1
|
Davies N, Sampson EL, Aworinde J, Gillam J, Kenten C, Moore K, Phillips B, Harvey C, Anderson J, Ward J, Evans CJ, Ellis‐Smith C. Co-Designing a Palliative Dementia Care Framework to Support Holistic Assessment and Decision Making: The EMBED-Care Framework. Health Expect 2024; 27:e70011. [PMID: 39215967 PMCID: PMC11365481 DOI: 10.1111/hex.70011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND People with dementia have complex palliative care needs that are often unmet, including physical and psycho-social needs. It is essential to empower people with dementia, family carers and professionals to better assess and manage care needs. We aimed to co-design a palliative dementia care Framework delivered through a digital app to support holistic assessment and decision making for care in the community and care homes-the EMBED-Care Framework. METHODS A systematic co-design approach was adopted to develop the EMBED-Care Framework across three stages: 1) Framework analysis to synthesise data from preceding evidence reviews, large routine clinical data and cohort studies of unmet palliative dementia care need; 2) Co-design using iterative workshops with people with dementia, family carers and health and social care professionals to construct the components, design of the app and implementation requirements; and 3) User testing to refine the final Framework and app, and strengthen use for clinical practice and methods of evaluation. RESULTS The Framework was co-designed for delivery through an app delivered by aTouchAway. It comprised five main components: 1) holistic assessment of palliative care needs using the Integrated Palliative care Outcome Scale-Dementia (IPOS-Dem); 2) alert system of IPOS-Dem scores to highlight unmet needs; 3) IPOS-Dem scores and alerts enable shared decision making between the practitioner, patient and/or carer to support priority setting and goals of care; 4) evidence-informed clinical decision support tools automatically linked with identified needs to manage care; and 5) Training package for users incorporating face-to-face sessions, clinical champions who received additional face-to-face sessions, animated videos and manual covering the main intervention components and email and telephone support from the research team. CONCLUSIONS This is a novel digital palliative dementia care intervention to link holistic assessment with clinical decision support tools that are practical and easy to use but address the complexity of palliative dementia care. The Framework is ready for feasibility testing and pilot studies for people with dementia residing at home or in a care home. PATIENT OR PUBLIC CONTRIBUTION We were guided by our Patient and Public Involvement (PPI) group consisting of three people with mild dementia, including younger onset dementia, and seven family carers throughout the project. They supported the overall development of the Framework, including planning of workshops, interpreting findings and testing the framework in our PPI meetings.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population HealthQueen Mary University of LondonLondonUK
| | - Elizabeth L. Sampson
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population HealthQueen Mary University of LondonLondonUK
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Psychological Medicine, Royal London HospitalEast London NHS Foundation TrustLondonUK
| | - Jesutofunmi Aworinde
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteKing's College LondonLondonUK
| | - Juliet Gillam
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteKing's College LondonLondonUK
| | - Charlotte Kenten
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population HealthQueen Mary University of LondonLondonUK
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Kirsten Moore
- Department of Medicine, Royal Melbourne HospitalThe University of MelbourneMelbourneVictoriaAustralia
- National Ageing Research InstituteParkvilleMelbourneAustralia
| | - Bethan Phillips
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | - Catherine Harvey
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteKing's College LondonLondonUK
| | - Janet Anderson
- Faculty of Medicine, Nursing and Health Sciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Jane Ward
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | - Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteKing's College LondonLondonUK
| | - Clare Ellis‐Smith
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteKing's College LondonLondonUK
| | | |
Collapse
|
2
|
Rooney D, Aplin T, Bennett S, Gui DS, Scott T. Exploring occupational therapy practice in Australian residential aged care facilities: A cross-sectional survey. Aust Occup Ther J 2024; 71:578-592. [PMID: 38459851 DOI: 10.1111/1440-1630.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 01/14/2024] [Accepted: 02/17/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. METHODS Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. RESULTS A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. CONCLUSION This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.
Collapse
Affiliation(s)
- Donna Rooney
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Dorcas Simin Gui
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
3
|
Richards K, Mills N, Hitch D. Role of occupational therapy in person-centred dementia care: Exploring family member and clinician perceptions. Australas J Ageing 2024; 43:140-147. [PMID: 38268199 DOI: 10.1111/ajag.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/07/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study aimed to explore the role of occupational therapy in dementia facilities using a person-centred model of care, from the perspective of family members, occupational therapists and multidisciplinary health professionals. METHODS A descriptive qualitative approach was adopted, and all data were evaluated using thematic analysis. Semi-structured interviews were completed with eight family members and five multidisciplinary health professionals. Four occupational therapists practising in dementia care also provided qualitative data via an online survey. RESULTS The analysis identified two key themes around perceptions of occupational therapy in person-centred dementia care. These themes were (1) the poorly defined scope of the occupational therapy role and (2) the perceived features of the occupational therapy role. CONCLUSIONS While the perceptions and experiences of participants varied, the scope of this role is currently poorly defined. Occupational therapists in this setting commonly facilitate positive social interaction and present-oriented occupational engagement with residents and are also recognised as building workforce capacity with multidisciplinary colleagues. Without a clearly defined scope of practice, the role of occupational therapy in enabling health and well-being for people with dementia cannot be coherently articulated. This could lead to underutilisation of occupational therapy services, and lost opportunities for residents to experience improved health and well-being.
Collapse
Affiliation(s)
- Kieva Richards
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Nicole Mills
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Danielle Hitch
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
4
|
Mossello E, Baccini M, Caramelli F, Biagini CA, Cester A, De Vreese LP, Darvo G, Vampini C, Gotti M, Fabbo A, Marengoni A, Cavallini MC, Gori G, Chattat R, Marini M, Ceron D, Lanzoni A, Pizziolo P, Mati A, Zilli I, Cantini C, Caleri V, Tonon E, Simoni D, Mecocci P, Ungar A, Masotti G. Italian guidance on Dementia Day Care Centres: A position paper. Aging Clin Exp Res 2023; 35:729-744. [PMID: 36795236 PMCID: PMC9933825 DOI: 10.1007/s40520-023-02356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.
Collapse
Affiliation(s)
- Enrico Mossello
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy.
| | | | - Francesca Caramelli
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | | | | | - Luc Pieter De Vreese
- Department of Mental Health and Addictions, Cognitive Clinic, Azienda USL Modena, Italy
| | - Gianluca Darvo
- Department of Architecture, University of Florence, Florence, Italy
| | - Claudio Vampini
- Psychiatric and Psychogeriatric Service, San Francesco Hospital, Garofalo Health Care, Verona, Italy
| | - Mabel Gotti
- Psychotherapist and Psychoanalyst, Italian Society of Interpersonal Psychoanalysis, Florence, Italy
| | - Andrea Fabbo
- Cognitive Disorders and Dementia Unit, Health Authority and Services of Modena, Modena, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Cavallini
- Continuity of Care Agency, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Gori
- Scientific Director, PAS Pubbliche Assistenze Foundation, Florence, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Monica Marini
- Staff Coordinator, Healthcare Executive, Tuscany Region, Italy
| | - Davide Ceron
- Opera Immacolata Concezione Foundation, Padua, Italy
| | - Alessandro Lanzoni
- Cognitive Disorders and Dementia Unit, Primary Care Department, Health District of Modena, Modena, Italy
| | | | | | | | | | | | | | - David Simoni
- Health Area Manager, Arnera Cooperativa Sociale, Pontedera, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | - Giulio Masotti
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | | |
Collapse
|
5
|
Briones Rojas C, León Godoy A, Osorio Viarengo N, Oyarzún Díaz P. Creencias y actitud hacia la Práctica Basada en la Evidencia de fonoaudiólogos latinoamericanos dedicados exclusivamente a la práctica clínica y educativa. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2023. [DOI: 10.5209/rlog.81165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
La Práctica Clínica Basada en la Evidencia (PBE) sugiere al fonoaudiólogo/a la incorporación de acciones orientadas a dar respuesta a las necesidades de los usuarios en contextos específicos. Dichas acciones incluyen planteamiento de interrogantes, revisión crítica de evidencia disponible y toma de decisiones integrando la experiencia clínica, la evidencia y las preferencias del usuario. Si bien este paradigma se ha posicionado en la disciplina en la última década, resulta compleja su implementación para los profesionales que se encuentran completamente dedicados a la práctica clínica y/o educativa. El objetivo de este estudio es analizar las creencias y actitud hacia la PBE de fonoaudiólogos/as dedicados a labores clínicas y/o educativas a tiempo completo en diferentes países de Latinoamérica. Se trata de un estudio cualitativo, fenomenológico. Se realizaron entrevistas semiestructuradas a fonoaudiólogos/as residentes en Argentina, Paraguay, Chile, Perú, Colombia, Uruguay y Costa Rica. Para los análisis de resultados se contó con entrevistas a 9 profesionales. La mayoría de los encuestados considera que la PBE se limita a las publicaciones científicas y que se dificulta la implementación en su contexto laboral, principalmente por la falta de tiempo asociada a la revisión de literatura científica actualizada. Como conclusión cabe indicarse que existe una creencia errada en términos conceptuales sobre el significado de la PBE, generando actitudes ambiguas hacia dicho paradigma. En Latinoamérica se hace necesaria la reflexión respecto a la formación de fonoaudiólogos/as para que desde el pregrado puedan manejar mayores recursos para la toma de decisiones en la evaluación e intervención; y así disminuir la brecha entre los investigadores y quienes se dedican eminentemente a la práctica clínica.
Collapse
|
6
|
Naismith SL, Michaelian JC, Low LF, Arsenova V, Mehrani I, Fyfe K, Kochan NA, Kurrle SE, Rowe C, Sachdev PS. Characterising Australian memory clinics: current practice and service needs informing national service guidelines. BMC Geriatr 2022; 22:578. [PMID: 35836238 PMCID: PMC9281346 DOI: 10.1186/s12877-022-03253-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. Methods The ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. Results Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. Conclusions In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03253-7.
Collapse
Affiliation(s)
- Sharon L Naismith
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia. .,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Johannes C Michaelian
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Valerie Arsenova
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katrina Fyfe
- School of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
| |
Collapse
|
7
|
Liddle J, Worthy P, Frost D, Taylor E, Taylor D, Beleno R, Angus D, Wiles J, Angwin A. Personal and complex: The needs and experiences related to technology use for people living with dementia. DEMENTIA 2022; 21:1511-1531. [PMID: 35420505 DOI: 10.1177/14713012221084521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With increasing focus on living well with dementia, technology has been identified as having potential benefits for safety, independence and wellbeing. Despite a large growth in specialised technology development, there has been limited uptake. There is a need to understand the current use and needs related to technology for people living with dementia and their care partners (informal carers). METHODS As part of a participatory design study, a qualitative inquiry into technology experiences and needs was undertaken within an interpretive description approach. A cross-disciplinary team including living experience experts (people living with dementia, unpaid care partners) was involved. Semi-structured interviews, including sharing technology locations and supports, were conducted, audio-recorded and transcribed. Key aspects of the technology use experience were constructed. FINDINGS Thirteen people living with dementia and 21 care partners participated in the study. Two core aspects of technology use were identified: Lots of moving parts: the complex context, and A technology cycle: the use and non-use. The findings indicated that the context involved an individual configuration of multiple factors including the user, their technology identity, their supporters, the technology and the environment. The experience is underpinned by shifting foundations created by constantly changing technologies and user characteristics. The cycle of use and non-use identified the processes required to maintain technology engagement. CONCLUSION The use of technology for people living with dementia is complex and personal. Future technology development, policies and practices need to consider this complexity and the effort required to keep using technology to realise the benefits.
Collapse
Affiliation(s)
- Jacki Liddle
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Peter Worthy
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Dennis Frost
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Eileen Taylor
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Dubhglas Taylor
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Ron Beleno
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Daniel Angus
- School of Communication, 1969Queensland University of Technology, Brisbane, QLD, Australia
| | - Janet Wiles
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| | - Anthony Angwin
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, QLD, Australia
| | -
- Human Centred Computing Group, School of Information Technology and Electrical Engineering, 1974The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
8
|
Rhodus EK, Lancaster EA, Hunter EG, Nudell T, Humphrey C, Duke M, Harris AM. Occupational Therapy Utilization in Veterans With Dementia: A Retrospective Review of Root Cause Analyses of Falls Leading to Adverse Events. J Patient Saf 2022; 18:e503-e507. [PMID: 34009869 DOI: 10.1097/pts.0000000000000860] [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: 11/26/2022]
Abstract
INTRODUCTION Falls in persons with dementia are associated with increased mortality. Occupational therapy (OT) is a rehabilitation discipline, which has, among its goals, the promotion of safety and fall prevention in older adults and those with dementia. The purpose of this study was to evaluate root cause analysis (RCA) data to identify causes of falls with adverse events in patients with dementia who were referred to or receiving OT services within the Veterans Health Administration (VHA). METHODS This study used retrospective review of RCAs within the National Center for Patient Safety database for the VHA. The RCA database was searched using these terms: falls with adverse events, dementia, and OT. Descriptive statistical analysis of demographic information, location, occurrence of orthopedic fracture, and mortality was used. All root causes were qualitatively categorized using thematic analysis of determined causes. RESULTS Eighty RCAs were included in analysis. Mean age of veterans included was 80 years; 96% were male; 76% resulted in hip fracture; and 20% died as a result of the fall. Occupational therapy evaluations occurred within 7 days of admission to VHA and falls most frequently occurred within 4 days of OT evaluation. Most common causes included inappropriate or lack of equipment (21%), need for falls/rehabilitation assessment (20%), compliance/training to fall protocol of all staff (19%), and behavior/medical status (17%). CONCLUSIONS Earlier identification for OT evaluation need may improve access to services, and use of proper equipment to decrease frequency of falls may improve patient safety for older adults with dementia.
Collapse
Affiliation(s)
| | | | - Elizabeth G Hunter
- Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky
| | - Tina Nudell
- National Center on Patient Safety, U.S. Department of Veterans Affairs, Ann Arbor, Michigan
| | - Casey Humphrey
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond
| | | | | |
Collapse
|
9
|
Yaddaden A, Spalla G, Gouin-Vallerand C, Briskie-Semeniuk P, Bier N. A mixed reality cognitive orthosis to support older adults in achieving their daily living activities: A qualitative study (Preprint). JMIR Rehabil Assist Technol 2021; 9:e34983. [PMID: 35857354 PMCID: PMC9350820 DOI: 10.2196/34983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amel Yaddaden
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Guillaume Spalla
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Laboratoire Domus, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charles Gouin-Vallerand
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Laboratoire Domus, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patricia Briskie-Semeniuk
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Nathalie Bier
- École de réadaptation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| |
Collapse
|
10
|
Training persons with early-stage Alzheimer’s disease how to use an electronic medication management device: development of an intervention protocol. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground/Objectives:Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.Methods:Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.Results:The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.Conclusions:This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.
Collapse
|
11
|
Culph J, Clemson L, Scanlan J, Jeon YH, Laver K. Promoting occupational therapy interventions in the Australian community aged care sector. Aust Occup Ther J 2021; 68:228-235. [PMID: 33415736 DOI: 10.1111/1440-1630.12717] [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] [Received: 06/23/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the introduction of consumer-directed care in the Australian community aged care sector, there are more opportunities for occupational therapists to provide evidence-based services that meet consumer needs. There is also an increasing requirement for health professionals to promote their interventions to consumers. Particularly for the implementation of new programs within organisations. However, occupational therapists have historically neglected widely promoting the role of occupational therapy services for older people. This study examines the perceptions of occupational therapists and their managers in promoting their service; the Care of People in their Environment (COPE) Program. METHODS This study utilised a qualitative interpretative description; including 28 in-depth interviews. Purposeful sampling ensured a variety of occupational therapists from different health contexts. Thematic analysis captured key emergent themes related to promoting occupational therapy interventions and implementation. RESULTS Many occupational therapists were apprehensive about promoting or selling their services and interventions. Greater levels of confidence in promoting the program were present when the program aligned with traditional models of service delivery and organisational processes. Occupational therapists described having limited opportunity to directly promote the program to consumers as community case managers were mostly the main contact at the organisation. There was limited consideration of promotion strategies and therefore limited enactment of strategies by organisations. Not-for-profit and non-government organisations recognise that the changed community aged care market provided new business opportunities. CONCLUSION With changes in the Australian aged care system, occupational therapy has great opportunity to provide diverse, evidence-based interventions driven by the needs of consumers. Reframing the notion of 'selling', to empowering consumers to be more informed about their options, will allow occupational therapists to build confidence in their promotional skills. Promoting evidence-based programs will have positive outcomes for the visibility, professional identity and recognition of occupational therapy.
Collapse
Affiliation(s)
| | - Lindy Clemson
- The University of Sydney, Camperdown, NSW, Australia
| | | | - Yun-Hee Jeon
- The University of Sydney, Camperdown, NSW, Australia
| | - Kate Laver
- Flinders University, Bedford Park, SA, Australia
| |
Collapse
|
12
|
Cox R, Kendall M, Molineux M, Miller E, Tanner B. Consumer engagement in occupational therapy health-related research: A scoping review of the Australian Occupational Therapy Journal and a call to action. Aust Occup Ther J 2020; 68:180-192. [PMID: 33047341 DOI: 10.1111/1440-1630.12704] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Consumer engagement in research is becoming an ethical, political, and moral imperative. The aim of this scoping review was to provide a snapshot of the current status of the emerging area of consumer engagement in occupational therapy health-related research, as published in the Australian Occupational Therapy Journal. METHODS A scoping review was conducted of all health-related original research published in the Australian Occupational Therapy Journal for 5½ years, plus Early View, as at June 2019. Eligible papers were examined for consumer engagement content which included any active choice or control by consumers, beyond being a research participant. A recognised six stage methodology was used with quantitative and qualitative data analysed. Two consumers collaborated in interpreting the data including finalising themes, leading theme naming, developing key discussion points, and producing recommendations. RESULTS Of the 123 eligible papers, 48 (39.02%) included consumer engagement. However, only two incorporated consumer engagement across all research phases-preparation, execution and translation. A total of 103 consumer engagement activities were charted and categorised across all papers. There were limited instances of consumer collaboration (14/103, 13.59%) or consumer-led research processes (15/103, 14.56%) reported. Four themes emerged: Parity in research partnerships; It's important to know the Who, What, When, How and So What of consumer involvement; Consumer engagement must be a two-way process-not a dead end street; and Meeting the challenge-being diverse and inclusive. CONCLUSION Comprehensive consumer-researcher partnerships may not be common-place in health-related occupational therapy research in the Australian Occupational Therapy Journal. This paper is a call to action. Occupational therapists must embrace consumer research partnerships as a demonstration of the key philosophies of enabling and empowering consumers and communities. Collaboration with two consumers in finalising data analysis, results interpretation and reporting added a diverse and valuable perspective.
Collapse
Affiliation(s)
- Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Qld, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Melissa Kendall
- Acquired Brain Injury Outreach Service and Transitional Rehabilitation Program, Princess Alexandra Hospital, Buranda, Qld, Australia.,School of Human Services and Social Work, Griffith University, Qld, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Elizabeth Miller
- Consumer Co-Researcher, C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Qld, Australia
| | - Bernadette Tanner
- Consumer Co-Researcher, C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Qld, Australia
| |
Collapse
|
13
|
Yaddaden A, Couture M, Gagnon-Roy M, Belchior P, Lussier M, Bottari C, Giroux S, Pigot H, Bier N. Using a cognitive orthosis to support older adults during meal preparation: Clinicians' perspective on COOK technology. J Rehabil Assist Technol Eng 2020; 7:2055668320909074. [PMID: 32435504 PMCID: PMC7223197 DOI: 10.1177/2055668320909074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Occupational therapists promote safety and autonomy of older adults with cognitive impairments. A technology, named COOK, offers support on a touch screen installed next to the stove to support task performance while correcting risky behaviors. We aimed to document (1) the functional profiles according the diagnosis (2) the types of interventions used to increase autonomy in the kitchen (3) the facilitators and obstacles to the implementation of COOK with this clientele. Methods Four focus groups were conducted with occupational therapists (n = 24) and were transcribed and analyzed using thematic analysis, including coding and matrix building. Results Occupational therapists identified different (1) functional profiles and (2) interventions for both diagnoses. The use of COOK (3) could be more beneficial in mild cognitive impairment, as many barriers occur for the use in Alzheimer's disease. Some parameters, such as digital control of the stove and complex information management, need to be simplified. Discussion According to occupational therapists, this technology is particularly applicable to people with mild cognitive impairment, because this population has better learning abilities. Conclusion This study documented the specific needs of older adults with cognitive impairments as well as interventions used by occupational therapists. The perspectives of caregivers should be captured in future research.
Collapse
Affiliation(s)
- Amel Yaddaden
- École de réadaptation,Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire en Gériatrie de Montréal, Montreal, Canada
| | - Mélanie Couture
- Centre de Recherche et d'Expertise en Gérontologie Sociale, Côte St-Luc, Canada
| | - Mireille Gagnon-Roy
- École de réadaptation,Université de Montréal, Montreal, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - Patricia Belchior
- Centre de Recherche de l'Institut Universitaire en Gériatrie de Montréal, Montreal, Canada.,School of Physical and Occupational Therapy, McGill University, School of Physical & Occupational Therapy, Montreal, Canada
| | - Maxime Lussier
- École de réadaptation,Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire en Gériatrie de Montréal, Montreal, Canada
| | - Carolina Bottari
- École de réadaptation,Université de Montréal, Montreal, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - Sylvain Giroux
- Laboratoire DOMUS, Université de Sherbrooke, Laboratoire DOMUS, Sherbrooke, Canada
| | - Hélène Pigot
- Laboratoire DOMUS, Université de Sherbrooke, Laboratoire DOMUS, Sherbrooke, Canada
| | - Nathalie Bier
- École de réadaptation,Université de Montréal, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire en Gériatrie de Montréal, Montreal, Canada
| |
Collapse
|
14
|
Norris J. Cognitive Function in Cardiac Patients: Exploring the Occupational Therapy Role in Lifestyle Medicine. Am J Lifestyle Med 2020; 14:61-70. [PMID: 31903085 PMCID: PMC6933569 DOI: 10.1177/1559827618757189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/20/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with cardiac dysfunction are at increased risk of mild cognitive impairment, which can affect their ability to successfully engage in daily activities important for home and community safety and in maintaining health and well-being. This risk increases in accordance with the number of cardiac conditions and cardiovascular risk factors or comorbidities. Occupational therapy has a role in chronic disease management in assessing and improving functional abilities affected by physical, emotional, and cognitive domains. With a holistic and client-centered approach, occupational therapy can complement lifestyle medicine principles through promotion and enablement of engagement in purposeful activity and self-management practices. It is suggested that the clinical management of patients with cardiac dysfunction expands beyond the traditional physical aspects of care to encompass cognitive considerations and incorporate occupational therapy in practice.
Collapse
Affiliation(s)
- Jennifer Norris
- Tamworth Rural Referral Hospital, New South Wales,
Australia
| |
Collapse
|
15
|
Schneider CE, Bristol AA, Brody AA. A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-based Settings. CURRENT GERIATRICS REPORTS 2019; 8:291-301. [PMID: 33552845 DOI: 10.1007/s13670-019-00307-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. Purpose of Review The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. Recent Findings One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.
Collapse
Affiliation(s)
- Catherine E Schneider
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010
| | - Alycia A Bristol
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7170
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7341
| |
Collapse
|
16
|
A pilot study of community-based occupational therapy for persons with dementia (COTID-IT Program) and their caregivers: evidence for applicability in Italy. Aging Clin Exp Res 2019; 31:1299-1304. [PMID: 30488182 DOI: 10.1007/s40520-018-1078-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the applicability in Italy of a community-based occupational therapy program (COTID) on occupational performance of persons with dementia and their caregivers. METHODS Prospective cohort study: twenty-seven older persons with mild-to-moderate dementia living in the community and their primary caregivers were included. Ten sessions of occupational therapy over 5 weeks were delivered. Main outcome measures were the level of performance and satisfaction perceived by people with dementia during the participation in significant activities assessed with the Canadian Occupational Performance Measure (COPM); caregiver burden assessed with the sense of competence questionnaire (SCQ). RESULTS The average age of the population was 80.59 ± 8.46 in persons with dementia and 57.78 ± 13.47 in the caregivers. There was a significant improvement in the caregivers' burden in the SCQ (pre treatment 77.19 ± 13.27 vs 82.56 ± 12.57 post treatment; p = .005). Persons with dementia showed a significant improvement in the COPM performance (4.56 ± 1.44 vs 6.68 ± 1.59; p = .000) as well as in the satisfaction (5.08 ± 1.84 vs 7.04 ± 1.71; p = .000). No significant variations were registered in the overall cognitive functions, behavioral and psychological symptoms of dementia, daily functioning, depressive symptoms, perceived quality of life and global health of people with dementia. There was also no difference in the quality of life, global health, depression or burden in the caregivers. CONCLUSIONS The study shows that the COTID program is applicable in the Italian context. The findings suggest a positive effect on patients and caregivers providing a preliminary support for the program implementation at a national level.
Collapse
|
17
|
Evaluation of Person-Centredness in Rehabilitation for People Living with Dementia Is Needed: A Review of the Literature. J Aging Res 2019; 2019:8510792. [PMID: 31192013 PMCID: PMC6525915 DOI: 10.1155/2019/8510792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background With an expected increase in the prevalence of dementia, change in care policies and healthcare systems worldwide is needed. Rehabilitation is increasingly recognised as contributing to dementia care. Rehabilitation subscribes to person-centredness, and thus, evaluations of person-centredness in rehabilitation for people living with dementia are relevant in order for healthcare professionals to know how best to practice person-centredness. Aim The aim of this study was to identify methods of evaluating person-centeredness in rehabilitation for people living with dementia. Materials and Methods Review of the literature using the search terms dementia, person-centredness, and rehabilitation or occupational therapy. Databases searched included: CINAHL, PubMed, Embase, PsycINFO, OTseeker, and SveMed+. The study included peer-reviewed articles from year 2000 to 2018 in Danish, English, Norwegian, or Swedish. Results Only one academic article met the inclusion criteria. In that article, person-centred practice was evaluated using observation and interview as well as analytical frameworks from person-centred care and occupational therapy. Conclusion Evaluations of person-centred practice in rehabilitation for people living with dementia in peer-reviewed literature are lacking. Evaluations are needed to identify effective strategies to pursue and uphold person-centred care. Given the dearth of research on evaluations of person-centredness in rehabilitation, this article included research in person-centred dementia care in the discussion, which potentially can inspire practice and research of rehabilitation for people living with dementia. To understand the complex nature of person-centredness, a variety of research methodologies of qualitative and quantitative characters are recommended for evaluations.
Collapse
|
18
|
Cordier R, Chen Y, Clemson L, Byles J, Mahoney N. Subjective memory complaints and difficulty performing activities of daily living among older women in Australia. Aust Occup Ther J 2018; 66:227-238. [DOI: 10.1111/1440-1630.12548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Reinie Cordier
- School of Occupational Therapy Social Work and Speech Pathology Curtin University Perth Western Australia
| | - Yu‐Wei Chen
- Faculty of Health Sciences University of Sydney Sydney New South Wales
| | - Lindy Clemson
- Faculty of Health Sciences University of Sydney Sydney New South Wales
| | - Julie Byles
- Research Centre for Gender, Health and Ageing Faculty of Health The University of Newcastle Callaghan New South Wales Australia
| | - Natasha Mahoney
- School of Occupational Therapy Social Work and Speech Pathology Curtin University Perth Western Australia
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Rahja M, Comans T, Clemson L, Crotty M, Laver K. Are there missed opportunities for occupational therapy for people with dementia? An audit of practice in Australia. Aust Occup Ther J 2018; 65:565-574. [PMID: 30187917 DOI: 10.1111/1440-1630.12514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Randomised trials have demonstrated that occupational therapy can delay functional decline, improve quality of life and increase leisure participation in people with dementia. However, surveys conducted with occupational therapists suggest that clinical practice does not reflect the type of intervention shown to be effective in research studies. Case note audits can be used to quantify practice and demonstrate how and where provision of care could improve without the potential bias associated with self-report. METHOD A total of 87 occupational therapy case notes were audited from different service contexts in two states in Australia. The case notes were reviewed against criteria including duration of service, assessments conducted and interventions used. Descriptive statistics were used to present the data and examine associations between intervention, age of the person with dementia and whether or not the person lived alone. RESULTS Services tended to be short-term with an average of 2.1 consultations per referral. The most common assessments related to home safety, falls risk and function. Intervention most commonly focussed on referrals to other services, environmental modification advice and assistive device prescription. CONCLUSION This audit reveals that current occupational therapy practice for people with dementia focusses on assessment and management of risk and is usually limited to a couple of consultations. Future work should seek to evaluate if such approaches to care are effective for people with dementia.
Collapse
Affiliation(s)
- Miia Rahja
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, Aging Work and Health Research Unit, The University of Sydney, Lidcombe, New South Wales, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia
| |
Collapse
|
21
|
Abrahams R, Liu KPY, Bissett M, Fahey P, Cheung KSL, Bye R, Chaudhary K, Chu LW. Effectiveness of interventions for co-residing family caregivers of people with dementia: Systematic review and meta-analysis. Aust Occup Ther J 2018. [DOI: 10.1111/1440-1630.12464] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Rebecca Abrahams
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Karen P. Y. Liu
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Michelle Bissett
- School of Allied Health Sciences; Griffith University; Gold Coast QLD Australia
| | - Paul Fahey
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Karen S. L. Cheung
- Mindlink Research Centre; Hong Kong
- Sau Po Center on Ageing; The University of Hong Kong; Hong Kong
| | - Rosalind Bye
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Katrina Chaudhary
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Leung-Wing Chu
- Sau Po Center on Ageing; The University of Hong Kong; Hong Kong
- Division of Geriatric Medicine; Department of Medicine; The University of Hong Kong; Hong Kong
- Alzheimer's Disease Research Network; The University of Hong Kong; Hong Kong
| |
Collapse
|
22
|
Hewitt A, Day S. Life stories support staff and relatives to see, hear and understand people with dementia living in a nursing home as a whole person. Aust Occup Ther J 2018; 65:75-76. [DOI: 10.1111/1440-1630.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Alana Hewitt
- Department of Occupational Therapy; School of Primary and Allied Health Care; Faculty of Medicine, Nursing and Health Sciences, Monash University; Victoria Australia
| | - Sally Day
- Project Manager - COPE Project; Ageing, Work & Health Research Unit; Faculty of Health Sciences; University of Sydney
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|