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Du H, Wang X, Lai X, Wang W, Huo X. Nurses' knowledge, attitude and practice regarding non-pharmacologic interventions for behavioral and psychological symptoms of dementia. BMC Psychiatry 2024; 24:528. [PMID: 39048967 PMCID: PMC11267692 DOI: 10.1186/s12888-024-05962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD). METHODS This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022. RESULTS The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42-2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35-2.51, P = 0.010 vs. ≤30 years-old) and bachelor's degree or higher (β = 1.11, 95%CI = 0.12-2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score. CONCLUSIONS Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China.
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Affiliation(s)
- Hongdi Du
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Wang
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxing Lai
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaopeng Huo
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Kojima K, Hirakawa Y, Yamanaka T, Hirahara S, Okochi J, Kuzuya M, Miura H. Challenges faced by older people with dementia during the COVID-19 pandemic as perceived by professionals: a qualitative study with interviews. Psychogeriatrics 2024; 24:854-860. [PMID: 38769462 DOI: 10.1111/psyg.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Previous studies have highlighted a decline in the mental health of older adults over the course of the coronavirus disease 2019 (COVID-19) pandemic. Few studies have determined the possible causes of behavioural and psychological symptoms of dementia during COVID-19 in a comprehensive manner. We aimed to identify the challenges faced by older adults with dementia during the COVID-19 pandemic. METHODS This study adopted a qualitative approach to understanding the perceptions of healthcare professionals, such as regarding the negative effects of COVID-19 on the mental health of people with dementia. Between January and March 2022, the authors conducted individual in-depth interviews on how COVID-19 affected the stress levels, care, and self-determination of people with dementia. Qualitative data from the individual interviews were data cleansed to ensure the clarity and readability of the transcripts. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach. The grouping process involved reading and comparing individual labels to cluster similar labels into categories and inductively formulate themes. RESULTS Qualitative analysis extracted 61 different semantic units that were duplicated. Seven categories were inductively extracted using a grouping process. These were further integrated to extract the following four themes: fear of personal protective equipment (PPE), loneliness, dissatisfaction with behavioural restrictions and limitations of video calls, and family interference with service use. DISCUSSION People with dementia often faced mental distress during the pandemic owing to preventive measures against COVID-19, and a lack of awareness and understanding of such preventive measures worsened their distress. They experienced a severe sense of social isolation and loneliness. Findings also indicated that families tended to ignore the needs of people with dementia and their decisions and opinions regarding healthcare service use.
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Affiliation(s)
- Kaori Kojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Center for Well-being and Society, Nihon Fukushi University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Health Research and Innovation, Aichi Comprehensive Health Science Center, Chita-gun, Japan
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Hirahara
- Tokyo Fureai Medical Co-op Research & Education Center, Tokyo, Japan
| | - Jiro Okochi
- Geriatric Health Services Faculty Tatsumanosato, Daito, Japan
| | | | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Japan
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Aini N, Chen R, Chu H, Chang CY, Lin HC, Jen HJ, Liu D, Lee TY, Chou KR. The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2024; 32:681-706. [PMID: 38216355 DOI: 10.1016/j.jagp.2023.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD. METHODS A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity. RESULTS A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g = 0.19), wake after sleep onset (Hedges' g = 0.24), sleep efficiency (Hedges' g = 0.31), sleep latency (Hedges' g = 0.35), circadian rhythm (acrophase: Hedges' g = 0.36; amplitude: Hedges' g = 0.43), number of night awakenings (Hedges' g = 0.37), sleep disturbance (Hedges'g = 0.45), and sleep quality (Hedges' g = 0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g = -0.46) with medium-to-large effect on cyclical function (Hedges' g = -0.68) and mood-related signs and symptoms (Hedges' g = -0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g = -0.34) with medium-to-large effect on agitation (Hedges' g = -0.65), affective symptom (Hedges' g = -0.70), psychosis (Hedges' g = -0.72), and melancholic behavior (Hedges' g = -0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g = 0.39). CONCLUSION Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.
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Affiliation(s)
- Nur Aini
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Sciences (NA), University of Muhammadiyah Malang, Indonesia
| | - Ruey Chen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing (RC), College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine (HC), School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology (HC), Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing (DL), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing, Nursing Research Center (TYL), Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center (KRC), Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center (KRC), Taipei Medical University, Taipei, Taiwan.
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Ayeno HD, Kassie GM, Atee M, Nguyen T. PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: A systematic review and qualitative evidence synthesis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1393. [PMID: 38524867 PMCID: PMC10958098 DOI: 10.1002/cl2.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
This is a protocol for a Cochrane Review. The objectives are as follows. This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.
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Affiliation(s)
- Hunduma Dinsa Ayeno
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Department of PharmacyAmbo UniversityAmboEthiopia
| | - Gizat M. Kassie
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Mustafa Atee
- The Dementia Centre, HammondCareOsborne ParkWestern AustraliaAustralia
- Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- School of Nursing and Midwifery, Centre for Research in Aged CareEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
| | - Tuan Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- School of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
- National Ageing Research InstituteMelbourneVictoriaAustralia
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Wong B, Ismail Z, Watt J, Holroyd-Leduc J, Goodarzi Z. Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care. BMC Geriatr 2024; 24:330. [PMID: 38600482 PMCID: PMC11008022 DOI: 10.1186/s12877-024-04919-0] [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: 10/23/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. METHODS This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. RESULTS Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. CONCLUSIONS This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.
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Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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Mangone G, Tosin MHS, Goetz CG, Stebbins GT, Mestre TA. Unveiling Assessment Gaps in Parkinson's Disease Psychosis: A Scoping Review. Mov Disord 2024; 39:560-570. [PMID: 38291860 DOI: 10.1002/mds.29710] [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: 08/10/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Parkinson's disease psychosis (PDP) is a multidimensional construct that is challenging to measure. Accurate assessment of PDP requires comprehensive and reliable clinical outcome assessment (COA) measures. OBJECTIVE To identify PDP measurement gaps in available COAs currently used in clinical and research settings. METHODS We conducted a scoping review using Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. We implemented a three-step search strategy in international databases with keywords related to Parkinson's disease (PD), psychosis, and COA. We analyzed studies using COA to assess PDP, classifying their items according to domains and subdomains. RESULTS From 5673 identified studies, we included 628 containing 432 PDP core items from 32 COAs. Among the 32 COAs, 19 were PD-specific, containing 266 items, constructed as clinician-reported outcomes (ClinRO) (148 items), patient-reported outcomes (PRO) (112 items), and observer-reported outcomes (ObsRO) (six items). Across all PD-specific COAs, regardless of structure, 89.4% of the items from 27 COAs focused primarily on assessing PDP symptoms' severity, and only 9.7% of items probed the impact of PDP on a person's daily functioning. CONCLUSIONS Symptom-based domains are currently prioritized for measuring the severity of PDP, with limited coverage of the functional impact of PDP on patients' lives. Whereas the International Parkinson and Movement Disorder Society has traditionally developed a "Unified" COA that culls items from prior COAs to form a new one, a new COA will largely need newly developed items if the functional impact of PDP is prioritized. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Graziella Mangone
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurology, Centre d'Investigation Clinique Neurosciences, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Parkinson's Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Michelle H S Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tiago A Mestre
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
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Sisti A, Gutman R, Mor V, Dionne L, Rudolph JL, Baier RR, McCreedy EM. Using Structured Observations to Evaluate the Effects of a Personalized Music Intervention on Agitated Behaviors and Mood in Nursing Home Residents With Dementia: Results From an Embedded, Pragmatic Randomized Controlled Trial. Am J Geriatr Psychiatry 2024; 32:300-311. [PMID: 37973488 PMCID: PMC10922136 DOI: 10.1016/j.jagp.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The objective of this research was to determine if a personalized music intervention reduced the frequency of agitated behaviors as measured by structured observations of nursing home (NH) residents with dementia. DESIGN The design was a parallel, cluster-randomized, controlled trial. SETTING The setting was 54 NH (27 intervention, 27 control) from four geographically-diverse, multifacility NH corporations. PARTICIPANTS The participants were 976 NH residents (483 intervention, 493 control) with Alzheimer's disease or related dementias (66% with moderate to severe symptoms); average age 80.3 years (SD: 12.3) and 25.1% were Black. INTERVENTION The intervention was individuals' preferred music delivered via a personalized music device. MEASUREMENT The measurement tool was the Agitated Behavior Mapping Instrument, which captures the frequency of 13 agitated behaviors and five mood states during 3-minute observations. RESULTS The results show that no verbally agitated behaviors were reported in a higher proportion of observations among residents in NHs randomized to receive the intervention compared to similar residents in NHs randomized to usual care (marginal interaction effect (MIE): 0.061, 95% CI: 0.028-0.061). Residents in NHs randomized to receive the intervention were also more likely to be observed experiencing pleasure compared to residents in usual care NHs (MIE: 0.038; 95% CI: 0.008-0.073)). There was no significant effect of the intervention on physically agitated behaviors, anger, fear, alertness, or sadness. CONCLUSIONS The conclusions are that personalized music may be effective at reducing verbally-agitated behaviors. Using structured observations to measure behaviors may avoid biases of staff-reported measures.
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Affiliation(s)
- Anthony Sisti
- Department of Biostatistics (AS, RG, RRB), Brown University School of Public Health, Providence, RI.
| | - Roee Gutman
- Department of Biostatistics (AS, RG, RRB), Brown University School of Public Health, Providence, RI
| | - Vincent Mor
- Center for Gerontology & Healthcare Research (VM, JLR, EMM), Brown University School of Public Health, Providence, RI; Department of Health Services, Policy & Practice (VM, JLR, RRB, EMM), Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation (VM, RRB, EMM), Brown University School of Public Health, Providence, RI; U.S. Department of Veterans Affairs Medical Center (VM, JLR), Providence, RI
| | - Laura Dionne
- Center for Health Promotion and Health Equity (LD), Brown University School of Public Health, Providence, RI
| | - James L Rudolph
- Center for Gerontology & Healthcare Research (VM, JLR, EMM), Brown University School of Public Health, Providence, RI; Department of Health Services, Policy & Practice (VM, JLR, RRB, EMM), Brown University School of Public Health, Providence, RI; U.S. Department of Veterans Affairs Medical Center (VM, JLR), Providence, RI
| | - Rosa R Baier
- Department of Biostatistics (AS, RG, RRB), Brown University School of Public Health, Providence, RI; Department of Health Services, Policy & Practice (VM, JLR, RRB, EMM), Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation (VM, RRB, EMM), Brown University School of Public Health, Providence, RI
| | - Ellen M McCreedy
- Center for Gerontology & Healthcare Research (VM, JLR, EMM), Brown University School of Public Health, Providence, RI; Department of Health Services, Policy & Practice (VM, JLR, RRB, EMM), Brown University School of Public Health, Providence, RI; Center for Long-Term Care Quality & Innovation (VM, RRB, EMM), Brown University School of Public Health, Providence, RI
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Kooijmans ECM, Hoogendijk EO, Pokladníková J, Smalbil L, Szczerbińska K, Barańska I, Ziuziakowska A, Fialová D, Onder G, Declercq A, Finne-Soveri H, Hoogendoorn M, van Hout HPJ, Joling KJ. The prevalence of non-pharmacological interventions in older homecare recipients: an overview from six European countries. Eur Geriatr Med 2024; 15:243-252. [PMID: 37792242 PMCID: PMC10876758 DOI: 10.1007/s41999-023-00868-w] [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: 06/12/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Non-pharmacological interventions (NPIs) play an important role in the management of older people receiving homecare. However, little is known about how often specific NPIs are being used and to what extent usage varies between countries. The aim of the current study was to investigate the prevalence of NPIs in older homecare recipients in six European countries. METHODS This is a cross-sectional study of older homecare recipients (65+) using baseline data from the longitudinal cohort study 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care' (IBenC). The analyzed NPIs are based on the interRAI Home Care instrument, a comprehensive geriatric assessment instrument. The prevalence of 24 NPIs was analyzed in Belgium, Germany, Finland, Iceland, Italy and the Netherlands. NPIs from seven groups were considered: psychosocial interventions, physical activity, regular care interventions, special therapies, preventive measures, special aids and environmental interventions. RESULTS A total of 2884 homecare recipients were included. The mean age at baseline was 82.9 years and of all participants, 66.9% were female. The intervention with the highest prevalence in the study sample was 'emergency assistance available' (74%). Two other highly prevalent interventions were 'physical activity' (69%) and 'home nurse' (62%). Large differences between countries in the use of NPIs were observed and included, for example, 'going outside' (range 7-82%), 'home health aids' (range 12-93%), and 'physician visit' (range 24-94%). CONCLUSIONS The use of NPIs varied considerably between homecare users in different European countries. It is important to better understand the barriers and facilitators of use of these potentially beneficial interventions in order to design successful uptake strategies.
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Affiliation(s)
- Eline C M Kooijmans
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands.
| | - Emiel O Hoogendijk
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jitka Pokladníková
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - Louk Smalbil
- Department of Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV, Amsterdam, The Netherlands
| | - Katarzyna Szczerbińska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Ilona Barańska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Adrianna Ziuziakowska
- Chair of Epidemiology and Preventive Medicine, Laboratory for Research on Aging Society, Medical Faculty, Jagiellonian University Medical College, ul. Skawińska 8, Kraków, Poland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic
| | - Graziano Onder
- Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anja Declercq
- LUCAS-Center for Care Research and Consultancy and Ceso-Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Amsterdam Public Health, Ageing and Later Life, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Rapaport P, Amador S, Adeleke M, Banerjee S, Barber J, Charlesworth G, Clarke C, Connell C, Espie C, Gonzalez L, Horsley R, Hunter R, Kyle SD, Manela M, Morris S, Pikett L, Raczek M, Thornton E, Walker Z, Webster L, Livingston G. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open 2024; 14:e075273. [PMID: 38307536 PMCID: PMC10836385 DOI: 10.1136/bmjopen-2023-075273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives' sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care. METHODS AND ANALYSIS We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1-2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation. ETHICS AND DISSEMINATION London-Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention. TRIAL REGISTRATION NUMBER ISRCTN13072268.
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Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Mariam Adeleke
- Department of Statistical Science, University College London, London, UK
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Georgina Charlesworth
- Division of Psychology and Language Sciences, University College London, London, UK
- North East London NHS Foundation Trust, Rainham, UK
| | | | | | - Colin Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lina Gonzalez
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Sarah Morris
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Liam Pikett
- Division of Psychiatry, University College London, London, UK
| | - Malgorzata Raczek
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Emma Thornton
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
| | - Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
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Kor PPK, Parial LL, Yu CTK, Liu JYW, Liu DPM, Hon JMK. Effects of a Family Caregiver-Delivered MultiSensory Cognitive Stimulation Intervention for Older People With Dementia During Coronavirus 2019: A Randomized Controlled Trial. THE GERONTOLOGIST 2024; 64:gnad054. [PMID: 37179458 DOI: 10.1093/geront/gnad054] [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: 01/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Many community dementia services such as home-visiting services and center-based activities were suspended during the coronavirus 2019 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic. RESEARCH DESIGN AND METHODS This was a 2-arm randomized controlled trial involving 241 patient-caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, and quality of life) and their caregivers (caregiving appraisal, attitudes, and psychological well-being) at postintervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes. RESULTS A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p < .001), behavioral and psychiatric symptoms (p =. 027), and quality of life (p =.001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p = .008; p = .049) and decreased negative attitudes toward people with dementia (p =. 013; p < .001) at both T1 and T2. There were nonsignificant changes in the caregivers' perceived burden, distress, and psychological well-being. DISCUSSION AND IMPLICATIONS Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers. CLINICAL TRIAL REGISTRATION NUMBER NCT03803592.
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Affiliation(s)
- Patrick Pui Kin Kor
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Clare Tsz Kiu Yu
- Division of Psychiatry, University of College London, London, UK
| | - Justina Yat Wah Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Denise Pik Mei Liu
- Ming Yue District Elderly Community Centre, Hong Kong Young Women's Christian Association, Hong Kong SAR, China
| | - Joan Mo King Hon
- Hong Kong Young Women's Christian Association, Hong Kong SAR, China
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11
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Appel L, Appel E, Kisonas E, Lewis-Fung S, Pardini S, Rosenberg J, Appel J, Smith C. Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT). J Med Internet Res 2024; 26:e51758. [PMID: 38289666 PMCID: PMC10865216 DOI: 10.2196/51758] [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: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings. OBJECTIVE The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience. METHODS A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method. RESULTS VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy. CONCLUSIONS Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. TRIAL REGISTRATION ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22406.
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Affiliation(s)
- Lora Appel
- School of Health Policy and Management, Faculty of Health, York Universtiy, Toronto, ON, Canada
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Michael Garron Hospital, Toronto, ON, Canada
| | - Eva Appel
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Erika Kisonas
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Samantha Lewis-Fung
- OpenLab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | | | - Julian Appel
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
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12
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Peng Y, Liu Y, Guo Z, Zhang Y, Sha L, Wang X, He Y. Doll therapy for improving behavior, psychology and cognition among older nursing home residents with dementia: A systematic review and meta-analysis. Geriatr Nurs 2024; 55:119-129. [PMID: 37980780 DOI: 10.1016/j.gerinurse.2023.10.025] [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: 09/01/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To explore the effectiveness of doll therapy (DT) on behavior, psychology and cognition among older nursing home residents with dementia. METHODS A systematic review and meta-analysis was conducted. Subgroup analyses were performed to determine whether the intervention characteristics influenced effect sizes. RESULTS Ten studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high. DT significantly improved all behaviors [SMD=-0.42, P=0.01], including agitation [SMD=-0.94, P<0.001], apathy, irritability and wandering, and psychological states (i.e., pleasure, anxiety and depression). However, there was no significant difference in the improvement of cognition. Subgroup analyses revealed that the DT process employing empathy dolls and coordinating with caregivers was more beneficial for improving all behaviors (P=0.01; P=0.02). CONCLUSION DT significantly reduced behavioral and psychological disturbances among older nursing home residents with dementia. Specifically, administering empathy dolls and coordinating with caregivers may be the most appropriate and effective option.
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Affiliation(s)
- Yu Peng
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang Liu
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhongxian Guo
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yuhan Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Liyan Sha
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Xiaorun Wang
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang He
- School of Nursing, Dalian Medical University, Dalian, Liaoning, China
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13
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Mar J, Zubiagirre U, Larrañaga I, Soto-Gordoa M, Mar-Barrutia L, González-Pinto A, Ibarrondo O. Disparities by Socioeconomic Status and Diagnosis of Dementia in the Prescribing of Antipsychotics in a Real-World Data Population Over 60 Years of Age. J Alzheimers Dis 2024; 100:645-655. [PMID: 38943388 PMCID: PMC11307046 DOI: 10.3233/jad-240004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 07/01/2024]
Abstract
Background Antipsychotics are widely used in the elderly due to the high prevalence of neuropsychiatric associated with dementia. Objective To analyze potential disparities in antipsychotic use in the general population of Gipuzkoa by socioeconomic status (SES) and diagnosis of Alzheimer's disease and related dementia (ADRD) adjusting for somatic and psychiatric comorbidities, age, and sex. Methods A retrospective observational study was carried out in all the 221,777 individuals over 60 years of age (Gipuzkoa, Spain) to collect diagnosis of ADRD, the Charlson Comorbidity Index, and psychiatric comorbidities considering all primary, outpatient, emergency and inpatient care episodes and first- and second-generation antipsychotics, and sociodemographic variables, namely, age, sex, SES and living in a nursing home. Logistic regression was used for multivariate statisticalanalysis. Results Use of any antipsychotic was greater in women, individuals over 80 years old, living in a nursing home, with a diagnosis of dementia, somatic and psychiatric comorbidities, and low SES. Quetiapine was the most used drug. The likelihood of any antipsychotic use was significantly associated with low SES (odds ratio [OR]: 1.60; confidence interval [CI]: 1.52-1.68), age over 80 years (OR: 1.56; CI: 1.47-1.65), institutionalization (OR: 12.61; CI: 11.64-13.65), diagnosis of dementia (OR: 10.18; CI: 9.55-10.85) and the comorbidities of depression (OR: 3.79; CI: 3.58-4.01) and psychosis (OR: 4.96; CI: 4.64-5.30). Conclusions The greater levels of antipsychotic use and institutionalization in people of low SES indicate inequity in the management of neuropsychiatric symptoms. Increasing the offer of non-pharmacological treatments in the health system might help reduce inequity.
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Affiliation(s)
- Javier Mar
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain
- Biosistemak Institute for Health Service Research, Barakaldo, Spain
| | - Uxue Zubiagirre
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain
| | - Igor Larrañaga
- Biosistemak Institute for Health Service Research, Barakaldo, Spain
| | - Myriam Soto-Gordoa
- Electronics and Computing Department, Faculty of Engineering, Mondragon University, Mondragon, Gipuzkoa, Spain
| | - Lorea Mar-Barrutia
- Department of Psychiatry, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Oliver Ibarrondo
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Spain
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14
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Trudeau SA, Slotnick SD, Gately ME. Can Residents With Late-Stage Dementia Still Engage? Am J Alzheimers Dis Other Demen 2024; 39:15333175241228383. [PMID: 38262932 PMCID: PMC10807356 DOI: 10.1177/15333175241228383] [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] [Indexed: 01/25/2024]
Abstract
Institutionalized persons with dementia often lack access to meaningful activity, which can lead to agitation, loneliness, and depression. Engagement in activity may improve negative symptoms but is difficult in most settings. In this study, we investigated the degree to which the Reading Buddies Program, in which occupational therapy graduate students read books with residents with dementia, engaged residents. We further assessed whether the level of engagement was affected by various parameters, including those related to interaction, environment, attention, attitude, and activity. The primary outcome measure was engagement percentage-duration of time the book was read divided by duration of time the person with dementia engaged with the book. As expected, increased attention, attitude, and activity parameters were associated with increased engagement. None of the environmental parameters significantly affected engagement. Overall, we found that reading with persons with dementia led to a very high level of engagement and appeared to reduce negative symptoms.
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Affiliation(s)
- Scott A. Trudeau
- American Occupational Therapy Association, Bethesda, MD, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
- Geriatric Research Education and Clinical Center (GRECC), VA Bedford Health Care System, Bedford, MA, USA
| | - Scott D. Slotnick
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, USA
| | - Megan E. Gately
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
- Geriatric Research Education and Clinical Center (GRECC), VA Bedford Health Care System, Bedford, MA, USA
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15
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Baird C, Miller H, Hoti K, Hughes J. Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program. Front Psychiatry 2023; 14:1191105. [PMID: 38144480 PMCID: PMC10748381 DOI: 10.3389/fpsyt.2023.1191105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Background To better meet the needs of people living with advanced dementia, Orchard Care Homes, United Kingdom have established an enhanced person focused program, namely the Reconnect program, which provides an enriched psycho-social care to enhance peoples' quality of life and well-being. Here we aimed to review the impact of this program on people living with dementia. Methods In this study the implementation of the Reconnect program was evaluated for two six-month periods (April-September 2020 and April-September 2021). The focus of this evaluation was on three key interventions: increasing meaningful occupation and engagement; improving pain identification and management, and reducing constipation. The Reconnect program was conducted in a single for-profit care home. It involved residents with complex dementia needs who previously not responded to support in alternative settings or found previous care ineffective in relieving their distress and reducing risks they pose to themselves or others. Results A total of 24 people participated in the program during this evaluation. We observed a substantial increase in engagement in meaningful activity per person, including an increase of outdoor access to fresh air. Pain management improved as evidenced by more standardized pain assessments using the PainChek system and coverage of people with either regular and/or "when required" pain management. Constipation relief also improved. For the two comparison periods, distress responses per resident reduced from 14.5 to 10.6 events and use of regular pain relief increased from 21.7 to 48.1%. Use of "when required" benzodiazepine halved from 6 months average of 46 to 23.2 doses given. Benzodiazepine dose reductions increased from 13.3 to 31.8%, while cessations increased from 20 to 50%. We also observed a reduction from 76.3 to 56.3% in antipsychotic use. Their dose reductions increased from 8.3 to 40% and drug cessation was made in 30% of people using antipsychotics (compared to the first period in which no medication cessation was observed). A 91.7% reduction (i.e., from 36 to 3 events) in safeguarding events related to behaviors was also observed. Conclusion Introduction of the Reconnect program, through its interventions focused on meaningful activity engagement, pain management and constipation relief resulted in substantial improvements related to people's distress, safeguarding and psychotropic use.
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Affiliation(s)
| | | | - Kreshnik Hoti
- Faculty of Medicine, University of Prishtina, Pristina, Albania
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Jeffery Hughes
- Faculty of Medicine, University of Prishtina, Pristina, Albania
- PainChek Ltd., Sydney, NSW, Australia
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16
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Ma G, Ma X. Music Intervention for older adults: Evidence Map of Systematic Reviews. Medicine (Baltimore) 2023; 102:e36016. [PMID: 38050267 PMCID: PMC10695625 DOI: 10.1097/md.0000000000036016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND With the increasing aging population, the health problems of the elderly have received increasing attention. As a non-pharmacological interventions, music intervention has been widely used in clinical practice to improve the physical and mental health of the elderly. This article aims to provide a comprehensive review of existing systematic reviews on the health effects of music interventions for older adults in clinical practice. METHODS The study utilized the evidence map methodology, which involved identifying all relevant systematic reviews, meta-analysis from 7 electronic databases from their inception to November 2022. The studies were analyzed using AMSTAR 2. RESULTS The researchers identified 67 studies, with the majority published in the past 5 years. The effects of music interventions were categorized into 4 groups of health outcomes: positive (58 results), potentially positive (4 results), inconclusive (2 results), and no effect (3 results). The health outcomes were further classified into 5 groups: psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being. CONCLUSIONS The study revealed that music interventions for older adults can have positive or potentially positive effects on health outcomes, encompassing psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being. However, some studies yielded inconclusive or no effect. The study offers valuable insights for healthcare professionals and serves as a visual resource to access evidence-based information on the use of music interventions in promoting health and addressing various conditions in older adults.
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Affiliation(s)
- Guiyue Ma
- School of Nursing, Anhui University of Chinese Medicine, Hefei, China
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoqin Ma
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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17
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Vaillant-Ciszewicz AJ, Lantermino L, Quin C, Cuni A, Guerin O. [Setting up, running and evaluating NMIs as part of the "ageing well" project]. SOINS. GERONTOLOGIE 2023; 28:13-23. [PMID: 37977760 DOI: 10.1016/j.sger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
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Affiliation(s)
| | | | - Cassandra Quin
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Alice Cuni
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Olivier Guerin
- Inserm U1081, IRCAN, CNRS UMR 7284, Université Côte-d'Azur, CHU de Nice, 4 avenue Reine-Victoria, 06000 Nice, Alpes-Maritimes, France
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18
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Ajra Z, Xu B, Dray G, Montmain J, Perrey S. Using shallow neural networks with functional connectivity from EEG signals for early diagnosis of Alzheimer's and frontotemporal dementia. Front Neurol 2023; 14:1270405. [PMID: 37900600 PMCID: PMC10602655 DOI: 10.3389/fneur.2023.1270405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Dementia is a neurological disorder associated with aging that can cause a loss of cognitive functions, impacting daily life. Alzheimer's disease (AD) is the most common cause of dementia, accounting for 50-70% of cases, while frontotemporal dementia (FTD) affects social skills and personality. Electroencephalography (EEG) provides an effective tool to study the effects of AD on the brain. Methods In this study, we propose to use shallow neural networks applied to two sets of features: spectral-temporal and functional connectivity using four methods. We compare three supervised machine learning techniques to the CNN models to classify EEG signals of AD / FTD and control cases. We also evaluate different measures of functional connectivity from common EEG frequency bands considering multiple thresholds. Results and discussion Results showed that the shallow CNN-based models achieved the highest accuracy of 94.54% with AEC in test dataset when considering all connections, outperforming conventional methods and providing potentially an additional early dementia diagnosis tool.
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Affiliation(s)
- Zaineb Ajra
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Binbin Xu
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Ales, France
| | - Gérard Dray
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Ales, France
| | - Jacky Montmain
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Ales, France
| | - Stéphane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
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Julião M, Bruera E, Silva C, Calado J, Cruz M, Vaz M, Paiva BSR. "Mãos de Conforto" (Hands of Comfort): A novel non-pharmacological intervention to ease agitation in elderly persons with dementia. Palliat Support Care 2023; 21:946-952. [PMID: 36788747 DOI: 10.1017/s147895152300007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Behavioral symptoms associated with dementia, such as agitation, are frequent and associated with well-known negative consequences for patients, their carers, and their environment. Pharmacological treatments for agitation using sedatives and antipsychotics are known to have several undesirable side effects and modest efficacy. Non-pharmacological alternatives are recommended as first-line options for agitation in persons with dementia with few side effects, but there is limited evidence of efficacy. We developed a novel and simple non-pharmacological alternative for agitation in dementia residents based on a Brazilian intervention using warm water surgical gloves used in patients with COVID-19 in intensive care units during the pandemic. We coined it "Mãos de Conforto" - Hands of Comfort. We report a series of 7 cases in 3 residents with dementia who whore Hands of Comfort.
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Affiliation(s)
- Miguel Julião
- Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Rio de Mouro, Portugal
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - José Calado
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Mário Cruz
- Inválidos do Comércio IPSS, Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona, Lisboa, Portugal
- USF Tapada, ACeS Sintra, Sintra, Portugal
| | - Marília Vaz
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- Research Group on Palliative Care and Health-Related Quality of Life, Barretos Cancer, Hospital - Barretos (SP), São Paulo, Brazil
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Rommerskirch-Manietta M, Manietta C, Purwins D, Braunwarth JI, Quasdorf T, Roes M. Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia-a scoping review. Implement Sci Commun 2023; 4:104. [PMID: 37641142 PMCID: PMC10463361 DOI: 10.1186/s43058-023-00486-4] [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] [Received: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. METHODS We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). RESULTS We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. CONCLUSIONS We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. TRIAL REGISTRATION The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany.
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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21
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Chen YR, Huang WY, Lee TY, Chu H, Chiang KJ, Jen HJ, Liu D, Chen R, Kang XL, Lai YJ, Chou KR. Efficacy of Blue LED Phototherapy on Sleep Quality and Behavioral and Psychological Symptoms of Dementia: A Double-Blind Randomized Controlled Trial. Gerontology 2023; 69:1175-1188. [PMID: 37527625 DOI: 10.1159/000531968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION People with dementia often experience behavioral and psychological symptoms of dementia (BPSD), which are a major cause of caregiver burden and institutionalization. Therefore, we conducted a double-blind, parallel-group randomized controlled trial to examine the efficacy of blue-enriched light therapy for BPSD in institutionalized older adults with dementia. METHODS Participants were enrolled and randomly allocated into blue-enriched light therapy (N = 30) or the conventional light group (N = 30) for 60 min in 10 weeks with five sessions per week. The primary outcome was sleep quality measured by actigraphy and Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was overall BPSD severity (Cohen-Mansfield Agitation Inventory [CMAI] and Neuropsychiatric Inventory [NPI-NH]). The outcome indicators were assessed at baseline, mid-test, immediate posttest, 1-month, 3-month, and 6-month follow-up. The effects of the blue-enriched light therapy were examined by the generalized estimating equation model. RESULTS Blue-enriched light therapy revealed significant differences in the objective sleep parameters (sleep efficiency: β = 5.81, Waldχ2 = 32.60, CI: 3.82; 7.80; sleep latency: β = -19.82, Waldχ2 = 38.38, CI:-26.09; -13.55), subjective sleep quality (PSQI: β = -2.07, Waldχ2 = 45.94, CI: -2.66; -1.47), and overall BPSD severity (CMAI: β = -0.90, Waldχ2 = 14.38, CI: -1.37; -0.44) (NPI-NH: β = -1.67, Waldχ2 = 30.61, CI: -2.26; -1.08) compared to conventional phototherapy immediate posttest, 1-month, 3-month, and 6-month follow-up. Furthermore, the effects for sleep efficiency and sleep latency lasted for up to 6 months. In the subscale analysis, the differences of the behavioral symptoms changed significantly between the groups in physical/nonaggressive (CI: -1.01; -0.26) and verbal/nonaggressive (CI: -0.97; -0.29). CONCLUSIONS Blue-enriched light therapy is a feasible low-cost intervention that could be integrated as a comprehensive therapy program for BPSD among older adults with dementia.
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Affiliation(s)
- Ying-Ren Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yu Huang
- Department of Nursing, Taipei Veterans General Hospital, Yuanshan Branch, I-lan, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Philadelphia, USA
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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22
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Stella F, Radanovic M, Gallucci-Neto J, Forlenza OV. Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review. Dement Neuropsychol 2023; 17:e20230007. [PMID: 37533598 PMCID: PMC10392879 DOI: 10.1590/1980-5764-dn-2023-0007] [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: 01/26/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 08/04/2023] Open
Abstract
Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention. Results We selected 19 studies (156 patients; 64.1% women; 51-98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time. Conclusions Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.
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Affiliation(s)
- Florindo Stella
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Psiquiatria, LIM-27, São Paulo SP, Brazil
- Universidade Estadual Paulista, Instituto de Biociências, Rio Claro SP, Brazil
| | - Márcia Radanovic
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Psiquiatria, LIM-27, São Paulo SP, Brazil
| | - José Gallucci-Neto
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Psiquiatria, Serviço de ECT, São Paulo SP, Brazil
| | - Orestes Vicente Forlenza
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Psiquiatria, LIM-27, São Paulo SP, Brazil
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Pessoa RMDP, Maximiano-Barreto MA, Lambert L, Leite ÉDM, Chagas MHN. The frequency of psychotic symptoms in types of dementia: a systematic review. Dement Neuropsychol 2023; 17:e20220044. [PMID: 37223834 PMCID: PMC10202325 DOI: 10.1590/1980-5764-dn-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 05/25/2023] Open
Abstract
The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.
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Affiliation(s)
- Rebeca Mendes de Paula Pessoa
- Universidade de São Paulo, Departamento de Neurociências e do Comportamento, Ribeirão Preto SP, Brazil
- Universidade Federal de São Carlos, Grupo de Estudos e Pesquisas em Saúde Mental, Cognição e Envelhecimento, São Carlos SP, Brazil
| | - Madson Alan Maximiano-Barreto
- Universidade Federal de São Carlos, Grupo de Estudos e Pesquisas em Saúde Mental, Cognição e Envelhecimento, São Carlos SP, Brazil
| | | | - Érica Dayanne Meireles Leite
- Universidade de São Paulo, Departamento de Neurociências e do Comportamento, Ribeirão Preto SP, Brazil
- Universidade Federal de São Carlos, Grupo de Estudos e Pesquisas em Saúde Mental, Cognição e Envelhecimento, São Carlos SP, Brazil
| | - Marcos Hortes Nisihara Chagas
- Universidade de São Paulo, Departamento de Neurociências e do Comportamento, Ribeirão Preto SP, Brazil
- Universidade Federal de São Carlos, Grupo de Estudos e Pesquisas em Saúde Mental, Cognição e Envelhecimento, São Carlos SP, Brazil
- Instituto Bairral de Psiquiatria, Itapira SP, Brazil
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Complementary and integrative medicines for behavioral and psychological symptoms of dementia: Overview of systematic reviews. Explore (NY) 2023; 19:176-194. [PMID: 35973932 DOI: 10.1016/j.explore.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSDs) are major contributing factors to disease burden in dementia patients. Complementary and integrative medicine (CIM) has received attention in the management of dementia in patients with BPSDs. This overview aimed to comprehensively and critically review previous systematic reviews (SRs) of CIM modalities for BPSD management. METHODS Thirteen databases were searched in November 2021 to identify SRs on CIM for BPSDs. The methodological quality of the included studies was assessed using A MeaSurement Tool to Assess systematic Reviews 2. RESULTS Among 38 SRs, aromatherapy was the most commonly studied intervention, followed by herbal medicine (HM), acupuncture/acupressure, mindfulness-based interventions, relaxation, and Taichi. Half of the studies on aromatherapy reported significantly improved BPSDs, especially agitation, while the remainder reported mixed results/insufficient evidence. Most studies (85.71%) on HM supported its significant benefits in BPSDs. Yokukansan, an individual HM, was most frequently studied for BPSDs, with a significant beneficial effect on delusions, hallucinations, and agitation/aggression. Moreover, some meta-analyses supported the benefits of HM as an adjunct to psychotropic drugs in BPSD management. Other CIM interventions had insufficient clinical evidence. The methodological quality of the included studies was poor, and most were rated low or critically low (92.11%). CONCLUSION Aromatherapy, the most frequently investigated CIM for BPSD, had mixed results or insufficient evidence. HM, as an adjunct to psychotropic drugs including antipsychotics, exhibited additional benefits regarding the efficacy and safety for BPSDs. This overview emphasizes the requirement for greater quantity and quality of research in this field. REGISTRATION NUMBER Open Science Framework registry (g5f3m) (https://osf.io/g5f3m), PROSPERO (CRD42020211009) (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211009).
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Talebzadeh A, Decoutere I, Vander Mynsbrugge T, Botteldooren D, Devos P, Aletta F, Van de Velde D, De Vriendt P. The Influence of Everyday Acoustic Environments on the Challenging Behavior in Dementia: A Participatory Observation Study in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4191. [PMID: 36901204 PMCID: PMC10002302 DOI: 10.3390/ijerph20054191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Challenging behavior (CB) is a group of behaviors, reactions and symptoms due to dementia, which can be challenging for the caregivers. The study aims to research the influence of acoustics on CB in people with dementia (PwD). An ethnographic method was used to study the daily life of PwD in their nursing homes with a specific focus on how people react to everyday environmental sounds. Thirty-five residents were included in the sample based on purposeful, homogeneous group characteristics and sampling. Empirical data were collected using 24/7 participatory observations. The collected data were analyzed using a phenomenological-hermeneutical method: a naïve understanding, a structural analysis and a comprehensive understanding. The result shows that the onset of CB depends on whether the resident feels safe and is triggered by an excess or lack of stimuli. The excess or shortage of stimuli and whether and when it affects a person is personal. It depends on various factors, the person's state and the time of day, the nature of the stimuli, familiarity, or strangeness is also a determining factor for the onset and progression of CB. The results can form an essential basis for developing soundscapes to make the PwD feel safe and reduce CB.
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Affiliation(s)
- Arezoo Talebzadeh
- Department of Information Technology, WAVES—iGent, Ghent University, 9000 Ghent, Belgium
| | - Ine Decoutere
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Care Sciences, Ghent University, 9000 Ghent, Belgium
| | - Tara Vander Mynsbrugge
- Occupational Therapy Department, Artevelde University of Applied Sciences, 9000 Ghent, Belgium
| | - Dick Botteldooren
- Department of Information Technology, WAVES—iGent, Ghent University, 9000 Ghent, Belgium
| | - Paul Devos
- Department of Information Technology, WAVES—iGent, Ghent University, 9000 Ghent, Belgium
| | - Francesco Aletta
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Care Sciences, Ghent University, 9000 Ghent, Belgium
- Occupational Therapy Department, Artevelde University of Applied Sciences, 9000 Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Care Sciences, Ghent University, 9000 Ghent, Belgium
- Occupational Therapy Department, Artevelde University of Applied Sciences, 9000 Ghent, Belgium
- Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Vrije Universiteit, 1050 Brussel, Belgium
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Everly J, Plummer J, Lohman M, Neils-Strunjas J. A Tutorial for Speech-Language Pathologists: Physical Activity and Social Engagement to Prevent or Slow Cognitive Decline in Older Adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:83-95. [PMID: 36450149 DOI: 10.1044/2022_ajslp-22-00035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This tutorial provides an overview of two behavioral approaches, physical activity and social engagement, to prevent or slow cognitive decline in older adults and to increase awareness in the field of speech-language pathology of the important role that speech-language pathologists (SLPs) play in an interprofessional team working with this population. METHOD A review of exercise science, neuroscience, and social science literature was used to synthesize evidence and to outline the impact of physical activity and social engagement on cognition. The following topics were explored: How do exercise and social engagement support cognition? What are modifiable risk factors of dementia? What is the impact of inactivity and isolation on cognition? What is the potential role of the SLP on an interprofessional team focusing on preventive measures for cognitive decline? What is the impact of physical exercise and social engagement on nursing home residents? RESULTS Research increasingly points to the critical importance of physical activity and social engagement to prevent cognitive decline in normal aging and to slow cognitive decline associated with mild cognitive impairment and dementia. Research suggests that physical activity maintains or improves memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function. Social engagement has been found to maintain and improve general cognitive function. CONCLUSIONS Behavioral interventions are an effective strategy to prevent or slow cognitive decline in the older adult population. SLPs have a role to play on an interprofessional team that works to prevent cognitive decline. By considering factors that play a role in the prevention of cognitive decline, such as physical activity and social engagement, the quality of life and overall health of older adults can be improved. Areas of improvement include memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function.
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Affiliation(s)
- Janet Everly
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jamie Plummer
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
| | - Matthew Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia
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Liao YJ, Jao YL, Boltz M, Adekeye OT, Berish D, Yuan F, Zhao X. Use of a Humanoid Robot in Supporting Dementia Care: A Qualitative Analysis. SAGE Open Nurs 2023; 9:23779608231179528. [PMID: 37324571 PMCID: PMC10265350 DOI: 10.1177/23779608231179528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Cognitive impairment significantly affects independence in persons with dementia, and consistent supervision is often needed. While interest has arisen in using humanoid robots, such as Pepper, to assist with daily caregiving activities, little is known about the perceptions of using Pepper to assist people with dementia. Objective This study aimed to explore the perceptions of nonhealthcare workers, care partners, and healthcare workers on the use of a Pepper robot in dementia care. Methods This was a secondary qualitative analysis. Data were collected from a pilot study conducted from November 2020 to March 2021 using an online survey. The survey consisted of quantitative and qualitative questions; this study only focused on the qualitative responses. The detailed procedures and the quantitative results were published elsewhere. Participants included nonhealthcare workers, care partners, and healthcare workers. Results A total of 194 participants responded to the open-ended question. Participants described potential benefits of Pepper including assisting with daily activities, monitoring safety and medication use, initiating reminders, and promoting activities and social interactions. Participants had concerns about privacy, cost, poor acceptance/trust, Pepper making mistakes, limitations in environmental navigation and responding to emergencies, misuse of Pepper, and Pepper replacing humans. Participants suggested that Pepper should be tailored to each individual's background, preferences, and functions and recommended improving the logistics of using Pepper, offering more emotional support and responses, and using a more natural appearance and voice. Conclusion Pepper may support dementia care; yet some concerns need to be addressed. Future research should consider incorporating these comments when designing robots for dementia care.
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Affiliation(s)
- Yo-Jen Liao
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Ying-Ling Jao
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Marie Boltz
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Olayemi Timothy Adekeye
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Diane Berish
- Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA, USA
| | - Fengpei Yuan
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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Midorikawa H, Ekoyama S, Tachikawa H, Ota M, Tamura M, Takahashi T, Sekine A, Ide M, Matsuzaki A, Nemoto M, Nemoto K, Arai T. Association between behavioural and psychological symptoms of dementia and residence status in patients with Alzheimer's disease. Psychogeriatrics 2023; 23:45-51. [PMID: 36289565 DOI: 10.1111/psyg.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Examining the relationship between the behavioural and psychological symptoms of dementia (BPSD) and residence status is crucial to improving BPSD and reducing the burden on caregivers. However, studies on how BPSD differ between individuals living at home and those in institutional settings are lacking. We conducted a questionnaire survey among healthcare providers (HCPs) involved in dementia care and nursing to clarify the characteristics of BPSD by residence status in patients with Alzheimer's disease (AD) living at home or in facilities. METHODS We sent questionnaires to HCPs and asked them to answer questions on up to five cases that needed treatment for BPSD and who received long-term care insurance services from 1 April 2016 to 31 March 2017. Responses were received for 371 cases, of which 130 diagnosed with AD were analyzed. The patients were divided into two groups: patients with AD living at home (home care group) and patients with AD living in facilities (facility care group). A Chi-square test was used to identify differences between the two groups. A binomial logistic regression analysis was also conducted to clarify the association between residence status and BPSD. RESULTS Of the 130 patients, 72 lived at home (home care group) and 58 resided in facilities (facility care group). None of the background factors was significantly different between the two groups. The Chi-square test indicated that sleep disturbance was significantly more common in the facility care group (60.3% in the facility care group vs. 33.3% in the home care group, P = 0.003), while the logistic regression analysis indicated that sleep disturbance was significantly associated with residence status (odds ratio: 2.529, P = 0.038). CONCLUSIONS Sleep disturbances were more frequently observed among patients with AD living in institutions than among those living in their homes.
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Affiliation(s)
- Haruhiko Midorikawa
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Saori Ekoyama
- University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Miho Ota
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Tamura
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takumi Takahashi
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Aya Sekine
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Masayuki Ide
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Asaki Matsuzaki
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Miyuki Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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Is Living with Persons with Dementia and Depression Correlated to Impacts on Caregivers? A Scoping Review. Can J Aging 2022; 41:540-549. [PMID: 35314007 DOI: 10.1017/s071498082100060x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Caregivers of persons with dementia and depression experience adverse effects associated with their role. The aim of this scoping review was to identify the challenges faced by caregivers of people with dementia and depression, along with interventions to support them. The MEDLINE®, Embase and PsycINFO databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Grey literature was assessed using the Canadian Agency for Drugs and Technologies in Health's Gray Matter tool.The population consisted of caregivers of people with dementia and depression; the concept was to identify the negative impacts that caregivers experience and whether there are interventions to reduce them; the context was any study design targeting family or friends who were caregivers. A total of 12,835 citations were identified; 139 studies were included. Dementia and depression have variable impacts on outcomes experienced by caregivers, including burden/strain (n = 52), depression (n = 27), distress (n = 53), quality of life (n = 5) and health/well-being (n = 9). Pharmacological and non-pharmacological interventions have mixed effects. This study is important considering that depression in people with dementia is associated with caregiver distress. The use of a variety of non-pharmacological interventions could be beneficial to the latter.
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Shryock SK, Meeks S. Activity, Activity Personalization, and Well-Being in Nursing Home Residents With and Without Cognitive Impairment: An Integrative Review. Clin Gerontol 2022; 45:1058-1072. [PMID: 33218291 DOI: 10.1080/07317115.2020.1844356] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes. RESULTS After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences. CONCLUSIONS Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents. CLINICAL IMPLICATIONS Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.
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Chadwick C, Hussain A, Carone L, Yates J, Dening T. Going for gold: Sports and exercise groups for people with dementia and carers contribute to their well-being. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:953822. [DOI: 10.3389/fresc.2022.953822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022]
Abstract
BackgroundInterventions involving exercise appear to have positive effects, both for people with dementia and for their carers. Quality of life and well-being are especially important outcomes. This study investigated how a sports and exercise group for people with dementia and their carers could contribute to the well-being of those attending the group.MethodsThe study was a qualitative investigation, comprising semi-structured interviews, a focus group and observations. Participants included people with dementia and carers attending the group sessions, as well as staff providing the programme. The group sessions were provided weekly by the charitable trust of a leading sports venue. Data were analysed using thematic analysis.ResultsA total of 16 participants were interviewed, including four people with dementia, eight carers, and four members of staff. Five main themes were identified: “Support to keep active and engaged is highly valued by people with dementia and carers”; “The challenges of being a carer are significant but sharing the experience really helps”; “People with dementia can have flourishing social lives”; “The group helps to maintain identity despite physical and role changes”; and “There are practical aspects of the group that make it appealing”.DiscussionPeople with dementia enjoy physical activity and experience the benefits of it. The sports and exercise group had an important role in providing access to activities that people with dementia and their carers value and enjoy, but would be difficult to undertake without a facilitated and safe environment. The group benefited the well-being of both people with dementia and carers in various ways, with peer support being of particular importance for carers.
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Vuic B, Konjevod M, Tudor L, Milos T, Nikolac Perkovic M, Nedic Erjavec G, Pivac N, Uzun S, Mimica N, Svob Strac D. Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia. Expert Rev Neurother 2022; 22:707-720. [PMID: 35950234 DOI: 10.1080/14737175.2022.2112668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy. AREAS COVERED This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD. EXPERT OPINION Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.
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Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10 000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka cesta 54, 10000 Zagreb, Croatia
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Menezes AC, Drumond G, Shigaeff N. Dance therapy and cognitive impairment in older people: A review of clinical data. Dement Neuropsychol 2022; 16:373-383. [DOI: 10.1590/1980-5764-dn-2021-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/10/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The growing interest for nonpharmacological treatment alternatives to older people with mild cognitive impairment or dementia has increased exponentially for the past few years; in this context, dance therapy is an effective therapeutic tool in improving the cognition of older people. The aim of this study was to verify whether dance therapy is a viable tool in promoting benefits with regard to the cognition and mood of older people with cognitive impairment. A database search covering the past 10 years was carried out. Result: The search found 193 papers; after title, abstract, and duplicity analysis, 14 of those were selected, of which 10 were fully revised. The studies showed positive results regarding the improvement of cognitive function after dance stimulations, as well as beneficial effects on the mood of older people with cognitive impairment.
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Affiliation(s)
- Ana Clara Menezes
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Gabrielle Drumond
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
| | - Nadia Shigaeff
- Universidade Federal de Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora, Brazil
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34
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Mougias AA, Christidi F, Kontaxopoulou D, Zervou M, Kostoglou D, Vlami MA, Dimitriou M, Politis A. A Multicomponent Home-Based Intervention for Neuropsychiatric Symptoms in People With Dementia and Caregivers' Burden and Depression: A 6-Month Longitudinal Study. J Geriatr Psychiatry Neurol 2022; 35:535-543. [PMID: 34151638 DOI: 10.1177/08919887211023593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many people with dementia live in their home and require ongoing care, which is often provided by informal family caregivers. Thus, we examined the effectiveness of a multicomponent home-based intervention by evaluating its impact on a) neuropsychiatric symptoms of people with dementia and b) burden and depression of their caregivers. METHODS During the first 6 months of this prospective single-center study, we applied a home-based multicomponent intervention in 205 dyads of care-recipients and caregivers. In further analyzes, we included only dyads of caregivers and care-recipients with available data both at baseline and 6-month follow-up (N = 144). All assessments were conducted at home and included sociodemographic features, care-recipients' clinical data, cognitive status (Mini-Mental State Examination), activities of daily living (Instrumental Activities of Daily Living; Katz Index of Independence in Activities of Daily Living), neuropsychiatric symptoms (Neuropsychiatric Inventory), and caregivers' burden (Zarit Burden Inventory) and depression (Center for Epidemiological Studies-Depression). RESULTS We found significant decreases in the severity (pFDR = 0.002) and associated distress (pFDR = 0.001) of neuropsychiatric symptoms, as well as caregivers' burden (pFDR = 0.004) and depressive symptoms (pFDR = 0.001). As expected, there was significant deterioration in care-recipients' cognitive status (pFDR = 0.005) and measures of activities of daily living (pFDR < 0.005). CONCLUSION Despite the progressive course of dementia, the home-based multicomponent intervention was effective in decreasing caregivers' burden and depression and minimizing care-recipients' neuropsychiatric symptoms' severity and associated distress after 6 months. Our study highlights the establishment of home-based care units as an advantageous solution, specifically for family members seen to have a "taken-for-granted" role in dementia caring.
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Affiliation(s)
| | - Foteini Christidi
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mariyanna Zervou
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | | | - Maria Anna Vlami
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | - Maria Dimitriou
- Greek Psychogeriatric Association "243439Nestor," Athens, Greece
| | - Antonis Politis
- First Department of Psychiatry, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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35
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Styck AC, George DR. Evaluating the Impact of Community Gardening on Sense of Purpose for Persons Living with Dementia: A Cluster-Randomized Mixed Methods Pilot Study. J Alzheimers Dis Rep 2022; 6:359-367. [PMID: 36072363 PMCID: PMC9397880 DOI: 10.3233/adr-220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Gardening has been shown to have positive effects on persons living with dementia, but no studies have explored the effects of gardening on sense of purpose. Objective: Explore how gardening may influence sense of purpose for people with dementia. Methods: Ten residents with dementia diagnoses living in a skilled care facility participated in hour-long gardening sessions twice weekly at outdoor raised beds over a two-month duration. One group (n = 5) donated vegetables to a food pantry while the other (n = 5) harvested produce for personal use. Semi-structured interviews with participants and their caregivers conducted post-intervention were analyzed for themes. Results: Participants and caregivers reported biopsychosocial benefits of gardening, identifying four main themes: 1) Gardening outdoors provided specific physical benefits that improved quality of life; 2) Working on a project in a group setting improved mood and fostered a sense of community; 3) Gardening promoted reminiscence and reinforced a sense of self; 4) Gardening provided participants with a sense of purpose and pride. Conclusion: Gardening has biopsychosocial benefits for persons living with dementia, and there appears to be additive benefit linked to improved sense of purpose via charitable giving.
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Affiliation(s)
| | - Daniel R. George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
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36
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Lee H, Kim E, Yoon JY. Effects of a multimodal approach to food art therapy on people with mild cognitive impairment and mild dementia. Psychogeriatrics 2022; 22:360-372. [PMID: 35229407 DOI: 10.1111/psyg.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM-FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self-esteem, self-efficacy, self-expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. METHODS The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM-FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM-FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi-structured interviews (n = 9) were conducted to evaluate the overall experience of the MM-FAT program and its outcomes. RESULTS The findings reveal that MM-FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM-FAT program. Self-expression and self-efficacy were significantly higher in the MM-FAT group than in the control group. The semi-structured interviews revealed improvements in participants' behaviour, communication, and interaction. CONCLUSION This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID-19 pandemic, the study was able to enrich the effects of MM-FAT on cognitive, emotional, and social functioning through qualitative findings.
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Affiliation(s)
- Hyojin Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eunjoo Kim
- Center for Human-Caring Nurse Leaders for the Future, College of Nursing, Seoul National University, Seoul, South Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.,Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21(BK 21) Four Project, Seoul, South Korea
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37
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Harper AE, Rouch S, Leland NE, Turner RL, Mansbach WE, Day CE, Terhorst L. A Systematic Review of Tools Assessing the Perspective of Caregivers of Residents With Dementia. J Appl Gerontol 2022; 41:1196-1208. [PMID: 34229505 DOI: 10.1177/07334648211028692] [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] [Indexed: 11/17/2022] Open
Abstract
In collaboration with stakeholders, we conducted a systematic review of psychometric evidence for self-report tools measuring the perspective of family caregivers of nursing home residents with dementia. Our rationale for this review was based on evidence that nonpharmacological interventions can ameliorate dementia symptoms in nursing home residents. Such interventions require caregiver participation, which is influenced by perspectives. Yet, no existing tool measures the multidomain caregiver perspective. Our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The final sample included 42 articles describing 33 tools measuring domains of nursing home dementia care such as behavioral and psychological symptoms of dementia, resident quality of life, dementia-specific knowledge, communication, and medication use. We uncovered evidence gaps for tools measuring dementia-specific knowledge, communication, and medication use, all of which were important to our stakeholders. Future research should focus on development of psychometrically sound tools in alignment with the multidomain caregiver perspective.
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Sidani S, Fox MT, Butler JI, Maimets IK. Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home. Int J Older People Nurs 2022; 17:e12463. [PMID: 35362239 DOI: 10.1111/opn.12463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalised older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. OBJECTIVES To describe the development of a multi-component intervention to promote sleep. METHODS We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components. RESULTS The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with ageing, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress and sleep-related beliefs and behaviours. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalisation. DISCUSSION Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility. IMPLICATIONS FOR PRACTICE The intervention has potentials to improve sleep during the transition from hospital to home.
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Affiliation(s)
- Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Mary T Fox
- School of Nursing, York University, Toronto, Ontario, Canada.,York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Jeffrey I Butler
- School of Nursing, York University, Toronto, Ontario, Canada.,York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, Toronto, Ontario, Canada
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Merizzi A, Biasi R, Zamudio JFÁ, Spagnuolo Lobb M, Di Rosa M, Santini S. A Single-Case Design Investigation for Measuring the Efficacy of Gestalt Therapy to Treat Depression in Older Adults with Dementia in Italy and in Mexico: A Research Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063260. [PMID: 35328948 PMCID: PMC8950193 DOI: 10.3390/ijerph19063260] [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: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
Psychotherapy is one of the evidence-based clinical interventions for the treatment of depression in older adults with dementia. Randomised controlled trials are often the first methodological choice to gain evidence, yet they are not applicable to a wide range of humanistic psychotherapies. Amongst all, the efficacy of the Gestalt therapy (GT) is under-investigated. The purpose of this paper is to present a research protocol, aiming to assess the effects of a GT-based intervention on people with dementia (PWD) and indirect influence on their family carers. The study implements the single-case experimental design with time series analysis that will be carried out in Italy and Mexico. Six people in each country, who received a diagnosis of dementia and present depressive symptoms, will be recruited. Eight or more GT sessions will be provided, whose fidelity will be assessed by the GT fidelity scale. Quantitative outcome measures are foreseen for monitoring participants' depression, anxiety, quality of life, loneliness, carers' burden, and the caregiving dyad mutuality at baseline and follow-up. The advantages and limitations of the research design are considered. If GT will effectively result in the treatment of depression in PWD, it could enrich the range of evidence-based interventions provided by healthcare services.
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Affiliation(s)
- Alessandra Merizzi
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
- Correspondence:
| | - Rosanna Biasi
- Istituto di Gestalt HCC Human Communication Centre Italy, Via S. Sebastiano 38, 96100 Siracusa, Italy; (R.B.); (M.S.L.)
| | | | - Margherita Spagnuolo Lobb
- Istituto di Gestalt HCC Human Communication Centre Italy, Via S. Sebastiano 38, 96100 Siracusa, Italy; (R.B.); (M.S.L.)
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
| | - Sara Santini
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, Via Santa Margherita 5, 60124 Ancona, Italy;
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40
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Hayden L, Passarelli C, Shepley SE, Tigno W. A scoping review: Sensory interventions for older adults living with dementia. DEMENTIA 2022; 21:1416-1448. [PMID: 35230906 DOI: 10.1177/14713012211067027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).
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Freedman M, Binns MA, Serediuk F, Wolf MU, Danieli E, Pugh B, Gale D, Abdellah E, Teleg E, Halper M, Masci L, Lee A, Kirstein A. Virtual Behavioral Medicine Program: A Novel Model of Care for Neuropsychiatric Symptoms in Dementia. J Alzheimers Dis 2022; 86:1169-1184. [PMID: 35180119 PMCID: PMC9108590 DOI: 10.3233/jad-215403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with severe neuropsychiatric symptoms (NPS) due to dementia are often uprooted from their familiar environments in long-term care or the community and transferred to emergency departments, acute care hospitals, or specialized behavioral units which can exacerbate NPS. To address this issue, we developed the Virtual Behavioral Medicine Program (VBM), an innovative model of virtual care designed to support management of patients with NPS in their own environment. OBJECTIVE To determine efficacy of VBM in reducing admission to a specialized inpatient neurobehavioral unit for management of NPS. METHODS We reviewed outcomes in the first consecutive 95 patients referred to VBM. Referrals were classified into two groups. In one group, patients were referred to VBM with a simultaneous application to an inpatient Behavioral Neurology Unit (BNU). The other group was referred only to VBM. The primary outcome was reduction in proportion of patients requiring admission to the BNU regardless of whether they were referred to the BNU or to VBM alone. RESULTS For patients referred to VBM plus the BNU, the proportion needing admission to the BNU was reduced by 60.42%. For patients referred to VBM alone, it was 68.75%. CONCLUSION VBM is a novel virtual neurobehavioral unit for treatment of NPS. Although the sample size was relatively small, especially for the VBM group, the data suggest that this program is a game changer that can reduce preventable emergency department visits and acute care hospital admissions. VBM is a scalable model of virtual care that can be adopted worldwide.
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Affiliation(s)
- Morris Freedman
- Department of Medicine (Neurology), Baycrest Health Sciences, Mt. Sinai Hospital, and University of Toronto, Ontario, Canada.,Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada
| | - Malcolm A Binns
- Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - M Uri Wolf
- Department of Psychiatry, Baycrest Health Sciences and University of Toronto, Ontario Canada
| | | | - Bradley Pugh
- Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada.,Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Deb Gale
- Department of Psychiatry, Baycrest Health Sciences and University of Toronto, Ontario Canada
| | | | - Ericka Teleg
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Mindy Halper
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Lauren Masci
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Adrienne Lee
- Baycrest Health Sciences, Toronto, Ontario, Canada
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The Effects of Listening to Music on Anxiety, Pain, Vital Signs, and Patient Satisfaction in Intravitreal Injection. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1049397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lin SY, Schneider CE, Bristol AA, Clancy M, Sprague SA, Aldridge M, Cortes T, Goldfeld KS, Kutner JS, Mitchell SL, Shega JW, Wu B, Zhu CW, Brody AA. Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial. THE GERONTOLOGIST 2022; 62:304-314. [PMID: 33377138 PMCID: PMC8827334 DOI: 10.1093/geront/gnaa220] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. RESEARCH DESIGN AND METHODS Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care-Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). RESULTS Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. DISCUSSION AND IMPLICATIONS This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. CLINICAL TRIALS REGISTRATION NUMBER NCT03681119.
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Affiliation(s)
- Shih-Yin Lin
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Catherine E Schneider
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Maureen Clancy
- MJHS Hospice and Palliative Care, New York, New York, USA
| | - Sara A Sprague
- Providence TrinityCare Hospice, Torrance, California, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Tara Cortes
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Keith S Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joseph W Shega
- Vitas Healthcare, Miami, Florida, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Bei Wu
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA
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Liu CR, Liou YM, Jou JH. Pilot Study of the Effects of Bright Ambient Therapy on Dementia Symptoms and Cognitive Function. Front Psychol 2022; 12:782160. [PMID: 35002870 PMCID: PMC8740310 DOI: 10.3389/fpsyg.2021.782160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Light therapy potentially improves dementia symptoms. In this study, we examined the effects of bright light therapy on neuropsychiatric behaviors and cognitive function. Thirty-five participants were assigned to either the experimental or comparison group. The experimental group was exposed to bright light at 2,500 lux, and the comparison group was exposed to 114–307 lux. The instruments used were the Neuropsychiatric Inventory and the Mini-Mental State Examination. The experimental group showed a significant improvement in Neuropsychiatric Inventory scores; these scores, which were calculated using generalized estimating equations with medication (benzodiazepines) as a covariate, were reduced by 65% (P < 0.001) and 78% (P = 0.001) by the 5th and 9th weeks, respectively. At the same time, Mini-Mental State Examination scores increased by 19% (P = 0.007) and 28% (P = 0.04), respectively. However, differences in outcomes between the 5th and 9th weeks were not significant. A 4-week regimen of bright light therapy was the most effective, with higher adherence and acceptability.
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Affiliation(s)
- Chuen-Ru Liu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Psychiatric Nurse of City Hospital, Songde Branch, Taipei, Taiwan
| | - Yiing Mei Liou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jwo-Huei Jou
- Department of Materials Science and Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Yin S, Zhu F, Li Z, Che D, Li L, Zhang L, Zhong Y, Luo B, Wu X. Research Hotspots and Trends in Music Therapy Intervention for Patients With Dementia: A Bibliometrics and Visual Analysis of Papers Published From 2010 to 2021. Front Psychiatry 2022; 13:860758. [PMID: 35573325 PMCID: PMC9098357 DOI: 10.3389/fpsyt.2022.860758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As a serious public health problem, dementia has placed a heavy burden on society and families. Evidence suggests that the use of music therapy as a non-pharmacological intervention has certain advantages with respect to reducing the behavioral and psychological symptoms of dementia (BPSD) and improving the cognition and mental status of dementia patients. However, research trends and hotspots regarding music therapy intervention for dementia analysis have not been systematically studied via bibliometric analysis. METHODS We searched the Web of Science Core Collection (WoSCC) for texts published between January 1, 2010, and October 31, 2021, and visualized country, institution, journal, keyword co-occurrence, keyword emergence and keyword clustering. RESULTS A total of 217 articles from the WoSCC database were analyzed. In this research field, the annual number of publications has generally shown a slowly increasing trend, and the United States has the most publications and the most frequent cooperation among countries. University College London (UCL) has the most extensive influence among research institutions. Among articles, those published in the JOURNAL OF ALZHEIMER'S DISEASE were the most numerous, with 20 such articles being published, accounting for 9.22% (20/217) of the total. Comprehensive analysis of five clusters via biclustering shows that the research hotspots in this field during the past 11 years have mainly focused on the autobiographical memory, cognitive function, mental state and BPSD of dementia patients. CONCLUSION This study conducted a bibliometric and visual analysis of relevant studies concerning music therapy intervention for dementia patients. Psychological problems faced by dementia patients and the topics of quality of life, individualized music therapy, the mental state of caregivers and other related topics may be important research directions in the future. Therefore, the question of how to develop standardized research protocols and identify unified efficacy evaluation indicators should be a focus of and difficulty for future research.
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Affiliation(s)
- Shao Yin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengya Zhu
- Zigong First People's Hospital, Zigong, China
| | - Zhao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Deya Che
- Zigong First People's Hospital, Zigong, China
| | - Liuying Li
- Zigong First People's Hospital, Zigong, China
| | - Lu Zhang
- Department of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhong
- Zigong First People's Hospital, Zigong, China
| | - Biao Luo
- Zigong First People's Hospital, Zigong, China
| | - Xiaohan Wu
- Zigong First People's Hospital, Zigong, China
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Effects of Cognitive Stimulation Therapy for People with Dementia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Int J Nurs Stud 2022; 128:104181. [DOI: 10.1016/j.ijnurstu.2022.104181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
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Watson J, Darlington-Pollock F, Green M, Giebel C, Akpan A. The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002-2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13405. [PMID: 34949010 PMCID: PMC8708637 DOI: 10.3390/ijerph182413405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002-2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations-and for later-onset only dementia medications-are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes.
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Affiliation(s)
- James Watson
- School of Environmental Sciences, The University of Liverpool, Liverpool L69 7ZT, UK; (F.D.-P.); (M.G.)
| | | | - Mark Green
- School of Environmental Sciences, The University of Liverpool, Liverpool L69 7ZT, UK; (F.D.-P.); (M.G.)
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3GF, UK;
- NIHR ARC NWC, Liverpool L69 3GL, UK
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Lu S, Zhang AY, Liu T, Choy JCP, Ma MSL, Wong G, Lum T. Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis. BMJ Open 2021; 11:e048917. [PMID: 34845067 PMCID: PMC8634002 DOI: 10.1136/bmjopen-2021-048917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement. DESIGN Systematic review with meta-analysis. DATA SOURCES ProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020. ELIGIBILITY CRITERIA We included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups. DATA EXTRACTION AND SYNTHESIS Two researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest. RESULTS Thirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=-0.52, p<0.05), followed by medium (n=6; SMD=-0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=-0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation. CONCLUSIONS To develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances. PROSPERO REGISTRATION NUMBER CRD42020168556.
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Affiliation(s)
- Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, Hong Kong, Hong Kong
| | - Anna Y Zhang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Jacky C P Choy
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Maggie S L Ma
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Gloria Wong
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, Hong Kong
| | - Terry Lum
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
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Seok JW, Shin J, Kang B, Lee H, Cho E, Lee KH. Non-pharmacological interventions using information and communication technology for behavioral and psychological symptoms of dementia: A systematic review and meta-analysis protocol. J Adv Nurs 2021; 78:282-293. [PMID: 34812533 DOI: 10.1111/jan.15109] [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: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
AIM To review and examine the effectiveness of non-pharmacological interventions on behavioural and psychological symptoms of dementia using information and communication technology. DESIGN This is a systematic review and meta-analysis. METHODS The databases including PubMed, CINAHL with Full Text (EBSCOhost), PsycINFO, Embase, and the Cochrane Library will be searched for all published studies. Studies will be screened and selected with criteria described in PICOS format. Risk of bias will be assessed by the National Institute for Health and Clinical Excellence checklist. Data will be extracted from eligible studies and used to perform a meta-analysis examining the overall effects and effects on individual outcomes. Additionally, we will conduct meta-regression to examine the association between explanatory variables and behavioural and psychological symptoms. This study has been funded since June 2020. DISCUSSION This study will be the first to reveal the effects of non-pharmacological interventions using information and communication technology on behavioural and psychological symptoms of dementia. Furthermore, this study will provide updated and valid evidence of interventions using this for managing behavioural and psychological symptoms of dementia. IMPACT Although non-pharmacological interventions using information and communication technology for older adults living with dementia are continuously developing, their direct effect remains unclear. This study will evaluate the effectiveness of these interventions on behavioural and psychological symptoms of dementia and provide the evidence to implement these interventions among older adults living with dementia. Thus, caregivers and nursing staff can manage behavioural and psychological symptoms of dementia more effectively by incorporating information and communication technology.
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Affiliation(s)
- Jo Woon Seok
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Jinhee Shin
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Bada Kang
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Hyangkyu Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Kyung Hee Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Prinz A, Schumacher A, Witte K. Influence of a multidimensional music-based exercise program on selected cognitive and motor skills in dementia patients—a pilot study. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [PMCID: PMC8519499 DOI: 10.1007/s12662-021-00765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AbstractOne of the most common causes of needing care in old age is dementia. In order to enjoy a pleasant retirement for people with dementia, it is essential for them to maintain their independence. Studies have shown that a combination of physical activity and music has positive effects on dementia patients. Therefore, this study aimed to investigate the feasibility of implementing a multidimensional music-based exercise program for dementia patients and the effects on an intervention group (IG) compared to a control group (CG, usual care). The study design was based on a 12-week intervention with two (IG/CG) by two (pretest/posttest) parallel groups and block randomization with unequal group sizes. Participants had to be able to move independently or with a walker and not have severe cardiovascular disease or cardiac arrhythmias. Fifty-three blinded dementia patients (age: 83.63 ± 6.03 years) from inpatient facilities participated in the study and were assigned from the exercise instructors to IG (n = 34) and CG (n = 19). The primary outcomes were feasibility (Observation sheet), modified Chair Rising test, Timed Up and Go test, hand dynamometer test, FICSIT‑4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques), and drop bar test. Secondary endpoints included: verbal fluency (“animals”), the Mini-Mental State Examination, memory, Trail Making Test A, and Qualidem. Forty-nine subjects were analyzed (IG = 32; CG = 17). There were significant differences between the groups in the modified Chair Rising test (p = 0.033), FICSIT‑4 (p = 0.035), and Timed Up and Go test (p = 0.005) at posttest, which showed improved performance of the IG compared to the CG. The IG additionally showed improvements in the modified Chair Rising test (p = 0.000), drop bar test (p = 0.033), hand dynamometer test (p = 0.001), Timed Up and Go test (p = 0.000), verbal fluency (p = 0.002) and Trail Making Test A (p = 0.04) after 12 weeks. There were no adverse events or side effects. The multidimensional music-based exercise program could be performed by the dementia patients and was well received. The improved functional mobility could contribute to a lower risk of falls and thus maintain independence. For the follow-up study, the number of subjects, randomization, and parameters should be considered.
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Affiliation(s)
- A. Prinz
- Department of Sport Science, Otto-von-Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany
| | - A. Schumacher
- Department of Sport Science, Otto-von-Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany
| | - K. Witte
- Department of Sport Science, Otto-von-Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany
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