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Rodríguez-Míguez E, Sampayo A. Comparison of Caregiver and General Population Preferences for Dependency-Related Health States. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00908-x. [PMID: 39256323 DOI: 10.1007/s40258-024-00908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE We assess whether the preferences regarding dependency-related health states as stated by informal caregivers are aligned with those expressed by the general population. METHODS The preferences of a sample of 139 Spanish informal caregivers of dependent patients are compared with those obtained via a sample of 312 persons, also from the Spanish general population. We assess 24 dependency states extracted from the DEP-6D using the time trade-off method. Descriptive statistics and regression methods are used to explore differences between the two samples. RESULTS Mean difference tests establish that, for all but one of the 24 states, there are no significant differences between the samples. The estimated mean values ranged from - 0.64 to 0.60 for the caregiver sample and from - 0.60 to 0.65 for the general population sample, with a correlation of 0.96. On average, the classification of states as better or worse than dead matched in both samples (except for one state). Regression models also show that sample type does not have a significant average impact. After we introduce interaction effects, only the most severe level of two dimensions, cognitive problems and housework, result in significant differences-with the caregiver sample reporting higher values for the former, and lower values for the latter. CONCLUSION Caregivers and the general population exhibit quite similar preferences concerning dependency-related health states. This suggests that the results of cost-utility analyses, and the resource allocation decisions based on them, would likewise not be significantly affected by the preferences used to generate the weighting algorithm.
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Affiliation(s)
- Eva Rodríguez-Míguez
- ECOBAS, Universidade de Vigo, GRIEE, 36310, Vigo, Spain.
- Instituto de Investigación Sanitaria Galicia Sur, Hospital Álvaro Cunqueiro, 36213, Vigo, Spain.
| | - Antonio Sampayo
- ECOBAS, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Spain
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Luque-Uría Á, Calvo MV, Visioli F, Fontecha J. Milk fat globule membrane and its polar lipids: reviewing preclinical and clinical trials on cognition. Food Funct 2024; 15:6783-6797. [PMID: 38828877 DOI: 10.1039/d4fo00659c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
In most parts of the world, life expectancy is increasing thanks to improved healthcare, public health policies, nutrition, and treatment. This increase in lifespan is often not accompanied by an increase in health span, which severely affects people as they age. One notable consequence of this is the increasing prevalence of neurodegenerative diseases such as mild cognitive impairment, dementia, and Alzheimer's disease. Therefore, dietary and pharmaceutical measures must be taken to reduce the burden of such pathologies. Among the different types of nutrients found in the diet, lipids and especially polar lipids are very important for cognition due to their abundance in the brain. Amid the most studied sources of polar lipids, milk fat globule membrane (MFGM) stands out as it is abundant in industrial by-products such as buttermilk. In this narrative review, we discuss the latest, i.e. less than five years old, scientific evidence on the use of MFGM and its polar lipids in cognitive neurodevelopment in early life and their potential effect in preventing neurodegeneration in old age. We conclude that MFGM is an interesting, abundant and exploitable source of relatively inexpensive bioactive molecules that could be properly formulated and utilized in the areas of neurodevelopment and cognitive decline. Sufficiently large randomized controlled trials are required before health-related statements can be made. However, research in this area is progressing rapidly and the evidence gathered points to biological, health-promoting effects.
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Affiliation(s)
- Álvaro Luque-Uría
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
| | - María V Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy.
- IMDEA-Food, Madrid 28049, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
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Novotni G, Taneska M, Novotni A, Fischer J, Iloski S, Ivanovska A, Dimitrova V, Novotni L, Milutinović M, Joksimoski B, Chorbev I, Hasani S, Dogan V, Grimmer T, Kurz A. North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams. FRONTIERS IN DEMENTIA 2024; 3:1391471. [PMID: 39081604 PMCID: PMC11285573 DOI: 10.3389/frdem.2024.1391471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 08/02/2024]
Abstract
Introduction The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia. Method We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates. Results One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia. Discussion The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.
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Affiliation(s)
- Gabriela Novotni
- Department of Cognitive Neurology and Neurodegenerative Diseases, University Clinic of Neurology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Marija Taneska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Antoni Novotni
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Julia Fischer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Svetlana Iloski
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Andrea Ivanovska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vesna Dimitrova
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | - Miloš Milutinović
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Boban Joksimoski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Shpresa Hasani
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vildan Dogan
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Timo Grimmer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Kurz
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
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Wilson M, Doyle J, Turner J, Nugent C, O’Sullivan D. Designing technology to support greater participation of people living with dementia in daily and meaningful activities. Digit Health 2024; 10:20552076231222427. [PMID: 38235415 PMCID: PMC10793193 DOI: 10.1177/20552076231222427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Background People living with dementia should be at the center of decision-making regarding their plans and goals for daily living and meaningful activities that help promote health and mental well-being. The human-computer interaction community has recently begun to recognize the need to design technologies where the person living with dementia is an active rather than a passive user of technology in the management of their care. Methods Data collection comprised semi-structured interviews and focus groups held with dyads of people with early-stage dementia (n = 5) and their informal carers (n = 4), as well as health professionals (n = 5). This article discusses findings from the thematic analysis of this qualitative data. Results Analysis resulted in the construction of three main themes: (1) maintaining a sense of purpose and identity, (2) learning helplessness and (3) shared decision-making and collaboration. Within each of the three main themes, related sub-themes were also constructed. Discussion There is a need to design technologies for persons living with dementia/carer dyads that can support collaborative care planning and engagement in meaningful activities while also balancing persons living with dementia empowerment and active engagement in self-management with carer support.
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Affiliation(s)
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Ireland
| | - Jonathan Turner
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
| | - Ciaran Nugent
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
| | - Dympna O’Sullivan
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
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Power MC, Willens V, Prather C, Moghtaderi A, Chen Y, Gianattasio KZ, Grodstein F, Shah RC, James BD. Risks and Benefits of Clinical Diagnosis Around the Time of Dementia Onset. Gerontol Geriatr Med 2023; 9:23337214231213185. [PMID: 38026091 PMCID: PMC10666707 DOI: 10.1177/23337214231213185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Diagnostic delay in dementia is common in the U.S. Drivers of diagnostic delay are poorly understood, but appear related to misconceptions about dementia, stigma, concerns about autonomy, the nature of the diagnostic process, and provider-related factors. There is little quantitative evidence underlying cited risks and benefits of receiving a diagnosis around the time of dementia onset, including impacts on physical health, impacts on mental health, care partner interactions, costs of care, increased time for care planning, or earlier access to treatment. While various groups continue to push for reductions in diagnostic delay, realization of benefits and mitigation of harms will require new research on potential benefits and harms. Workforce and resource constraints, coupled with the expected growth in the number of persons living with dementia, may be a barrier to realization of potential benefits and mitigation of identified harms, which will require adequate access to providers, services, and supports.
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Affiliation(s)
| | | | | | | | - Yi Chen
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Raj C. Shah
- Rush University Medical Center, Chicago, IL, USA
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Context-Enhanced Human-Robot Interaction: Exploring the Role of System Interactivity and Multimodal Stimuli on the Engagement of People with Dementia. Int J Soc Robot 2021. [DOI: 10.1007/s12369-021-00823-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractEngaging people with dementia (PWD) in meaningful activities is the key to promote their quality of life. Design towards a higher level of user engagement has been extensively studied within the human-computer interaction community, however, few extend to PWD. It is generally considered that increased richness of experiences can lead to enhanced engagement. Therefore, this paper explores the effects of rich interaction in terms of the role of system interactivity and multimodal stimuli by engaging participants in context-enhanced human-robot interaction activities. The interaction with a social robot was considered context-enhanced due to the additional responsive sensory feedback from an augmented reality display. A field study was conducted in a Dutch nursing home with 16 residents. The study followed a two by two mixed factorial design with one within-subject variable - multimodal stimuli - and one between-subject variable - system interactivity. A mixed method of video coding analysis and observational rating scales was adopted to assess user engagement comprehensively. Results disclose that when additional auditory modality was included besides the visual-tactile stimuli, participants had significantly higher scores on attitude, more positive behavioral engagement during activity, and a higher percentage of communications displayed. The multimodal stimuli also promoted social interaction between participants and the facilitator. The findings provide sufficient evidence regarding the significant role of multimodal stimuli in promoting PWD’s engagement, which could be potentially used as a motivation strategy in future research to improve emotional aspects of activity-related engagement and social interaction with the human partner.
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Oliveira AM, Radanovic M, Mello PCHD, Buchain PC, Vizzotto ADB, Harder J, Stella F, Gitlin LN, Piersol CV, Valiengo LLC, Forlenza OV. Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program. J Alzheimers Dis 2021; 83:475-486. [PMID: 34334394 DOI: 10.3233/jad-210142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. OBJECTIVE Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. METHODS This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. RESULTS 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. CONCLUSION The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.
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Affiliation(s)
- Alexandra Martini Oliveira
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.,Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Patricia Cardoso Buchain
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Janaína Harder
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Florindo Stella
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA.,Drexel College of Nursing and Health Professions, Philadelphia, PA, USA
| | | | - Leandro L C Valiengo
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Orestes Vicente Forlenza
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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Biodanza as a Nonpharmacological Dance Movement-Based Treatment in Older People With Alzheimer's Disease: An Italian Pilot Study in 2 Tuscan Nursing Homes. Holist Nurs Pract 2021; 35:264-272. [PMID: 34407024 DOI: 10.1097/hnp.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this pilot, feasibility study was to assess health improvements in 16 institutionalized older people with Alzheimer's disease, after the Biodanza intervention, a nonpharmacological dance movement-based treatment. Biodanza significantly decreased agitated and neuropsychiatric behaviors. Effectiveness studies will be performed in order to assess the implication of such interventions.
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Stefanac S, Grabovac I, Andrews MR, Oppenauer C, Ramos R, Reichardt B, Stögmann E, Stamm T. Utilization of occupational therapy services and relation to survival in people taking dementia-specific medication in Austria-A retrospective population-based study with a 13-year observation period. Int J Geriatr Psychiatry 2021; 36:1179-1187. [PMID: 33565100 PMCID: PMC8359268 DOI: 10.1002/gps.5506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Evidence-based treatment of dementia includes pharmacological and non-pharmacological methods of which psycho-social interventions are an important component, commonly administered by occupational therapists. The aim of this study was to investigate the utilization of occupational therapy (OT) services and its association with survival in people taking dementia-specific medication in a population-based Austrian dataset compared to a two times as large control group without dementia-specific medication. METHODS/DESIGN A retrospective study with a 13-year observation period (2003-2016) was conducted on real-world data. Two stratifications were done and we used descriptive statistics, Chi-squared/Fisher's Exact Tests and survival analyses including three Cox models. RESULTS Data from 286,553 participants were analysed. Only 4.5% (n = 12,950) received OT services. In the dementia-medication group (n = 111,033), participants who received OT services (3.6%; n = 4032) had significantly more comorbidities (4.7%) compared to those without OT (3.5%; p < 0.001) and were also more likely to be male (4 vs. 3.5%; p < 0.001). While persons taking dementia-specific medication showed a slightly reduced survival with OT (p < 0.001) compared to those without, the result in the control group without dementia-specific medication showed a slightly better result of the participants who received OT (p < 0.001). The reduced survival in the dementia-medication group with OT is likely to be related to the higher number of comorbidities in this group. CONCLUSION People receiving dementia-specific medication were more likely to receive OT if they had additional comorbidities, however our analysis showed that utilization of OT services in Austria was very low indicating an overall insufficient accessibility of OT services for patients who needed it.
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Affiliation(s)
- Sinisa Stefanac
- Ludwig Boltzmann Institute for Arthritis and RehabilitationViennaAustria,Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Igor Grabovac
- Department of Social and Preventive MedicineCentre for Public HealthMedical University of ViennaViennaAustria
| | - Margaret R. Andrews
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Claudia Oppenauer
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Romualdo Ramos
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | | | | | - Tanja Stamm
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
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Wu VX, Chi Y, Lee JK, Goh HS, Chen DYM, Haugan G, Chao FFT, Klainin-Yobas P. The effect of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life for older adults with mild cognitive impairment: A systematic review and meta-analysis. Int J Nurs Stud 2021; 122:104025. [PMID: 34298320 DOI: 10.1016/j.ijnurstu.2021.104025] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Mild cognitive impairment is an age-related cognitive disorder which is associated with frequent memory lapses, impaired judgement, and progressive functional decline. If untreated early, 39.2% of people with mild cognitive impairment could progress to develop dementia. However, there are currently no approved pharmacological interventions to treat the condition, which lead researchers to explore non-pharmacological options, such as dance therapy. OBJECTIVES This systematic review aimed to examine the effectiveness of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life in older adults with mild cognitive impairment. METHODS Seven databases were systematically searched from their respective inception dates to 31 March 2020. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating dance interventions were included. RESULTS Results showed that dance interventions had a significant moderate effect on global cognition (SMD=0.54, Z = 3.55, p<0.001), significantly improved memory (SMD=0.33, Z = 3.97, p<0.001), visuospatial function (SMD=0.42, Z = 2.41, p = 0.02), and language (SMD=0.39, Z = 2.69, p = 0.007). We found that dance interventions produced a significant moderate effect on physical function (SMD=0.55, Z = 3.43, p<0.001), and a significant effect on quality of life (SMD=0.93, Z = 5.04, p<0.0.001). CONCLUSION Dance is a non-pharmacological and inexpensive intervention that can be implemented for older adults on a large scale. It can slow down the cognitive deterioration of older adults with mild cognitive impairment. However, the findings should be interpreted with caution due to the heterogeneity in intervention designs. Rigorous design studies with long-term follow-ups, neuroimaging, biological markers, and comprehensive neuropsychological assessment are required to understand the mechanism of dance interventions and demonstrate its efficacy for older adults with mild cognitive impairment. The protocol was registered on PROSPERO (CRD42020173659).
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Affiliation(s)
- Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Yuchen Chi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Jeong Kyu Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Y, Singapore 117549, Singapore.
| | - Hongli Sam Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Delphine Yu Mei Chen
- General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Gørill Haugan
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Address: Postbox 8905, 7491 Trondheim, Norway.
| | - Felicia Fang Ting Chao
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
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Regier NG, Taylor JL, Szanton SL, Parmelee PA, Perrin N, Liu M, Jenkins E, Hodgson NA, Gitlin LN. Pain in persons with dementia and the direct and indirect impacts on caregiver burden. Geriatr Nurs 2021; 42:366-371. [PMID: 33571930 PMCID: PMC8832466 DOI: 10.1016/j.gerinurse.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Unresolved pain is related to neuropsychiatric symptoms (NPS) in persons living with dementia (PLWD), and an increase in NPS is distressing for PLWD and their caregivers. Hence, we examined whether pain in PLWD was related to caregiver burden and whether caregiver upset with NPS mediated this relationship. METHOD We examined, cross-sectionally, the relationships among pain in PLWD, caregiver burden, and upset with NPS. Data from 272 PLWD and their caregivers who participated in the Advancing Caregiver Training (ACT) trial were analyzed using structural equation modeling (SEM). RESULTS Model fit was satisfactory, and caregiver upset with NPS fully mediated the association between pain in PLWD and caregiver burden. CONCLUSION Caregiver upset with NPS helps explain the relationship between pain in PLWD and burden in their caregivers. Pain and NPS are amenable to modification, as is caregiver burden, suggesting great opportunity to impact the lives of PLWD and their caregivers.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA.
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia A Parmelee
- The University of Alabama, Alabama Research Institute on Aging, Tuscaloosa, AL, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Minhui Liu
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Emerald Jenkins
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura N Gitlin
- Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA; Drexel College of Nursing and Health Professions, Philadelphia, PA, USA
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Ho RTH, Fong TCT, Chan WC, Kwan JSK, Chiu PKC, Yau JCY, Lam LCW. Psychophysiological Effects of Dance Movement Therapy and Physical Exercise on Older Adults With Mild Dementia: A Randomized Controlled Trial. J Gerontol B Psychol Sci Soc Sci 2020; 75:560-570. [PMID: 30496547 DOI: 10.1093/geronb/gby145] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Dementia interferes with older adults' functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. METHODS This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. RESULTS The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33-0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. DISCUSSION The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | | | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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13
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Lu LT, Huang CM, Huang SF, Wu SI, Guo JL. Perspectives of the Elderly with Mild Cognitive Impairment Living Alone on Participating in a Dementia Prevention Program: A Q Methodology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217712. [PMID: 33105662 PMCID: PMC7659959 DOI: 10.3390/ijerph17217712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to identify and describe the various patterns of perspectives among older adults with mild cognitive impairment (MCI) living alone on participating in a dementia prevention program. Q methodology was applied to investigate the perspectives of 30 community-dwelling elderly people with MCI living alone from March to August 2018. As Q methodology applies a forced distribution through the Q-sorting technique, it could capture participants’ perspective patterns. Thirty-two Q-statements were constructed to explore the participants’ attitudes regarding their participation in a dementia prevention program. The participants performed Q-sorting to rank the 32 statements into a Q-sort grid. Principal component analysis was conducted using the PQ Method 2.35 software to identify patterns in participants’ perspectives. Four patterns of shared perspectives, accounting for 54.65% of the total variance, were identified: (a) awareness of health benefits and readiness to take preventive actions; (b) emphasis on cost consideration, and not ready to participate; (c) concern about family’s attitude and needing family support; (d) emphasis on medical care and needing providers’ recommendation. The exploration of clusters of the elderly with MCI could assist health professionals in acknowledging elderly people’s attitudes and responses towards participating in a dementia prevention program.
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Affiliation(s)
- Li-Ting Lu
- Department of Nursing, University of Kang Ning, Taipei 114, Taiwan;
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei 112, Taiwan;
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan;
| | - Shu-I Wu
- Xinyi District Health Center, Taipei City 110, Taiwan;
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
- Correspondence: ; Tel.: +886-2-7749-3705
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14
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Begali VL. Neuropsychology and the dementia spectrum: Differential diagnosis, clinical management, and forensic utility. NeuroRehabilitation 2020; 46:181-194. [PMID: 32083596 DOI: 10.3233/nre-192965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The utility of neuropsychology in the treatment and evaluation of neuropsychological disorders and neurodegenerative diseases is supported by scientific study. As a discipline, neuropsychology's value and efficacy when applied to the dementia spectrum are rooted in its inherent adaptability as a practical, cost-effective, and scientifically based resource for differential diagnosis, treatment planning, and forensic decision making. OBJECTIVES This article provides a framework for conceptualizing dementia as a spectrum of disorders and outlines a rationale for preferential reliance upon neuropsychological tenets. The function of neuropsychology in differential diagnosis, clinical management, integrative care, and forensic applications is delineated for use as a contemporary interdisciplinary reference. METHODOLOGY An overview of the literature on dementia as a spectrum of disorders has been integrated with the science and practice of neuropsychology. CONCLUSIONS The utility of neuropsychology emanates from its focus on brain functioning and the discipline's appreciation for the relationship between brain functioning and cognition, mental state, and behavior. Early and routine referral for neuropsychological assessment allows for the objective determination of normal versus abnormal neurocognitive functioning, provides a baseline for serial reassessment, and leads to the more rapid deployment of effective treatments. Beyond the hospital and clinic, neuropsychological expertise is increasingly sought after as integral to the legal system when decisions regarding eligibility for long term care and questions about capacity require objective and reliable measurement.
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Affiliation(s)
- Vivian L Begali
- Neuropsychology and Psychological Healthcare, Fountain Park Medical Offices, 9327 MidlothianTurnpike, Suite 1-C, Richmond, VA 23235, USA Tel.: +1 804 728 2964; E-mail: ; Web: http://www.drvivianbegali.com
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15
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Does Telehealth Delivery of a Dyadic Dementia Care Program Provide a Noninferior Alternative to Face-To-Face Delivery of the Same Program? A Randomized, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:673-682. [PMID: 32234275 DOI: 10.1016/j.jagp.2020.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine whether delivery of a dyadic intervention using telehealth was noninferior to delivery of the same program using traditional face-to-face delivery through home visits. DESIGN We conducted a noninferiority randomized controlled trial. PARTICIPANTS Participants had a diagnosis of dementia, were living in the community, and had an informal caregiver who reported difficulties in managing activities of daily living or behavioral symptoms. INTERVENTION Participants were randomized to receive either telehealth or home visit delivery of the same intervention program. MEASUREMENTS The primary outcome was the Caregiving Mastery Index, secondary outcomes included caregiver's perceptions of change, activities of daily living function, and type and frequency of behavioral symptoms of persons living with dementia. Therapists delivering the intervention recorded the time spent delivering the intervention as well as travel time. RESULTS Sixty-three dyads were recruited and randomized. Both groups reported improvements for the primary outcome, however, these were not statistically significant. There were no significant differences between groups for the primary outcome (mean difference 0.09 (95% confidence interval -1.26 to 1.45) or the secondary outcomes at 4 months. Both groups reported significant improvements in caregiver's perceptions of change. The amount of time spent delivering the content of the program was similar between groups, however offering the intervention via telehealth significantly reduced travel time (mean 255.9 minutes versus mean 77.2 minutes, p <0.0001). CONCLUSION It is feasible to offer dyadic interventions via telehealth and doing so reduces travel time and results in similar benefits for families.
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16
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Potential Benefits of Physical Activity in MCI and Dementia. Behav Neurol 2020; 2020:7807856. [PMID: 32104516 PMCID: PMC7037481 DOI: 10.1155/2020/7807856] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/18/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
Physical activity improves overall health and reduces the risk of many negative health outcomes and may be effective in improving cognition, independent functioning, and psychological health in older adults. Given the evidence linking physical activity with improvements in various aspects of health and functioning, interventions exploring pathways for decreasing risk of dementia in those with mild cognitive impairment (MCI) and improving outcomes for those with dementia are of critical importance. The present review highlights the work examining physical activity interventions in order to achieve a comprehensive understanding of the potential benefits of physical activity for individuals experiencing cognitive decline. The primary focus is on aerobic exercise as this is the main intervention in the literature. Our review supports the thesis that physical activity can promote healthy aging in terms of cognition, independent functioning, and psychological health for individuals experiencing cognitive decline. Specifically, physical activity improves cognition, especially executive functioning and memory in MCI, independent functioning in MCI and dementia, and psychological health in dementia. Given that benefits of physical activity have been observed across these domains, such interventions provide an avenue for preventing decline and/or mitigating impairment across several domains of functioning in older adults with MCI or dementia and may be recommended (and adjusted) for patients across a range of settings, including medical and mental health settings. Further implications for clinical intervention and future directions for research are discussed.
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17
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Operationalizing the Disablement Process for Research on Older Adults: A Critical Review. Can J Aging 2020; 39:600-613. [PMID: 32000871 DOI: 10.1017/s0714980819000758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.
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18
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Li W, Guo J, Shen Y, Huang L, Leng B, Fan D, Shui L, Chen C. Probiotics, prebiotics, and synbiotics for the treatment of dementia: Protocol for a systematic review. Medicine (Baltimore) 2020; 99:e18608. [PMID: 32000366 PMCID: PMC7004668 DOI: 10.1097/md.0000000000018608] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The number of dementia patients in the world is large, and the number of dementia patients will continue to rise in the future, which will bring a heavy social and economic burden. No interventions have been found to cure dementia. Medication can delay the progression of the disease and impose an economic burden. Some non-drug therapies often require the care of the caregiver. Probiotics, prebiotics, and synbiotics may intervene in dementia through microbiota-gut-brain axis (MGBA). However, their effectiveness and safety are still obscure and deserve further investigation. The purpose of this study is to assess the effect and safety of probiotics, prebiotics, and synbiotics in treating dementia. METHODS We will summarize and meta-analyze randomized controlled trials (RCTs) of probiotics, prebiotics, and synbiotics for the treatment of dementia. RCTs comparing probiotics, prebiotics, and synbiotics with blank control, placebo or conventional therapies will be included. RCTs comparing probiotics, prebiotics, and synbiotics plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, CNKI, CBM, VIP, and WAN FANG DATA. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) pro-GDT web solution will be used for evidence evaluation. RESULTS This review will evaluate the effects of probiotics, prebiotics, and synbiotics on cognitive function, behavioral and psychological symptoms of dementia, quality of life (QOL), functional performance in activities of daily living, and compliance with the intervention and safety in patients with dementia. CONCLUSIONS This review will provide clear evidence to assess the effectiveness and safety of probiotics, prebiotics, and synbiotics for dementia.OSF registration number: DOI 10.17605/OSF.IO/2Q3AK.
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Affiliation(s)
- Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Yifeng Shen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Ling Huang
- Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Bingshuang Leng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Dong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Liyao Shui
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Chongli Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
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19
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Huang X, Li B, Yu F, Zhou J, Wan Q, Chang H. Path analysis from physical activity to quality of life among dementia patients: A dual-path mediating model. J Adv Nurs 2019; 76:546-554. [PMID: 31713881 DOI: 10.1111/jan.14260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/14/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
AIMS To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients. DESIGN A descriptive, cross-sectional design. METHODS Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life. RESULTS Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression. CONCLUSION The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients. IMPACT The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.
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Affiliation(s)
- Xiuxiu Huang
- School of Nursing, Peking University, Beijing, China
| | - Bei Li
- School of Nursing, Peking University, Beijing, China
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jiong Zhou
- Neurology Department, the Second Affiliated Hospital of Medical School, Zhejiang University, Hangzhou, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Hong Chang
- Xuanwu Hospital Capital Medical University, Beijing, China
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20
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Bennett S, Laver K, Voigt-Radloff S, Letts L, Clemson L, Graff M, Wiseman J, Gitlin L. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open 2019; 9:e026308. [PMID: 31719067 PMCID: PMC6858232 DOI: 10.1136/bmjopen-2018-026308] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. DESIGN Systematic review and meta-analysis. METHODS Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. RESULTS Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD -0.32, 95% CI -0.57 to -0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD -0.33, 95% CI -0.58 to -0.07); had less distress with behaviours (SMD -0.23, 95% CI -0.42 to -0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. CONCLUSIONS Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy. PROSPERO REGISTRATION NUMBER CRD42011001166.
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Affiliation(s)
- Sally Bennett
- School of Health and Rehabilitation Sciences, The University Queensland, Brisbane, Queensland, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Center for Geriatric Medicine and Gerontology, University of Freiburg, Germany
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lindy Clemson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maud Graff
- IQ Healthcare & Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
| | - Jodie Wiseman
- Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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21
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Scott I, Cooper C, Leverton M, Burton A, Beresford-Dent J, Rockwood K, Butler L, Rapaport P. Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials. Int J Geriatr Psychiatry 2019; 34:1386-1402. [PMID: 31026082 DOI: 10.1002/gps.5127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/19/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Slowing functional decline could enable people living with dementia to live for longer and more independently in their own homes. We aimed to update previous syntheses examining the effectiveness of nonpharmacological interventions in reducing functional decline (activities of daily living, activity-specific physical functioning, or function-specific goal attainment) in people living in their own homes with dementia. METHODS We systematically searched electronic databases from January 2012 to May 2018; two researchers independently rated risk of bias of randomised controlled trials (RCTs) fitting predetermined inclusion criteria using a checklist; we narratively synthesised findings, prioritising studies judged to have a lower risk of bias. RESULTS Twenty-nine papers (describing 26 RCTs) met eligibility criteria, of which we judged 13 RCTs to have a lower risk of bias. Study interventions were evaluated in four groups: physical exercise, occupational, multicomponent, and cognition-oriented interventions. Four out of 13 RCTs reported functional ability as a primary outcome. In studies judged to have a lower risk of bias, in-home tailored exercise, individualised cognitive rehabilitation, and in-home activities-focussed occupational therapy significantly reduced functional decline relative to control groups in individual studies. There was consistent evidence from studies at low risk of bias that group-based exercise and reminiscence therapies were ineffective at reducing functional decline. CONCLUSION We found no replicated evidence of intervention effectiveness in decreasing functional decline. Interventions associated with slower functional decline in individual trials have been individually delivered and tailored to the needs of the person with dementia. This is consistent with previous findings. Future intervention trials should prioritise these approaches.
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Affiliation(s)
- Iona Scott
- Division of Psychiatry, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Alex Burton
- Division of Psychiatry, University College London, London, UK
| | | | - Kenneth Rockwood
- Medicine, Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
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Lee GE, Kim JY, Jung JH, Kang HW, Jung IC. Non-pharmacological interventions for patients with dementia: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17279. [PMID: 31568010 PMCID: PMC6756704 DOI: 10.1097/md.0000000000017279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This protocol for a systematic review describes the methods that will be used to evaluate the efficacy and safety of non-pharmacological interventions for patients with dementia. METHODS We will search ALOIS, the specialized register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), without language or publication status restrictions. Additional separate searches will be run in many of the above six databases to ensure the most up-to-date results are retrieved.The study selection and data extraction will be performed independently by two authors and only randomized controlled trials will be included. The risk of bias will be assessed independently by two authors following the Cochrane Handbook for Systematic Reviews of Interventions. We will use RevMan software and random-effects models to assess the heterogeneity and data synthesis.If any plan for documenting important protocol amendments changes, the researchers will make a revision agreement and then register the modification on PROSPERO. CONCLUSION Through this systematic review, a comprehensive understanding of current non-pharmacological interventions on dementia will be available. Meanwhile, it will provide basic evidence for further clinical research. ETHICS AND DISSEMINATION Ethical approval is not required because no individual patient's data are included in this paper. This study will be disseminated through conference presentation. PROSPERO REGISTRATION NUMBER CRD42019136435.
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Affiliation(s)
- Go Eun Lee
- Department of Korean Neuropsychiatry Medicine, Wonkwang University Sanbon Hospital, Gyeonggi-do
| | - Ju Yeon Kim
- Department of Neuropsychiatry of Korean Medicine, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Jin Hyeong Jung
- Department of Neuropsychiatry of Korean Medicine, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Hyung won Kang
- Department of Korean Neuropsychiatry Medicine, Wonkwang University Sanbon Hospital, Gyeonggi-do
| | - In Chul Jung
- Department of Neuropsychiatry of Korean Medicine, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
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Dauphinot V, Moutet C, Rouch I, Verdurand M, Mouchoux C, Delphin-Combe F, Gaujard S, Krolak-Salmon P. A multicenter cohort study to investigate the factors associated with functional autonomy change in patients with cognitive complaint or neurocognitive disorders: the MEMORA study protocol. BMC Geriatr 2019; 19:191. [PMID: 31319809 PMCID: PMC6637582 DOI: 10.1186/s12877-019-1204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background The identification of factors associated with functional impairment, in particular those which are potentially modifiable, may help to delay the advanced stages of functional dependence in patients with neurocognitive disorders such as Alzheimer’s disease and related disorders. The objectives of the MEMORA cohort are to investigate the factors associated, first with functional autonomy change over time, and secondarily with the cognitive performance and behavioral disorders changes over time. Methods The MEMORA study is a multicenter prospective cohort study carried out throughout the patient’s care pathway, in Memory centers of Lyon (France). The study will include 6780 patients at all stages of memory disorders in 6 years. The follow-up for each patient is planned for 3 years. The main outcome is the functional autonomy level change as assessed by the instrumental abilities of daily living (IADL) score. Patient characteristics include sociodemographic and clinical features, neuropsychological performance, pharmaceutical and non-pharmaceutical therapy. Discussion This study conducted in a context of routine care may help to identify the factors associated with functional impairment related to progressive neurocognitive disorders. Subsequently, interventions on potentially modifiable factors could be proposed to the patients to improve their management and delay functional dependence. Trial registration NCT02302482, registered 27 November 2014.
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Affiliation(s)
- Virginie Dauphinot
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France. .,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France. .,Hôpital des Charpennes, 27 rue Gabriel Péri, 69100, Villeurbanne, France.
| | - Claire Moutet
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Rouch
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France.,Centre Mémoire Ressource et Recherche de Saint Etienne (CMRR), service de neurologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Mathieu Verdurand
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche Clinique CRC - VCF (Vieillissement - Cerveau - Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,INSERM, U1028; CNRS, UMR5292; Lyon Centre de Recherche en Neurosciences de Lyon, Dynamique Cérébrale et Cognition, Lyon, France
| | - Floriane Delphin-Combe
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Gaujard
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Centre Mémoire Ressource et Recherche de Lyon (CMRR), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,Institut du Vieillissement I-Vie, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche Clinique CRC - VCF (Vieillissement - Cerveau - Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.,INSERM, U1028; CNRS, UMR5292; Lyon Centre de Recherche en Neurosciences de Lyon, Dynamique Cérébrale et Cognition, Lyon, France
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Zhao L, Cheng X, Zhong C. Implications of Successful Symptomatic Treatment in Parkinson's Disease for Therapeutic Strategies of Alzheimer's Disease. ACS Chem Neurosci 2019; 10:922-930. [PMID: 30474958 DOI: 10.1021/acschemneuro.8b00450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease (AD) has been a devastating neurodegenerative disorder and lacks effective treatment to improve the prognosis for patients. Symptomatic treatment for AD mainly includes two categories: Acetylcholinesterase inhibitors and the N-methyl-d-aspartate (NMDA) receptor antagonist (memantine). They cannot significantly improve the quality of life and extend survival time for AD patients. Worse, almost all clinical trials for disease-modifying drugs have failed, and the reduction of brain β-amyloid (Aβ) deposition by multiple approaches, including inhibitors of β- or γ-secretase, vaccines, and antibodies against Aβ deposition, was found to have little effect on AD progression. A new therapeutic strategy for AD is urgently needed. Parkinson's disease also is a neurodegenerative disease having no effective treatment for modifying the disease. Nevertheless, successful symptomatic treatment using the combined therapies of l-DOPA supplement and modulators of l-DOPA metabolism greatly improves the prognosis for PD patients; the average survival time of the patient has been extended from 3-4 years to 10-15 years although dopaminergic neurons are still progressively decreasing. This provides useful implications for AD therapeutic strategies. AD patients manifest global cognitive decline, prominently represented by memory deficit, especially in the early stages of the disease. Further, the degree of decreased cognitive abilities correlates with cholinergic dysfunction and the hypometabolism of glucose, the dominant energy fuel for brain. Thus, the amelioration of brain cholinergic function and brain energy metabolism may be effective treatment to improve cognitive abilities of AD patients. Here, we highlighted the explorations of symptomatic therapeutics through modulating brain cholinergic function and energy metabolism in AD.
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Affiliation(s)
- Lei Zhao
- Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200111, China
| | - Xiaoqin Cheng
- Department of Neurology, Zhongshan Hospital, The State Key Laboratory of Medical Neurobiology, The Institute of Brain Science, Fudan University, Shanghai 200032, China
| | - Chunjiu Zhong
- Department of Neurology, Zhongshan Hospital, The State Key Laboratory of Medical Neurobiology, The Institute of Brain Science, Fudan University, Shanghai 200032, China
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Pimouguet C, Sitta R, Wittwer J, Hayes N, Petit-Monéger A, Dartigues JF, Helmer C. Maintenance of occupational therapy (OT) for dementia: protocol of a multi-center, randomized controlled and pragmatic trial. BMC Geriatr 2019; 19:35. [PMID: 30727947 PMCID: PMC6366025 DOI: 10.1186/s12877-019-1046-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background There is a growing interest in developing tailored non-pharmacological strategies to face patients’ needs in dementia. Occupational therapy (OT) may contribute to promote self-empowerment of both patients and caregivers. France has implemented nationwide OT over a short-term period of 3/4 months. The main objective of the MathéoAlz study is to measure the impact of maintaining OT over 4 supplementary months on patients’ neuropsychiatric symptoms. Methods/design The MatheoAlz trial (Maintenance of Occupational Therapy in Alzheimer’s disease) is a multi-center, pragmatic randomized controlled trial testing maintenance of OT over 4 supplementary months compared to routine OT delivered as recommended. This paper describes the study protocol. MatheoAlz plans to enroll 240 dyads, i.e. dementia patients and caregivers, whose main inclusion criteria are: prescription for routine OT, patients with mild or moderate dementia, living at home, receiving support from an informal caregiver. The study will compare a control group of patients benefiting from 12 to 15 initial sessions of OT over 3/4 months and an intervention group of patients benefiting from these initial sessions plus 8 extra home sessions over 4 supplementary months. The main outcome is the patient’s neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory at 8 months. Several clinical outcomes and economic consequences are measured at 4, 8 and 12 months. Discussion This is the first trial designed to assess the specific impact of the maintaining OT on the patients’ neuropsychiatric symptoms burden. The results will inform policymakers on strategies to implement in the near future. Trial registration This trial was registered at ClinicalTrials.gov on February 16, 2018, identifier: NCT03435705.
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Affiliation(s)
- Clément Pimouguet
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, ISPED, 146 rue Léo Saignat, CS61292, F-33076 BORDEAUX Cedex, UMR 1219, F-33000, Bordeaux, France.
| | - Rémi Sitta
- Methodology Research Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Wittwer
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, ISPED, 146 rue Léo Saignat, CS61292, F-33076 BORDEAUX Cedex, UMR 1219, F-33000, Bordeaux, France
| | - Nathalie Hayes
- Direction de la recherche clinique et de l'innovation, evaluation et accompagnement de l'innovation, Pole de sante publique, Service d'Information Medicale, CHU de Bordeaux, 33000, Bordeaux, France
| | - Aurélie Petit-Monéger
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, ISPED, 146 rue Léo Saignat, CS61292, F-33076 BORDEAUX Cedex, UMR 1219, F-33000, Bordeaux, France.,CHU de Bordeaux, place Amelie Raba-Léon, 33000, Bordeaux, France
| | - Jean-François Dartigues
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, ISPED, 146 rue Léo Saignat, CS61292, F-33076 BORDEAUX Cedex, UMR 1219, F-33000, Bordeaux, France.,Memory Consultation, CMRR, Bordeaux University Hospital, F-33076, Bordeaux, France
| | - Catherine Helmer
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, ISPED, 146 rue Léo Saignat, CS61292, F-33076 BORDEAUX Cedex, UMR 1219, F-33000, Bordeaux, France.,Clinical Investigation Center - Clinical Epidemiology 1401, INSERM, Bordeaux, France
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26
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Did Clarification of Medicare Guidelines Change Outpatient Physical Therapy and Occupational Therapy Usage? A Retrospective Analysis. Arch Phys Med Rehabil 2019; 100:78-85. [DOI: 10.1016/j.apmr.2018.07.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 11/21/2022]
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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Ceci C, Symonds Brown H, Judge H. Rethinking the assumptions of intervention research concerned with care at home for people with dementia. DEMENTIA 2018; 19:861-877. [DOI: 10.1177/1471301218790037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aging populations have been positioned as a challenge to health and social service planning around the world, a situation even more pronounced in the case of persons with a diagnosis of dementia. While policy responses emphasize that care be provided for persons with dementia in home settings for as long as possible and that family carers be supported in the provision of this care, finding good ways to support families as they do the work of ‘delaying institutionalization’ has been challenging despite decades of intervention research intended to develop and evaluate interventions to support families. In this context of limited effectiveness it is useful to examine the assumptions informing research practices. Problematization is a method of literature analysis useful for clarifying and challenging assumptions informing a field of research in order to generate new approaches to research or new research questions. Our analysis suggests that although community-based intervention research has contributed significant knowledge about the kinds of things that might help families, there are limitations related to the dominant assumptions underlying the field. We highlight three areas for re-consideration: the overriding focus on caregiver–care recipient dyads, the under-determination of the object(s) of inquiry and the algorithmic nature of interventions themselves. Issues in these areas, we argue, arise from a commitment to homogeneity characteristic of biomedical models of disease that may need to be rethought in the face of consequential heterogeneity among research populations. That is, there is a mismatch between ‘dementia’ in the intervention research literature and ‘dementia’ in the life that is consequential for families living with these concerns.
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Ávila A, De-Rosende-Celeiro I, Torres G, Vizcaíno M, Peralbo M, Durán M. Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:734-743. [PMID: 29998539 DOI: 10.1111/hsc.12594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 05/08/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.
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Affiliation(s)
- Adriana Ávila
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Iván De-Rosende-Celeiro
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Gabriel Torres
- Departamento de Educación Física e Deportiva, Universidade da Coruña, A Coruña, Spain
| | - Mirian Vizcaíno
- Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain
| | - Manuel Peralbo
- Departamento de Psicoloxía, Universidade da Coruña, A Coruña, Spain
| | - Montserrat Durán
- Departamento de Psicoloxía, Universidade da Coruña, A Coruña, Spain
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Cabrita M, Op den Akker H, Tabak M, Hermens HJ, Vollenbroek-Hutten MMR. Persuasive technology to support active and healthy ageing: An exploration of past, present, and future. J Biomed Inform 2018; 84:17-30. [PMID: 29935348 DOI: 10.1016/j.jbi.2018.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/06/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022]
Abstract
The age of the population worldwide is rapidly increasing, bringing social and economic challenges. Persuasive technology can alleviate the burden on traditional healthcare services when used to support healthy behaviors, for instance in the prevention and treatment of chronic diseases. Additionally, healthy behaviors are key factors for active and healthy ageing by delaying or even reversing functional decline. In this manuscript, we present a multi-perspective analysis of technologies that can be used in the support of active and healthy ageing in the daily life. First, we take the perspective of physical and mental health, by focusing on the promotion of physical activity and emotional wellbeing. From a temporal perspective, we look at how technology evolved from past, present and future. The overview of the literature is structured in four main sections: (1) measurement of current behavior (monitoring), (2) analysis of the data gathered to derive meaningful information (analyzing & reasoning), (3) support the individual in the adoption or maintenance of a behavior (coaching), and (4) tools or interfaces that provide the information to the individual to stimulate the desired behavior (applications). Finally, we provide recommendations for the design, development and implementation of future technological innovations to support Active and Healthy Ageing in daily life.
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Affiliation(s)
- Miriam Cabrita
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7522 AH Enschede, The Netherlands; Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Harm Op den Akker
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7522 AH Enschede, The Netherlands.
| | - Monique Tabak
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7522 AH Enschede, The Netherlands; Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Hermie J Hermens
- Telemedicine Group, Roessingh Research and Development, P.O. Box 310, 7522 AH Enschede, The Netherlands; Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - Miriam M R Vollenbroek-Hutten
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
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Stockwell-Smith G, Moyle W, Kellett U. The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early-stage dementia-A mixed-methods study. J Adv Nurs 2018; 74:2167-2180. [PMID: 29754408 DOI: 10.1111/jan.13710] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 03/02/2018] [Accepted: 04/09/2018] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. BACKGROUND There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia-related changes will cope better in the long term. DESIGN An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. METHODS Eighty-eight dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time points. Qualitative data were collected via evaluation questionnaires and semistructured interviews. RESULTS Intervention structure, content, and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the postintervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. CONCLUSION There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers, and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition.
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Affiliation(s)
- Gillian Stockwell-Smith
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Ursula Kellett
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
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Clemson L, Laver K, Jeon YH, Comans TA, Scanlan J, Rahja M, Culph J, Low LF, Day S, Cations M, Crotty M, Kurrle S, Piersol C, Gitlin LN. Implementation of an evidence-based intervention to improve the wellbeing of people with dementia and their carers: study protocol for 'Care of People with dementia in their Environments (COPE)' in the Australian context. BMC Geriatr 2018; 18:108. [PMID: 29739358 PMCID: PMC5941473 DOI: 10.1186/s12877-018-0790-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are effective non-pharmacological treatment programs that reduce functional disability and changed behaviours in people with dementia. However, these programs (such as the Care of People with dementia in their Environments (COPE) program) are not widely available. The primary aim of this study is to determine the strategies and processes that enable the COPE program to be implemented into existing dementia care services in Australia. METHODS This study uses a mixed methods approach to test an implementation strategy. The COPE intervention (up to ten consultations with an occupational therapist and up to two consultations with a nurse) will be implemented using a number of strategies including planning (such as developing and building relationships with dementia care community service providers), educating (training nurses and occupational therapists in how to apply the intervention), restructuring (organisations establishing referral systems; therapist commitment to provide COPE to five clients following training) and quality management (coaching, support, reminders and fidelity checks). Qualitative and quantitative data will contribute to understanding how COPE is adopted and implemented. Feasibility, fidelity, acceptability, uptake and service delivery contexts will be explored and a cost/benefit evaluation conducted. Client outcomes of activity engagement and caregiver wellbeing will be assessed in a pragmatic pre-post evaluation. DISCUSSION While interventions that promote independence and wellbeing are effective and highly valued by people with dementia and their carers, access to such programs is limited. Barriers to translation that have been previously identified are addressed in this study, including limited training opportunities and a lack of confidence in clinicians working with complex symptoms of dementia. A strength of the study is that it involves implementation within different types of existing services, such as government and private providers, so the study will provide useful guidance for further future rollout. TRIAL REGISTRATION 16 February 2017; ACTRN12617000238370 .
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Affiliation(s)
- Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | - Kate Laver
- Flinders University, Adelaide, Australia
| | - Yun-Hee Jeon
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | | | - Justin Scanlan
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | - Miia Rahja
- Flinders University, Adelaide, Australia
| | - Jennifer Culph
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | - Sally Day
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
| | | | | | - Susan Kurrle
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006 Australia
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Change in Health-related Quality of Life After Referral to Memory Assessment Services. Alzheimer Dis Assoc Disord 2018; 31:192-199. [PMID: 28248688 DOI: 10.1097/wad.0000000000000190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite strong support for the provision of memory assessment services (MASs) in England and other countries, their effectiveness in improving patient outcomes is uncertain. We aimed to describe change in patients' health-related quality of life (HRQL) 6 months after referral to MASs and to examine associations with patient characteristics and use of postdiagnostic interventions. Data from 883 patients referred to 69 MASs and their informal caregivers (n=569) were collected at referral and 6 months later. Multivariable linear regression was used to examine associations of change in HRQL (DEMQOL, DEMQOL-Proxy) with patient characteristics (age, sex, ethnicity, socioeconomic deprivation, and comorbidity) and use of postdiagnostic interventions (antidementia medications and nonpharmacological therapies). Mean HRQL improved, irrespective of diagnosis: self-reported HRQL increased 3.4 points (95% CI, 2.7-4.1) and proxy-reported HRQL 1.3 points (95% CI, 0.5-2.1). HRQL change was not associated with any of the patient characteristics studied. Patients with dementia (54%) receiving antidementia drugs reported greater improvement in their HRQL but those using nonpharmacological therapies reported less improvement compared with those note receiving therapy. HRQL improved in the first 6 months after referral to MASs. Research is needed to determine longer term sustainability of the benefits and the cost-effectiveness of MASs.
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Piersol CV, Jensen L, Lieberman D, Arbesman M. Occupational Therapy Interventions for People With Alzheimer's Disease. Am J Occup Ther 2018; 72:7201390010p1-7201390010p6. [PMID: 29280729 DOI: 10.5014/ajot.2018.721001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer's disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.
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Affiliation(s)
- Catherine Verrier Piersol
- Catherine Verrier Piersol, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, and Director, Jefferson Elder Care, Thomas Jefferson University, Philadelphia, PA;
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE
| | - Deborah Lieberman
- Deborah Lieberman, MSHA, OTR/L, FAOTA, is Director, Evidence-Based Practice Project, and Staff Liaison, Commission on Practice, American Occupational Therapy Association, Bethesda, MD
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, was Methodology Consultant, Evidence-Based Practice Project, American Occupational Therapy Association, Bethesda, MD. She is now President, ArbesIdeas, Williamsville, NY, and Adjunct Assistant Professor, Department of Rehabilitation Science, University at Buffalo, NY
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35
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MacNeil Vroomen JL, Han L, Monin JK, Lipska KJ, Allore HG. Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories. J Am Geriatr Soc 2018. [PMID: 29521414 DOI: 10.1111/jgs.15284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years. DESIGN Population-based complex survey design. SETTING National Health and Aging Trends Study. PARTICIPANTS Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609). MEASUREMENTS National estimates were generated using sampling weights. Sociodemographic characteristics, self-reported physician-diagnosed chronic conditions, six activities of daily living (ADL), and cognitive status were ascertained in annual in-person interviews. A joint model using group-based trajectory modeling was used to estimate the number of ADL disabilities and attrition probability. Multinomial logistic regression with survey weights was used to estimate the association between diabetes, heart disease, and dementia and resultant trajectories of disability, with the least disabled trajectory used as a reference. RESULTS Three functional disability trajectories were identified: 26.9 million (76.3%) individuals with no disability and a constant study attrition of 14.3%, 4.9 million (13.9%) with mild and increasing disability and 12% attrition in 2012 and 27.2% in 2015, and 3.4 million (9.7%) with severe and increasing disability and 25.4% attrition in 2012 and 35% in 2015. Persons with possible dementia, possible dementia and diabetes, or possible dementia with diabetes and heart disease had significantly greater odds of being on the mild disability trajectory than those with no disability. Persons with probable dementia, representing more than 1.5 million persons, regardless of concurrent conditions, had significantly greater odds of being on the severe disability trajectory than on the no disability trajectory. CONCLUSIONS Methods that generate national estimates and account for attrition and for multiple chronic conditions and cognitive status may be useful for health policy-makers to make decisions on care provisions and services.
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Affiliation(s)
- Janet L MacNeil Vroomen
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Joan K Monin
- Social and Behavioral Sciences Department, School of Public Health, Yale University, New Haven, Connecticut
| | - Kasia J Lipska
- Section of Endocrinology Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
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Pimouguet C, Le Goff M, Wittwer J, Dartigues JF, Helmer C. Benefits of Occupational Therapy in Dementia Patients: Findings from a Real-World Observational Study. J Alzheimers Dis 2018; 56:509-517. [PMID: 27983551 DOI: 10.3233/jad-160820] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a growing interest in developing non-pharmacological approaches in dementia. Clinical efficacy of occupational therapy (OT) under routine care conditions has not been investigated yet. OBJECTIVE To analyze the short-term effects of OT in patients with dementia; and to identify factors related to greater benefit. METHODS Patients referred to OT were evaluated before starting a 3-month intervention and at 3 and 6 months later. Measures included: Mini-Mental State Examination (MMSE), Disability Assessment in Dementia (DAD), Neuropsychiatric Inventory (NPI) Questionnaire, patients' quality of life (EQ 5D-VAS), caregivers' burden (Zarit scale), and amount of informal care. Linear mixed models were used to analyze trajectories of outcomes. Logistic regressions with stepwise descending selection were used to study factors associated with benefits. RESULTS 421 dementia patients benefited from OT (mean MMSE = 17.3). Patients remained cognitively stable over time. Functional performances also remained stable at 3 months and significantly decreased at 6 months (crude reduction of 2.8 points, p < 0.01). Behavioral troubles were significantly reduced over the intervention period and remained stable after (p < 0.01). Patients' quality of life increased over the 3-month intervention (p = 0.16) and significantly decreased thereafter. Caregivers' burden and informal care significantly decreased over the 3-month intervention and remained stable thereafter. Patients who benefited from OT with regard to function were less educated and had higher cognitive level. CONCLUSION OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.
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Affiliation(s)
- Clément Pimouguet
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Mélanie Le Goff
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jérôme Wittwer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jean-François Dartigues
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France
| | - Catherine Helmer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,INSERM, Clinical Investigation Center - Clinical Epidemiology 1401, Bordeaux, France
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37
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Corvol A, Netter A, Campeon A, Somme D. Implementation of an Occupational Therapy Program for Alzheimer's Disease Patients in France: Patients' and Caregivers' Perspectives. J Alzheimers Dis 2018; 62:157-164. [PMID: 29439340 DOI: 10.3233/jad-170765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The French National Alzheimer Plan 2008-2012 created specialized Alzheimer teams, which provide up to 15 sessions of cognitive rehabilitation in the patient's home for 3 months. Sessions are conducted by an occupational therapist and a gerontological nursing assistant. OBJECTIVES As the patient's experience is one determinant of successful implementation, we explored the usefulness of these teams as viewed by the patient and his or her main caregiver. METHODS Thirteen patients and their caregiver, previously assisted by a specialized Alzheimer team, were individually given semi-structured interviews (n = 26, duration 20 to 180 minutes). RESULTS Our study showed that although patients and caregiver had no initial expectations, most of them appreciated the support provided by the specialized Alzheimer teams. Patients valued the "human" component, and favored interventions that improved quality of life over those intended to maintain functional capacities. Caregivers observed improved mood and behavior in patients. Those involved in sessions felt empowered by contact with a specialized Alzheimer team. We discuss how patients' and caregivers' feedback influenced the implementation process through comprehensive use of the five dimensions of the RE-AIM framework. CONCLUSION Whereas intervention by specialized Alzheimer teams was largely accepted by health care professionals, patients, and caregivers, its effectiveness is questioned in view of its deviation from the evidence-based model. Interviews with patients and caregivers shed light on some reasons for this deviation, as what they value in the intervention differs from the functional focus of the model.
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Affiliation(s)
- Aline Corvol
- CHU Rennes, Rennes, France.,Arène, UMR 6051, Rennes, France
| | - Alix Netter
- Faculté de Medecine - Université Rennes 1, Rennes, France
| | - Arnaud Campeon
- Arène, UMR 6051, Rennes, France.,Ecole des hautes études en Santé publique, Rennes, France
| | - Dominique Somme
- CHU Rennes, Rennes, France.,Faculté de Medecine - Université Rennes 1, Rennes, France.,Arène, UMR 6051, Rennes, France
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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Olley R, Morales A. Systematic review of evidence underpinning non-pharmacological therapies in dementia. AUST HEALTH REV 2018; 42:361-369. [DOI: 10.1071/ah16212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/27/2017] [Indexed: 11/23/2022]
Abstract
Objective
Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35 million people around the globe. It is expected that this number will increase to 65.7 million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia.
Methods
To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used.
Results
This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base.
Conclusion
Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap.
What is known about the topic?
Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms.
What does this paper add?
This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists.
What are the implications for practitioners?
The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.
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Samus QM, Black BS, Bovenkamp D, Buckley M, Callahan C, Davis K, Gitlin LN, Hodgson N, Johnston D, Kales HC, Karel M, Kenney JJ, Ling SM, Panchal M, Reuland M, Willink A, Lyketsos CG. Home is where the future is: The BrightFocus Foundation consensus panel on dementia care. Alzheimers Dement 2017; 14:104-114. [PMID: 29161539 DOI: 10.1016/j.jalz.2017.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/13/2017] [Accepted: 10/15/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC). METHODS The panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations. RESULTS The panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed. DISCUSSION HBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.
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Affiliation(s)
- Quincy M Samus
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Betty Smith Black
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Christopher Callahan
- Department of Medicine, Indiana University School of Medicine, Center for Aging Research, Indianapolis, IN, USA
| | - Karen Davis
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura N Gitlin
- Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy Hodgson
- Department of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Deirdre Johnston
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Washington, DC, USA
| | - Michele Karel
- Veterans Administration Central Office, Washington, DC, USA
| | - John Jay Kenney
- Aging & Disability Services, Montgomery Department of Health & Human Services, Rockville, MD, USA
| | - Shari M Ling
- Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, MD, USA
| | - Maï Panchal
- Fondation Vaincre Alzheimer, Paris, France; Alzheimer Forschung Initiative, Düsseldorf, Germany; Alzheimer Nederland, Amersfoort, Amersfoort, The Netherlands
| | - Melissa Reuland
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amber Willink
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Correlation Between Caregiver Reports of Physical Function and Performance-based Measures in a Cohort of Older Adults With Alzheimer Disease. Alzheimer Dis Assoc Disord 2017; 30:169-74. [PMID: 26191966 DOI: 10.1097/wad.0000000000000101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The objectives of this report are to determine the association between performance-based measures of physical function with caregiver reports of physical function in older adults with Alzheimer disease (AD) and to examine whether those associations vary by the level of patients' cognitive functioning. Subjects included 180 patient-caregiver dyads who are enrolled in a clinical trial testing the impact of an occupational therapy intervention plus guideline-level care to delay functional decline among older adults with AD. The primary caregiver-reported measure is the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Inventory (ADCS-ADL). Performance-based measures include the Short Physical Performance Battery and the Short Portable Sarcopenia Measure. Analysis of covariance (ANCOVA) models were used to determine the associations of each physical performance measure with ADCS-ADL, adjusting for cognition function and other covariates. We found significant correlations between caregiver reports and observed performance-based measures across all levels of cognitive function, with patients in the lowest cognitive group showing the highest correlation. These findings support the use of proxy reports to assess physical function among older adults with AD.
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Smallfield S, Heckenlaible C. Effectiveness of Occupational Therapy Interventions to Enhance Occupational Performance for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review. Am J Occup Ther 2017; 71:7105180010p1-7105180010p9. [PMID: 28809651 DOI: 10.5014/ajot.2017.024752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to describe the evidence for the effectiveness of interventions designed to establish, modify, and maintain occupations for adults with Alzheimer's disease (AD) and related neurocognitive disorders. METHOD Titles and abstracts of 2,597 articles were reviewed, of which 256 were retrieved for full review and 52 met inclusion criteria. U.S. Preventive Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence. RESULTS Articles were categorized into five themes: occupation-based, sleep, cognitive, physical exercise, and multicomponent interventions. Strong evidence supports the benefits of occupation-based interventions, physical exercise, and error-reduction learning. CONCLUSION Occupational therapy practitioners should integrate daily occupations, physical exercise, and error-reduction techniques into the daily routine of adults with AD to enhance occupational performance and delay functional decline. Future research should focus on establishing consensus on types and dosage of exercise and cognitive interventions.
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Affiliation(s)
- Stacy Smallfield
- Stacy Smallfield, DrOT, OTR/L, BCG, FAOTA, is Assistant Director, Entry-Level Doctoral Program, and Associate Professor of Occupational Therapy and Medicine, Washington University School of Medicine, St. Louis, MO;
| | - Cindy Heckenlaible
- Cindy Heckenlaible, MS, OTR/L, is Inpatient/Outpatient Occupational Therapist, Avera Sacred Heart Hospital, Yankton, SD. At the time of the review, she was Graduate Student, Department of Occupational Therapy, University of South Dakota, Vermillion
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O'Connor CM, Clemson L, Brodaty H, Low LF, Jeon YH, Gitlin LN, Piguet O, Mioshi E. The tailored activity program (TAP) to address behavioral disturbances in frontotemporal dementia: a feasibility and pilot study. Disabil Rehabil 2017; 41:299-310. [PMID: 29034719 DOI: 10.1080/09638288.2017.1387614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). METHODS The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. RESULTS The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategies used by carer to engage person with dementia", "barriers to the Tailored Activity Program uptake/implementation", and "person with dementia engagement". Quantitative outcomes showed an overall reduction of behavioral symptoms (F18.34 = 8.073, p = 0.011) and maintenance of functional performance in the person with dementia (F18.03 = 0.375, p = 0.548). CONCLUSIONS This study demonstrates the potential for using an activity-based intervention such as the Tailored Activity Program in frontotemporal dementia. Service providers should recognize that while people with frontotemporal dementia present with challenging issues, tailored therapies may support their function and reduce their behavioral symptoms. Implications for rehabilitation The Tailored Activity Program is an occupational therapy based intervention that involves prescribing personalized activities for behavioral management in dementia. The Tailored Activity Program is an acceptable and feasible intervention approach to address some of the unique behavioral and functional impairments inherent in frontotemporal dementia.
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Affiliation(s)
- Claire M O'Connor
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Centre of Excellence in Population Ageing Research , University of Sydney , Sydney , Australia
| | - Henry Brodaty
- c Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing (CHeBA) , University of New South Wales , Sydney , Australia
| | - Lee-Fay Low
- a Ageing, Work & Health Research Unit, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Yun-Hee Jeon
- d Sydney Nursing School , University of Sydney , Sydney , Australia
| | - Laura N Gitlin
- e Center for Innovative Care in Aging , Johns Hopkins University , Baltimore , MD , USA
| | - Olivier Piguet
- f Brain and Mind Centre , Sydney , Australia.,g Neuroscience Research Australia , Sydney , Australia.,h ARC Centre of Excellence in Cognition and its Disorders , University of New South Wales , Sydney , Australia
| | - Eneida Mioshi
- i School of Health Sciences , University of East Anglia , Norwich , UK
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Cornelis E, Gorus E, Beyer I, Van Puyvelde K, Lieten S, Versijpt J, Vande Walle N, Aerts G, De Roover K, De Vriendt P. A retrospective study of a multicomponent rehabilitation programme for community-dwelling persons with dementia and their caregivers. Br J Occup Ther 2017. [DOI: 10.1177/0308022617728680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia ( n = 30) and their caregivers ( n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results Eight participants dropped out prematurely. For persons with dementia ( n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly ( Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers ( n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.
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Affiliation(s)
- Elise Cornelis
- Occupational Therapist and Gerontologist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Occupational Therapy, Artevelde University College Ghent, Belgium
| | - Ellen Gorus
- Clinical Psychologist and Gerontologist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium
| | - Ingo Beyer
- Geriatrician, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium
| | - Katrien Van Puyvelde
- Geriatrician, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Siddhartha Lieten
- Geriatrician, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Jan Versijpt
- Neurologist, Department of Neurology, Universitair Ziekenhuis Brussel, Belgium
| | - Nathalie Vande Walle
- Geriatrician (MD): Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium; Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Greet Aerts
- Gerontologist, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium
| | - Karen De Roover
- Occupational Therapist, Department of Geriatrics, Universitair Ziekenhuis Brussel, Belgium
| | - Patricia De Vriendt
- Occupational Therapist and Gerontologist, Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Belgium; Department of Gerontology (GERO), Vrije Universiteit Brussel, Belgium; Department of Occupational Therapy, Artevelde University College Ghent, Belgium
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Regier NG, Hodgson NA, Gitlin LN. Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages. THE GERONTOLOGIST 2017; 57:987-997. [PMID: 27986794 PMCID: PMC5881689 DOI: 10.1093/geront/gnw133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioral symptoms. Design and Methods Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorized as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal-Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal-Wallis tests, pairwise comparisons utilized the Mann-Whitney U test. Results Activity categories and instructions for set up were significantly related to cognitive and functional levels. Persons with mild dementia were most often prescribed complex arts and crafts and cognitive activities. Persons with moderate dementia were most often prescribed music/entertainment. Persons with severe dementia were most often prescribed simple physical exercises and manipulation/sensory/sorting activities. Average time prescribed for activities was less for those in severe (15min) versus moderate (24min) and mild (28min) stages. The severe group required more assistance with activity initiation and cueing/redirection. Implications Type of activity, recommended cueing, and engagement time differed by dementia stage. Findings provide guidance as to how to use and set up activities across the dementia trajectory.
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Affiliation(s)
- Natalie G Regier
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nancy A Hodgson
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
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46
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Öhman H, Savikko N, Strandberg T, Kautiainen H, Raivio M, Laakkonen ML, Tilvis R, Pitkälä KH. Effects of Exercise on Functional Performance and Fall Rate in Subjects with Mild or Advanced Alzheimer's Disease: Secondary Analyses of a Randomized Controlled Study. Dement Geriatr Cogn Disord 2017; 41:233-41. [PMID: 27160164 DOI: 10.1159/000445712] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exercise improves functional performance in subjects with dementia. However, whether the benefits of exercise are evident in all stages of dementia remains uncertain. This study examines how people in different stages of Alzheimer's disease (AD) benefit from exercise intervention in their physical functioning and risk of falling. METHODS The present study is a subanalysis of a randomized controlled trial examining the effects of exercise intervention (twice a week for 12 months) in AD patients (n = 194). We studied the effects separately in participants with mild dementia and in participants with advanced dementia. RESULTS In subjects with mild dementia, the deterioration in physical functioning was slower in the intervention group than in the controls. Changes in Functional Independence Measure at 12 months were -2.7 (95% CI -0.5 to -4.9) in the intervention group and -10.1 (95% CI -7.0 to -13.3) in the control group (p < 0.001). The exercise intervention proved effective in preventing falls among patients with advanced AD, with an incidence rate ratio of 0.47 (95% CI 0.37-0.60; p < 0.001). CONCLUSIONS Regular exercise may slow the rate of functional deterioration in mild AD and reduce falls in patients suffering from advanced AD.
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Affiliation(s)
- Hannareeta Öhman
- Department of General Practice and Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
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Jutkowitz E, Kane RL, Dowd B, Gaugler JE, MacLehose RF, Kuntz KM. Effects of Cognition, Function, and Behavioral and Psychological Symptoms on Medicare Expenditures and Health Care Utilization for Persons With Dementia. J Gerontol A Biol Sci Med Sci 2017; 72:818-824. [PMID: 28369209 DOI: 10.1093/gerona/glx035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization. Methods We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model. Results Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits. Conclusions Poorer function, not cognition or BPSD, was associated with higher Medicare expenditures.
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Affiliation(s)
- Eric Jutkowitz
- Division of Health Policy and Management, School of Public Health
| | - Robert L Kane
- Division of Health Policy and Management, School of Public Health
| | - Bryan Dowd
- Division of Health Policy and Management, School of Public Health
| | | | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health
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Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:450-458. [PMID: 29067351 PMCID: PMC5654482 DOI: 10.1016/j.trci.2017.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence. Reablement offers an approach to mitigate the impact of dementia on function and independence. This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support. In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors. We present a comprehensive reablement approach in dementia. The reablement approach is described across seven domains. Reablement aims to maintain or regain function, or adapt to lost function. Evidence-based reablement should be integrated into routine care across all sectors.
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Affiliation(s)
- Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Penarth, Wales, UK
| | - Lauren Beaupre
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
| | - Linda Clare
- REACH, School of Psychology, University of Exeter, Exeter, UK
| | - Roslyn G Poulos
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Rosalie H Wang
- Intelligent Assistive Technology and Systems Lab, Deptarment of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Katherine S McGilton
- Faculty of Nursing, Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
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Jutkowitz E, Kuntz KM, Dowd B, Gaugler JE, MacLehose RF, Kane RL. Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia. Alzheimers Dement 2017; 13:801-809. [PMID: 28161279 PMCID: PMC5644025 DOI: 10.1016/j.jalz.2016.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Clinical features of dementia (cognition, function, and behavioral and psychological symptoms) may differentially affect out-of-pocket medical and nursing home (NH) expenditures and informal care received (outcomes). METHODS We used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. For those experiencing an outcome, we estimated effects of clinical features on the amount of the outcome. RESULTS No clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending. Poorer function predicted having out-of-pocket NH expenditures. For those with NH expenditures, no clinical feature predicted the amount. Poorer function and a greater number of behavioral and psychological symptoms predicted the probability of receiving caregiving. For those receiving care, poorer function was associated with more caregiving. CONCLUSIONS Clinical features differentially impact outcomes with poorer function associated with all types of costs and caregiving received.
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Affiliation(s)
- Eric Jutkowitz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Bryan Dowd
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- Adult & Gerontological Health Co-Operative, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert L Kane
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Nyman SR, Szymczynska P. Meaningful activities for improving the wellbeing of people with dementia: beyond mere pleasure to meeting fundamental psychological needs. Perspect Public Health 2017; 136:99-107. [PMID: 26933079 DOI: 10.1177/1757913915626193] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. METHOD We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. RESULTS The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson's theory of psychosocial development to dementia care. CONCLUSION We argue for the importance of activity provision for people with dementia to help promote wellbeing among an increasing proportion of older people.
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Affiliation(s)
- Samuel R Nyman
- Bournemouth University Dementia Institute and Department of Psychology, Faculty of Science & Technology, Bournemouth University, UK
| | - Paulina Szymczynska
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Newham Centre for Mental Health, Queen Mary University of London, London, UK
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