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Sturge J, Janus S, Zuidema S, Frederiks B, Schweda M, Landeweer E. The Moral and Gender Implications of Measures Used to Modulate the Mobility of People With Dementia Living in Residential Care Environments: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad071. [PMID: 37330640 PMCID: PMC10943503 DOI: 10.1093/geront/gnad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Policies and measures often restrict the mobility of people with dementia living in residential care environments to protect them from harm. However, such measures can violate human rights and affect the quality of life. This review aims to summarize the literature on what is known about measures used to modulate the life-space mobility of residents with dementia living in a residential care environment. Furthermore, moral and sex and gender considerations were explored. RESEARCH DESIGN AND METHODS A scoping review framework was referenced to summarize the literature. A total of 5 databases were searched: PubMed, Embase, CINAHL, SCOPUS, and Web of Science. The studies for eligibility using the Rayyan screening tool. RESULTS A total of 30 articles met the inclusion criteria. A narrative description of the findings of the articles is presented across 3 themes: (1) measures and strategies used to modulate the life-space mobility; (2) moral aspects; and (3) sex and gender considerations. DISCUSSION AND IMPLICATIONS Various measures are used to modulate the life-space mobility of people with dementia living in residential care facilities. Research exploring the sex and gender differences of people with dementia is lacking. With a focus on human rights and quality of life, measures used to restrict or support mobility must support the diverse needs, capacity, and dignity of people with dementia. Noting the capacity and diversity of people with dementia will require society and public space to adopt strategies that promote safety and mobility to support the quality of life of people with dementia.
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Affiliation(s)
- Jodi Sturge
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Frederiks
- Department of Ethics, Law and Humanities, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mark Schweda
- Division of Ethics in Medicine, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Elleke Landeweer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Perez H, Miguel Cruz A, Neubauer N, Daum C, Comeau AK, Marshall SD, Letts E, Liu L. Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review. Can J Aging 2024:1-15. [PMID: 38297497 DOI: 10.1017/s0714980823000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.
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Affiliation(s)
- Hector Perez
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Antonio Miguel Cruz
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | | | - Christine Daum
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Aidan K Comeau
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Elyse Letts
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Backhouse T, Ruston A, Killett A, Ward R, Rose-Hunt J, Mioshi E. Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2037-2056. [PMID: 35703588 DOI: 10.1111/hsc.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first-order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second-order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person-centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Annmarie Ruston
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Renée Ward
- Older Persons' Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Julia Rose-Hunt
- Dementia Intensive Support Team East, Norfolk and Suffolk Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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Murata S, Takegami M, Ogata S, Ono R, Nakatsuka K, Nakaoku Y, Iihara K, Hagihara A, Nishimura K. Joint effect of cognitive decline and walking ability on incidence of wandering behavior in older adults with dementia: A cohort study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35451122 DOI: 10.1002/gps.5714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Inconsistent associations between physical function and wandering behavior were reported, and the effect of cognitive decline may be different according to walking ability. The purposes of this study are to investigate whether high walking ability is a risk factor for wandering behavior and to investigate the interaction of walking ability and cognitive function with wandering behavior in older adults with dementia. METHODS This retrospective cohort study included 3979 elderly adults with dementia. The association of cognitive function and walking ability with incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction (RERI) was calculated. RESULTS Severe cognitive decline and high walking ability were associated with a higher risk for wandering behavior. Additionally, some joint effects of cognitive decline and walking ability decline were higher than the sum of its individual effects (RERI [95% confidence interval], severe cognitive decline × 'walk with help': 1.58 [0.35, 2.81]; severe cognitive decline × 'independent': 3.09 [1.05, 5.14]). CONCLUSIONS Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.
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Affiliation(s)
- Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.,Department of Public Health, Kobe University, Graduate School of Health Sciences, Kobe, Hyogo, Japan.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Rei Ono
- Department of Public Health, Kobe University, Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Kiyomasa Nakatsuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.,Department of Public Health, Kobe University, Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Koji Iihara
- Director General, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan
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Margot-Cattin I, Berchtold A, Gaber S, Kuhne N, Nygård L, Malinowsky C. Associations between community participation and types of places visited among persons living with and without dementia: risks perception and socio-demographic aspects. BMC Geriatr 2022; 22:309. [PMID: 35397532 PMCID: PMC8994370 DOI: 10.1186/s12877-022-03015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Increasingly, literature has focused on community participation in places visited by persons living with and without dementia. Earlier research indicates that multiple factors, including socio-demographic aspects and risk perception may influence community participation.
Aim and methods
This cross-sectional, explorative study aims to inquire into how places visited, socio-demographic aspects and risks perception are associated with self-rated community participation for persons living with and without dementia (n = 70) in Switzerland. Data was collected through face-to-face interviews with questionnaires (ACT-OUT, MoCA, sociodemographic). First, we investigated whether the number of places visited was correlated with self-rated participation; then we added socio-demographic and risks perception factors with a bivariate analysis; and searched for a model using multinomial logistic regressions.
Results
For the group of participants living with dementia, risks of falling (p = .014) and of getting lost (p = .037) were significantly associated with self-rated participation. For the group of participants living without dementia, visiting places outside the home was significantly associated with self-rated participation, especially visiting places in domain D/places for recreational and physical activities (p = .005).
Discussion and conclusions
The results of exploring multiple factors and searching for a model highlights the complexity of community participation as a construct. Risks and visiting places for recreational and physical activities seem to play a role in self-rated participation. Mobile interviews might be better suited to gain in-depth understanding on community participation for persons living with dementia.
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Tzeng HM, Downer B, Haas A, Ottenbacher KJ. Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay. J Am Med Dir Assoc 2022; 23:128-132.e2. [PMID: 34237256 PMCID: PMC8712356 DOI: 10.1016/j.jamda.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. DESIGN Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. SETTINGS AND PARTICIPANTS 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. METHODS Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. RESULTS Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. CONCLUSIONS AND IMPLICATIONS Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Allen Haas
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
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Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders. J Aging Res 2021; 2021:5572764. [PMID: 34094601 PMCID: PMC8140831 DOI: 10.1155/2021/5572764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022] Open
Abstract
Information on strategies and practices in the search of missing persons with dementia is inconsistent which creates challenges for first responders, such as police, when they choose appropriate search and rescue approaches. The purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. They identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario.
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Murata S, Takegami M, Onozuka D, Nakaoku Y, Hagihara A, Nishimura K. Incidence and Mortality of Dementia-Related Missing and Their Associated Factors: An Ecological Study in Japan. J Epidemiol 2021; 31:361-368. [PMID: 32595183 PMCID: PMC8126676 DOI: 10.2188/jea.je20200113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Dementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors. Methods An ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults’ characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product). Results The incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval [CI], 3.3–12.4%) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (95% CI, 1.6–4.9%) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (95% CI, 8.7–33.2%) increase in the incidence rate and a 12.9% (95% CI, 5.6–19.8%) decrease in the mortality rate. Conclusions Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.
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Affiliation(s)
- Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
| | - Daisuke Onozuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute
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Puthusseryppady V, Emrich-Mills L, Lowry E, Patel M, Hornberger M. Spatial Disorientation in Alzheimer's Disease: The Missing Path From Virtual Reality to Real World. Front Aging Neurosci 2020; 12:550514. [PMID: 33192453 PMCID: PMC7652847 DOI: 10.3389/fnagi.2020.550514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Luke Emrich-Mills
- Research Development Programme, Norfolk and Suffolk National Health Service Foundation Trust, St Andrew's Lodge, Julian Hospital, Norwich, United Kingdom.,Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Ellen Lowry
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,School of Psychology, University of East Anglia, Norwich, United Kingdom
| | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom
| | - Michael Hornberger
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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