address the status quo of poor practice around chemical restraint and may instead codify it.
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Affiliation(s)
- Carmelle Peisah
- Capacity Australia, Sydney, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Discipline of Psychiatry, Sydney University Medical School, Sydney, New South Wales, Australia
| | - Tiffany Jessop
- Capacity Australia, Sydney, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, UNSW, Sydney, New South Wales, Australia
| | - Juanita Breen
- Capacity Australia, Sydney, New South Wales, Australia.,Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Schneider CE, Bristol AA, Brody AA. A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-based Settings. CURRENT GERIATRICS REPORTS 2019; 8:291-301. [PMID: 33552845 DOI: 10.1007/s13670-019-00307-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. Purpose of Review The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. Recent Findings One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.
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Affiliation(s)
- Catherine E Schneider
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010
| | - Alycia A Bristol
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7170
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7341
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Nordhausen T, Langner H, Fleischer S, Meyer G, Berg A. [Improving psychosocial health of nursing home residents: a systematic review of interventions for prevention and health promotion]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:7-19. [PMID: 31727536 DOI: 10.1016/j.zefq.2019.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Long-term care insurance funds have been mandated by the German Prevention Act to support long-term care facilities in the implementation of health-promoting structures. One area of action is the promotion of the nursing home residents' psychosocial health. The objective of this systematic review was to describe and analyze interventions and intervention components related to the psychosocial health of nursing home residents. METHODS First, we conducted a search for systematic reviews and meta-analyses in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo, and hand-searched additional sources. Second, references of all relevant randomized controlled trials (n=86) were extracted from the identified systematic reviews (n=27). The original articles of the included primary studies were then analyzed using criteria for the evaluation of complex interventions. The GRADE approach was used to assess the quality of the evidence. RESULTS Seventeen interventions for promoting the psychosocial health of nursing home residents were identified. The majority of the study participants were nursing home residents with dementia. Since the underlying evidence was predominantly very low, it was not possible to draw clear conclusions concerning the efficacy of the interventions for psychosocial health outcomes. The best indications of positive effects were found for reminiscence, mealtime interventions, music therapy, and special care staff training. CONCLUSION The diversity and heterogeneity of the interventions made both classification and consistent judgments of the quality of the evidence difficult. From the perspective of promoting the psychosocial health of nursing home residents, the identified interventions should only be considered as suggestions or proposals for prevention and health promotion measures, and future studies should evaluate their implementation.
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Affiliation(s)
- Thomas Nordhausen
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, 06112 Halle, Saale, Deutschland.
| | - Henriette Langner
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, 06112 Halle, Saale, Deutschland.
| | - Steffen Fleischer
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, 06112 Halle, Saale, Deutschland.
| | - Gabriele Meyer
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, 06112 Halle, Saale, Deutschland.
| | - Almuth Berg
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, 06112 Halle, Saale, Deutschland.
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Testad I, Kajander M, Froiland CT, Corbett A, Gjestsen MT, Anderson JG. Nutritional Interventions for Persons With Early-Stage Dementia or Alzheimer's Disease: An Integrative Review. Res Gerontol Nurs 2019; 12:259-268. [PMID: 31545384 DOI: 10.3928/19404921-20190813-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/07/2019] [Indexed: 11/20/2022]
Abstract
Persons with Alzheimer's disease and related dementias (ADRD) are at particular risk of malnutrition and weight loss. Clinical research concerning the role and impact of nutritional intervention in early-stage ADRD, specifically on cognition and key symptoms such as behavior, is less straightforward. Thus, an integrative review was conducted to examine the literature pertaining to nutritional interventions for persons with ADRD and to make recommendations for priority areas for future research and practice. Findings from the studies reviewed highlight multiple potential opportunities for improving nutritional status and support for persons with ADRD living in the community. Despite the small amount of evidence, the six studies identified in the current review suggest a broad benefit may be conferred through educational approaches and nutritional supplementation. [Res Gerontol Nurs. 2019; 12(5):259-268.].
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Dröes RM, van Rijn A, Rus E, Dacier S, Meiland F. Utilization, effect, and benefit of the individualized Meeting Centers Support Program for people with dementia and caregivers. Clin Interv Aging 2019; 14:1527-1553. [PMID: 31692559 PMCID: PMC6717152 DOI: 10.2147/cia.s212852] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE There are few interventions on an individual basis to support community-dwelling people with dementia to continue to fulfill their potential in society and to support their informal caregivers via e-Health. This study explored the effectiveness of the individualized Meeting Centers Support Program (iMCSP) consisting of DemenTalent (people with dementia work as volunteers in a society based on their talents), Dementelcoach (telephone coaching), and STAR e-Learning for caregivers, compared to regular MCSP and No day care support. METHOD An explorative randomized controlled trial with pre/post measurements (M0-M6) and two groups (iMCSP and regular MCSP). In addition, a comparison was made between iMCSP and a reference No day care control group. Standardized questionnaires were administered on self-esteem, neuropsychiatric symptoms, experienced autonomy and quality of life of the person with dementia, and on caregiver's sense of competence, quality of life, and happiness. RESULTS The iMCSP interventions resulted in a broader group of participants utilizing the Meeting Centers. Compared to regular MCSP, DemenTalent had a moderate positive effect on neuropsychiatric symptoms, which also proved less severe. Positive affect of participants improved within the DemenTalent and regular MCSP group after six months. Caregivers of DemenTalent participants experienced less emotional impact of neuropsychiatric symptoms. No differences were found in experienced burden, sense of competence, or quality of life in caregivers using iMCSP or regular MCSP. Compared to those receiving No day care support, caregivers of DemenTalent participants and caregivers using Dementelcoach or STAR e-Learning proved happier. Post-hoc analyses, accounting for potential between-group differences in outcome measures at baseline, generally showed results in the same direction. People with dementia and caregivers highly appreciated iMCSP and regular MCSP. CONCLUSION iMCSP can be effectively applied as alternative or additional support via regular Meeting Centers for people with dementia and caregivers who prefer individualized activities/support. DemenTalent decreased the severity of neuropsychiatric symptoms of people with dementia and emotional burden of caregivers. All iMCSP interventions tended to result in caregivers being happier compared to those receiving no support. Larger-scale studies are needed to investigate the effect of iMCSP on other domains of quality of life of participants.
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Affiliation(s)
- Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, Regional Mental Health Organization Ggzingeest, Amsterdam, The Netherlands
| | - Annelies van Rijn
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Eline Rus
- Department of Clinical Pyschology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Seghoslène Dacier
- Department of Neuropsychology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Franka Meiland
- Department of Psychiatry, Amsterdam University Medical Centers, Location Vumc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Neuropsychology, Faculty of Behavior and Movement Sciences, VU University, Amsterdam, The Netherlands
- Gerion, Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Centers, Location Vumc, Amsterdam, The Netherlands
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Lichtwarck B, Myhre J, Goyal AR, Rokstad AMM, Selbaek G, Kirkevold Ø, Bergh S. Experiences of nursing home staff using the targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms (TIME) - a qualitative study. Aging Ment Health 2019; 23:966-975. [PMID: 29669442 DOI: 10.1080/13607863.2018.1464116] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.
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Affiliation(s)
- Bjørn Lichtwarck
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway.,b Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Janne Myhre
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway
| | - Alka R Goyal
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway.,b Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway.,c Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Anne Marie Mork Rokstad
- c Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway.,d Faculty of Health Sciences and Social Care , Molde University College , Molde , Norway
| | - Geir Selbaek
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway.,b Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway.,c Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Øyvind Kirkevold
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway.,c Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway.,e Department of Health, Care and Nursing, Faculty of Medicine NTNU , Norwegian University of Science and Technology , Gjøvik , Norway
| | - Sverre Bergh
- a Centre For Old Age Psychiatric Research , Innlandet Hospital Trust , Ottestad , Norway.,c Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
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Dichter MN, Reuther S, Trutschel D, Köpke S, Halek M. Organizational interventions for promoting person-centred care for people with dementia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Martin N Dichter
- German Center for Neurodegenerative Diseases (DZNE); Witten North Rhine Westphalia Germany 58453
- Witten/Herdecke University; School of Nursing Science; Stockumer Straße 12 Witten North Rhine Westphalia Germany 58453
| | - Sven Reuther
- German Center for Neurodegenerative Diseases (DZNE); Witten North Rhine Westphalia Germany 58453
- Witten/Herdecke University; School of Nursing Science; Stockumer Straße 12 Witten North Rhine Westphalia Germany 58453
| | - Diana Trutschel
- German Center for Neurodegenerative Diseases (DZNE); Witten North Rhine Westphalia Germany 58453
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany D-23538
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE); Witten North Rhine Westphalia Germany 58453
- Witten/Herdecke University; School of Nursing Science; Stockumer Straße 12 Witten North Rhine Westphalia Germany 58453
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McDermott O, Charlesworth G, Hogervorst E, Stoner C, Moniz-Cook E, Spector A, Csipke E, Orrell M. Psychosocial interventions for people with dementia: a synthesis of systematic reviews. Aging Ment Health 2019; 23:393-403. [PMID: 29338323 DOI: 10.1080/13607863.2017.1423031] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works. METHODS A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted. RESULTS Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews. CONCLUSION There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.
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Affiliation(s)
- Orii McDermott
- a Division of Psychiatry and Applied Psychology , University of Nottingham , Nottingham , United Kingdom
| | - Georgina Charlesworth
- b Division of Psychology and Language Sciences , University College London , London , United Kingdom
| | - Eef Hogervorst
- c School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , United Kingdom
| | - Charlotte Stoner
- d Department of Neurodegenerative Disease , Institute of Neurology, University College London , London , United Kingdom
| | - Esme Moniz-Cook
- e Faculty of Health Sciences , University of Hull , Hull , United Kingdom
| | - Aimee Spector
- b Division of Psychology and Language Sciences , University College London , London , United Kingdom
| | - Emese Csipke
- f Division of Psychiatry , University College London , London , United Kingdom
| | - Martin Orrell
- a Division of Psychiatry and Applied Psychology , University of Nottingham , Nottingham , United Kingdom
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Husebø BS, Ballard C, Aarsland D, Selbaek G, Slettebo DD, Gulla C, Aasmul I, Habiger T, Elvegaard T, Testad I, Flo E. The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS). J Am Med Dir Assoc 2019; 20:330-339. [DOI: 10.1016/j.jamda.2018.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Wharton T, Paulson D, Burcher K, Lesch H. Delirium and Antipsychotic Medications at Hospital Intake: Screening to Decrease Likelihood of Aggression in Inpatient Settings Among Unknown Patients With Dementia. Am J Alzheimers Dis Other Demen 2019; 34:118-123. [PMID: 30384769 PMCID: PMC10852489 DOI: 10.1177/1533317518809345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For individuals with dementia, disorientation and both external and internal stimuli may trigger behaviors that are difficult to manage or dangerous to health-care providers. Identification of correlational risk factors to aggressive behavior in patients who are unknown to the hospital can allow providers to adapt patient care quickly. Records for patients aged 60+ who spent at least 24 hours at the hospital other than in the psychiatric unit were used (N = 14 080). The first 4000 records and every 10th person who met criteria (N = 5008) were searched for documentation of dementia (n = 505). Logistic regressions and χ2 tests were used to examine relationships between variables. Recognition of delirium (P = .014, Exp(B) = 2.53), coupled with an existing prescription for antipsychotic medication at intake (P < .001, Exp(B) < 4.37), may be a reliable means of screening for risk and intervening at the earliest possible contact, improving quality of care and safety in acute care for individuals with dementia.
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Affiliation(s)
- Tracy Wharton
- School of Social Work & College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Daniel Paulson
- UCF Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Kimberly Burcher
- UCF College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Heather Lesch
- UCF College of Medicine, University of Central Florida, Orlando, FL, USA
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Abstract
Neurodegenerative disorders are progressive, debilitating impairments of neurologic function. Dementia affects cognition and function. Persons with cognitive deficits should undergo a full workup and may be treated with cholinesterase inhibitors and/or memantine. Behavioral and psychological symptoms of dementia may be assessed and treated individually. Parkinson disease is a disorder of movement. Levodopa is the standard treatment of dopamine-related movement symptoms. Associated symptoms should be assessed and treated. Other neurodegenerative syndromes are less common but highly debilitating. Currently, there are no curative or disease-modifying therapies for neurodegenerative disorders. Novel therapies or research are in the pipeline.
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Affiliation(s)
- Abby Luck Parish
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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Management of behavioral and psychological symptoms in people with Alzheimer's disease: an international Delphi consensus. Int Psychogeriatr 2019; 31:83-90. [PMID: 30068400 DOI: 10.1017/s1041610218000534] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
UNLABELLED ABSTRACTObjectives:Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer's disease (AD) overall, as well as specifically for agitation and psychosis. DESIGN International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process. SETTINGS 2015 International Psychogeriatric Association meeting. PARTICIPANTS Expert panel comprised of 11 international members with clinical and research expertise in BPSD management. RESULTS Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin. CONCLUSIONS This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.
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Mendelevich EG. Alzheimer's disease: some pharmacological and non-pharmacological approaches to correcting neuropsychiatric disorders. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-3-129-134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Today, there is no reliable pharmacological correction of dementia, despite its high prevalence worldwide. The clinical presentation of Alzheimer's disease at one or another stage is accompanied by neuropsychiatric disorders (NPDs) in addition to cognitive defect. The intensity and range of NPDs are different. The possibilities of drug therapy for NPDs are demonstrated. The role of akatinol memantine in correcting a number of psychological and behavioral disorders is highlighted. Biological, psychological, social, and environmental factors are identified among those that contribute to or provoke the development of NPDs. Knowledge of the triggers of mental disorders makes it possible to prevent and thereby reduce or eliminate NPDs. Special emphasis is laid on the patient-caregiver relationship. In recent years, non-pharmacological interventions have been increasingly used as priority-line therapy for NPDs. There are data on main methods for non-pharmacological correction and on the efficiency of their application.
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Affiliation(s)
- E. G. Mendelevich
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia 49, Butlerov St., Kazan, Republic of Tatarstan
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Patient- and family-centered care interventions for improving the quality of health care: A review of systematic reviews. Int J Nurs Stud 2018; 87:69-83. [DOI: 10.1016/j.ijnurstu.2018.07.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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Jennings AA, Guerin N, Foley T. Development of a tool for monitoring the prescribing of antipsychotic medications to people with dementia in general practice: a modified eDelphi consensus study. Clin Interv Aging 2018; 13:2107-2117. [PMID: 30425465 PMCID: PMC6203170 DOI: 10.2147/cia.s178216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite their adverse effects, antipsychotics are frequently used to manage behavioral and psychological symptoms of dementia. Regular monitoring of antipsychotic prescribing has been shown to improve the appropriateness of prescribing. However, there is currently no consensus on what the components of such a monitoring tool would be. Aim The aim of this study was to use an expert consensus process to identify the key components of an antipsychotic repeat prescribing tool for use with people with dementia in a general practice setting. Methods A modified eDelphi technique was employed. We invited multidisciplinary experts in antipsychotic prescribing to people with dementia to participate. These experts included general practitioners (GPs), geriatricians and old age psychiatrists. The list of statements for round 1 was developed through a review of existing monitoring tools and international best practice guidelines. In the second round of the Delphi, any statement that had not reached consensus in the first round was presented for re-rating, with personalized feedback on the group and the individual’s response to the specific statement. The final round consisted of a face-to-face expert meeting to resolve any uncertainties from round 2. Results A total of 23 items were rated over two eDelphi rounds and one face-to-face consensus meeting to yield a total of 18 endorsed items and five rejected items. The endorsed statements informed the development of a structured, repeat prescribing tool for monitoring antipsychotics in people with dementia in primary care. Conclusion The development of repeat prescribing tool provides GPs with practical advice that is lacking in current guidelines and will help to support GPs by providing a structured format to use when reviewing antipsychotic prescriptions for people with dementia, ultimately improving patient care. The feasibility and acceptability of the tool now need to be evaluated in clinical practice.
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Affiliation(s)
| | - Naoihse Guerin
- Department of General Practice, University College Cork, Cork, Ireland,
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland,
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Smaling HJA, Joling KJ, van de Ven PM, Bosmans JE, Simard J, Volicer L, Achterberg WP, Francke AL, van der Steen JT. Effects of the Namaste Care Family programme on quality of life of nursing home residents with advanced dementia and on family caregiving experiences: study protocol of a cluster-randomised controlled trial. BMJ Open 2018; 8:e025411. [PMID: 30327407 PMCID: PMC6196971 DOI: 10.1136/bmjopen-2018-025411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Quality of life of people with advanced dementia living in nursing homes is often suboptimal. Family caregivers can feel frustrated with limited contact with their relatives, which results in visits that are perceived as stressful and not very meaningful. Few psychosocial interventions are specifically developed for people with advanced dementia, and actively involve family caregivers or volunteers. Also, interventions usually stop when it becomes difficult for people to participate. The Namaste Care Family programme aims to increase the quality of life of people with advanced dementia, and improve family caregiving experiences through connecting to people and making them comfortable. METHODS AND ANALYSIS Our study will evaluate the effects of the Namaste Care Family programme on quality of life of people with advanced dementia living in nursing homes and family caregiving experiences using a cluster-randomised controlled trial. Longitudinal analyses will be performed taking into account clustering at the nursing home level. Both a cost-effectiveness and a cost-utility analysis from a societal perspective will be performed. We will modify the Namaste Care Family programme to increase family and volunteer involvement in ongoing and end-of-life care. Data collection involves assessments by family caregivers, nursing staff and elderly care physicians using questionnaires, and observations by the researchers at baseline and multiple times over 12 months. The last questionnaire will be sent up to month 24 after the death of the person with dementia. During semistructured interviews, the feasibility, accessibility and sustainability of the Namaste Care Family programme will be assessed. ETHICS AND DISSEMINATION The study protocol is approved by the Medical Ethics Review Committee of the VU University Medical Center in Amsterdam (protocol no. 2016.399) and registered with the Nederlands Trial Register (NTR5692). The findings will be disseminated via publications in peer-reviewed journals, conference presentations and presentations for healthcare professionals where appropriate. TRIAL REGISTRATION NUMBER NTR5692.
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Affiliation(s)
- Hanneke J A Smaling
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Joyce Simard
- School of Nursing and Midwifery, College of Health and Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Land O'Lakes, Florida, USA
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: a cross-sectional survey. Int Psychogeriatr 2018; 30:1279-1290. [PMID: 29198221 PMCID: PMC6190067 DOI: 10.1017/s1041610217002708] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED ABSTRACTBackground:Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). METHODS Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. RESULTS Higher levels of PCC were associated with a greater job satisfaction, three years or more of health-related education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. CONCLUSION This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
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O’ Philbin L, Woods B, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia: an abridged Cochrane systematic review of the evidence from randomized controlled trials. Expert Rev Neurother 2018; 18:715-727. [DOI: 10.1080/14737175.2018.1509709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Laura O’ Philbin
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Emma M Farrell
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Aimee E Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Bain KT, Schwartz EJ, Chan-Ting R. Reducing Off-Label Antipsychotic Use in Older Community-Dwelling Adults With Dementia: A Narrative Review. J Osteopath Med 2018; 117:441-450. [PMID: 28662557 DOI: 10.7556/jaoa.2017.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The off-label use of antipsychotics for the management of behavioral and psychologic symptoms of dementia (BPSD) in older adults (age ≥65 years) is common, despite evidence of modest benefits and serious risks. Although national initiatives aimed at reducing antipsychotic use among older adults with BPSD in nursing homes have been successful, similar initiatives are lacking for community-dwelling adults with dementia. As a result, older adults with BPSD residing in the community may be at an even greater risk of being negatively affected by antipsychotic use. Physicians should be knowledgeable of this issue and understand the alternatives to antipsychotics, as well as how to reduce antipsychotic use in patients with dementia who are already taking antipsychotics.
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