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Fan SM, Chiu PY, Liu CH, Liao YC, Chang HT. Predictive value of hypercholesterolemia, vegetarian diet, and hypertension for incident dementia among elderly Taiwanese individuals with low educational levels. Ther Adv Chronic Dis 2023; 14:20406223231171549. [PMID: 37255548 PMCID: PMC10226334 DOI: 10.1177/20406223231171549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Early management of modifiable dementia-related factors is seen as a novel approach to preventing dementia onset; however, these efforts are often hindered by the complexity of interactions among these factors. In addition, different modifiable dementia-related factors may contribute to different etiologies of dementia. Design The current study investigated the effects of common modifiable dementia-related factors on prediction of incident dementia, dementia of the Alzheimer's type (DAT), and vascular dementia (VaD). Methods Vascular- and lifestyle-related factors were used as predictors of incident dementia, DAT, and VaD among 1,285 elderly individuals without obvious signs of dementia or mild cognitive impairment. Cox proportional hazard models were used to evaluate the risks associated with each modifiable factor. Results After controlling for factors other than stroke-related factors, hypercholesterolemia was correlated with a relatively low risk of all-cause incident dementia and DAT, whereas a vegetarian diet was correlated with an elevated risk of all-cause incident dementia and VaD. Hypertension was correlated with incident VaD. After controlling for stroke-related factors, a vegetarian diet was correlated with an elevated risk of all-cause dementia. A history of myocardiac infarction and the use of anti-platelet medication were, respectively, associated with a reduced risk of DAT and elevated risk of VaD. The use of anti-hypertensives was associated with a reduced risk of all-cause dementia, whereas the use of anti-lipid agents was associated with slow progression DAT (i.e. exceeding the average conversion time). Hypercholesterolemia was associated with an elevated risk for slow progression DAT. Conclusion These findings could perhaps be used as clinical markers in predicting and preventing incident dementia, DAT, and VaD.
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Affiliation(s)
| | | | - Chung-Hsiang Liu
- Department of Neurology, China Medical
University Hospital, College of Medicine, China Medical University,
Taichung
| | - Yu-Chi Liao
- Department of Psychology, College of Medical
and Health Sciences, Asia University, Taichung
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Lu YR, Wu TH, Jeng Y, Lee WY, Hsu WC, Yen AMF, Pan SL, Chen YC, Chen SLS, Chen HH, Liou HH. The impact of active community-based survey on dementia detection ratio in Taiwan: A cohort study with historical control. Front Public Health 2023; 10:1005252. [PMID: 36684977 PMCID: PMC9859413 DOI: 10.3389/fpubh.2022.1005252] [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: 07/28/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background Although early dementia detection is crucial to optimize the treatment outcomes and the management of associated symptoms, the published literature is scarce regarding the effectiveness of active screening protocols in enhancing dementia awareness and increasing the rate of early detection. The present study compared the detection ratio of an active community-based survey for dementia detection with the detection ratio of passive screening during routine clinical practice. Data for passive screening were obtained from the National Health Insurance (NHI) system, which was prospectively collected during the period from 2000 to 2003. Design A population-based cohort study with historical control. Setting Taiwan. Participants A total of 183 participants aged 65 years or older were involved in a community-based survey. Data from 1,921,308 subjects aged 65 years or older were retrieved from the NHI system. Measurements An adjusted detection ratio, defined as a ratio of dementia prevalence to incidence was used. Results The results showed that the dementia prevalence during the 2000-2003 period was 2.91% in the elderly population, compared with a prevalence of 6.59% when the active survey was conducted. The incidence of dementia in the active survey cohort was 1.83%. Overall, the dementia detection ratio was higher using active surveys [4.23, 95% confidence interval (CI): 2.68-6.69] than using passive detection (1.45, 95% CI: 1.43-1.47) for those aged 65-79 years. Similar findings were observed for those aged 80 years and older. Conclusion The implementation of an active community-based survey led to a 3-fold increase in the detection rate of early dementia detection compared to passive screening during routine practice.
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Affiliation(s)
- Yun-Ru Lu
- Department of Neurology, China Medical University Hospital, Taipei, Taiwan
| | - Tzy-Haw Wu
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Yachung Jeng
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yuan Lee
- Department of Neurosurgey, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chih Hsu
- Department of Neurology, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Horng-Huei Liou
- Department of Neurology and Pharmacology, College of Medicine, National Taiwan University Hospital, Yunlin, Taiwan,*Correspondence: Horng-Huei Liou ✉
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Lee KT, Wang WL, Yang YC. Impact of a magic recreation program on older adults with minor depressive symptoms in a long-term care facility: A pilot randomized controlled trial. Geriatr Nurs 2022; 48:169-176. [PMID: 36257222 DOI: 10.1016/j.gerinurse.2022.09.014] [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: 06/25/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate a magic recreation program to reduce depressive symptoms in institutionalized older adults. METHODS We conducted a pilot randomized controlled trial in which participants were assigned to either a magic group (n = 6) or a control group with usual activities (n = 6). The magic group received a 6-week magic recreation program. The data were analyzed by generalized estimating equations in terms of intention-to-treat analysis. A sensitivity analysis was conducted by examining the complete case analysis. RESULTS The magic recreation program significantly improved the scores of Patient Health Questionnaire-9 in the magic group (Wald χ 2 = 8.816, p = 0.004, Cohen's d = 1.51, power = 0.9968). The results of the sensitivity analysis were consistent with the results of primary analysis. CONCLUSIONS The 6-week magic recreation program reduced depressive symptoms among institutionalized older adults with minor depressive symptoms.
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Affiliation(s)
- Kuan-Ting Lee
- Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan City 704302, Taiwan; Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, 1 University Road, Tainan City 701401, Taiwan
| | - Wei-Li Wang
- Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan City 704302, Taiwan; Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, 1 University Road, Tainan City 701401, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan City 704302, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City 701401, Taiwan.
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Screening malnutrition in long-term care facility: A cross-sectional study comparing mini nutritional assessment (MNA) and minimum data set (MDS). Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kao YH, Hsu CC, Yang YH. A Nationwide Survey of Dementia Prevalence in Long-Term Care Facilities in Taiwan. J Clin Med 2022; 11:1554. [PMID: 35329879 PMCID: PMC8955493 DOI: 10.3390/jcm11061554] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As the average life expectancy of global citizens has increased, the prevalence of dementia has increased rapidly. The number of patients with dementia has increased by 6.7 times, reaching 300,000 in the past three decades in Taiwan. To realize the latest actual situation, the need for institutional care for elderly patients with dementia, and also a reference basis for government agencies to formulate dementia-related care policies, we investigated the institutional prevalence of dementia. METHODS We randomly sampled 299 out of the 1607 registered long-term care facilities including senior citizens' institutions, nursing homes, and veteran homes in every administrative region of Taiwan. Then, a two-phase survey including MMSE screening, CDR, and clinical confirmation was conducted on each subject from 2019 to 2020. RESULTS Among 5753 enrolled subjects, 4765 from 266 facilities completed the examinations with a response rate of 82.8%. A total of 4150 subjects were diagnosed with dementia, 7.4% of whom had very mild dementia. The prevalence of all-cause dementia, including very mild dementia, was 87.1% in all facilities, 87.4% in senior citizens' institutions, 87.1% in nursing homes, and 83.3% in veteran homes. Advanced age, low education, hypertension, Parkinsonism, respiratory disease, stroke, and intractable epilepsy were associated with dementia risk. CONCLUSIONS We show that in an aged society, the prevalence of all-cause dementia in long-term care institutions can be as high as 87.1%. This study was completed before the outbreak of COVID-19 and provides a precious hallmark for future epidemiological research. We recommend that the long-term care policy in an aged society needs to take into account the increasing high prevalence of dementia in the institution.
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Affiliation(s)
- Yi-Hui Kao
- Department of Medical Education and Research, National Taiwan University Hospital Yun-Lin Branch, Douliu 640, Taiwan;
- Graduate Institute of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan 350, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan 350, Taiwan
- Department of Health Services Administration, China Medical University, Taichung 404, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 330, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City 801, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- School of Post-Baccalaureate Medicine, Colleague of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
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Hsieh SW, Huang LC, Hsieh TJ, Lin CF, Hsu CC, Yang YH. Behavioral and psychological symptoms in institutional residents with dementia in Taiwan. Geriatr Gerontol Int 2021; 21:718-724. [PMID: 34184383 DOI: 10.1111/ggi.14220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
AIM Behavioral and psychological symptoms of dementia (BPSD) are important predictors for institutional placement, caregiver distress and depression for patients with dementia. We aim to investigate BPSD in institutional residents with dementia in Taiwan. METHODS We conducted a nationwide study surveying institutional residents in Taiwan. Institutional residents from 22 counties and cities in Taiwan were recruited and analyzed in our study. We recorded demographic data, severity of dementia and disability, presence of BPSD, and past medical history of institutional residents in Taiwan. We recorded the characteristics of BPSD and analyzed the possible risks of BPSD in residents with dementia. RESULTS A total of 4722 institutional residents were recruited and analyzed in our study. The prevalence of dementia was 87.2% (4119 residents). Among residents with dementia, 1546 (37.5%) had presented BPSD in the past 3 months. The most frequent three types of BPSD were nighttime behavior (17.9%), resistance against care (13.4%) and depression (12.9%). Old age, female gender, and lower MMSE (Mini-Mental State Examination) scores were associated with BPSD. Moderate dementia (OR = 1.73, 95% CI = 1.30-2.31) and mild activities of daily living (ADL) dependence (OR = 2.13, 95% CI = 1.06-4.27) increased the risks of BPSD. Reviews of past medical history showed that orthopedic disease, eye disease, genitourinary disease, dementia, psychiatric disorder and intellectual disability were associated with increasing risks of BPSD. CONCLUSIONS We concluded that moderate dementia and mild ADL dependence increased the risks of BPSD in institutional residents with dementia. Geriatr Gerontol Int 2021; 21: 718-724.
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Affiliation(s)
- Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Chung-Fen Lin
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Chinese Mentality Protection Association, Kaohsiung, Taiwan
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Shea YF, Lam HY, Yuen JKY, Adrian Cheng KC, Chan TC, Mok WYW, Chiu KCP, Luk KHJ, Chan HWF. Maintaining Zero Coronavirus Disease 2019 Infection Among Long-Term Care Facility Residents in Hong Kong. J Am Med Dir Assoc 2020; 21:981-982. [PMID: 32674831 PMCID: PMC7256494 DOI: 10.1016/j.jamda.2020.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Yat-Fung Shea
- Tung Wah Group of Hospitals, Fung Yiu King Hospital, Hong Kong
| | - Ho Yeung Lam
- Center for Health Protection, Department of Health, Hong Kong Special Administrative Region, Hong Kong
| | - Jacqueline Kwan Yuk Yuen
- Tung Wah Group of Hospitals, Fung Yiu King Hospital, Hong Kong; Division of Geriatrics, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Tuen Ching Chan
- Tung Wah Group of Hospitals, Fung Yiu King Hospital, Hong Kong
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- Tung Wah Group of Hospitals, Fung Yiu King Hospital, Hong Kong
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Chou HH, Tsou MT, Hwang LC. Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison. BMC Geriatr 2020; 20:60. [PMID: 32059646 PMCID: PMC7023686 DOI: 10.1186/s12877-020-1464-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). METHODS Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. RESULTS A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration. CONCLUSIONS For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.
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Affiliation(s)
- Hsiao-Hui Chou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan. .,Department of Medicine, Mackay Medical College, Taipei, Taiwan.
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Chen HC, Chan SWC, Yeh TP, Huang YH, Chien IC, Ma WF. The Spiritual Needs of Community-Dwelling Older People Living With Early-Stage Dementia-A Qualitative Study. J Nurs Scholarsh 2019; 51:157-167. [PMID: 30604590 DOI: 10.1111/jnu.12454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the spiritual needs of community-dwelling older people living with early-stage dementia. DESIGN A descriptive qualitative research design with purposive sampling was used. METHODS Ten older people who were receiving home care services from a mental hospital in central Taiwan were recruited. In-depth semistructured interviews were conducted and content analysis was performed. FINDINGS Four themes emerged that described the spiritual wishes and needs of older people with early-stage dementia: the wish to turn back time, the need to instill meaning into past experiences, the need to rely on faith-based strength, and the wish to have one's remaining life under control. The spiritual needs centered on a strong yearning to engage in a tug-of-war with time to reverse the impaired memory and independence. CONCLUSIONS This study provides insights into the spiritual needs of older people with early-stage dementia. They struggled to maintain a balance between independence and dependence, build a sense of self and value, seek guidance and support from religious faith, and retain control over their lives. CLINICAL RELEVANCE The findings can be expected to help caregivers improve care of older people with dementia by empowering older people to hold onto control in their lives and providing opportunities for them to connect with others for fulfilling their spiritual needs.
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Affiliation(s)
- Hsing-Chia Chen
- Head Nurse, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Sally Wai-Chi Chan
- Upsilon Eta, Professor and Dean of School, School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
| | - Tzu-Pei Yeh
- Assistant Professor, School of Nursing, China Medical University, Taichung, Taiwan and Adjunct Supervisor, Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Yao-Hui Huang
- Supervisor, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - I-Chia Chien
- Superintendent, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, and Adjunct Professor, Department of Public Health & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Fen Ma
- Lambda Beta-at-Large, Professor, School of Nursing, China Medical University , Taichung, Taiwan; Adjunct Supervisor, Department of Nursing, China Medical University Hospital, Taichung, Taiwan; and Professor, Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
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Estimating the survival of elderly patients diagnosed with dementia in Taiwan: A longitudinal study. PLoS One 2018; 13:e0178997. [PMID: 30044781 PMCID: PMC6059383 DOI: 10.1371/journal.pone.0178997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Dementia is characterized by prolonged progressive disability. Therefore, predicting mortality is difficult. An accurate prediction tool may be useful to ensure that end-of-life patients with dementia receive timely palliative care. Purpose This study aims to establish a survival prediction model for elderly patients with dementia in Taiwan. Methods Data from the 2001 to 2010 National Health Insurance Research Database in Taiwan were used to identify 37,289 patients with dementia aged ≥65 years for inclusion in this retrospective longitudinal study. Moreover, this study examined the mortality indicators for dementia among demographic characteristics, chronic physical comorbidities, and medical procedures. A Cox proportional hazards model with time-dependent covariates was used to estimate mortality risk, and risk score functions were formulated using a point system to establish a survival prediction model. The prediction model was then tested using the area under the receiver operating characteristic curve. Results Thirteen mortality risk factors were identified: age, sex, stroke, chronic renal failure, liver cirrhosis, cancer, pressure injury, and retrospectively retrieved factors occurring in the 6 months before death, including nasogastric tube placement, supplemental oxygen supply, ≥2 hospitalization, receiving ≥1 emergency services, ≥2 occurrences of cardiopulmonary resuscitation, and receiving ≥2 endotracheal intubations. The area under the receiver operating characteristic curves for this prediction model for mortality at 6 and 12 months were 0.726 and 0.733, respectively. Conclusions The survival prediction model demonstrated moderate accuracy for predicting mortality at 6 and 12 months before death in elderly patients with dementia. This tool may be valuable for helping health care providers and family caregivers to make end-of-life care decisions.
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Tseng YP, Huang LH, Hsu LL, Huang TH, Hsieh SI, Chi SF, Chou YF. The family surrogates' psychological experience of making a do-not-resuscitate decision for older relatives: a qualitative study. Contemp Nurse 2018; 54:195-207. [PMID: 29845875 DOI: 10.1080/10376178.2018.1478232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. AIM To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. METHODS The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semi-structured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. RESULTS Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. CONCLUSIONS Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation.
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Affiliation(s)
- Yi-Ping Tseng
- a Medical College , National Taiwan University , Taipei , Taiwan.,b Taoyuan Chang Gung Memorial Hospital, Nursing Home , Chang Gung Medical Foundation , No. 26-8, Dongjiulukeng, Guishan Dist., Taoyuan , Taiwan, R.O.C
| | - Lian-Hua Huang
- c School of Nursing , University of Colorado , Boulder , Colorado.,d College of Medicine, Department of Nursing , National Taiwan University , No. 1, Sec 1, Jen-Ai Rd, Taipei , Taiwan, R.O.C
| | - Li-Ling Hsu
- e Teacher College , Columbia University , New York , NY , USA.,f Department of Nursing , Oriental Institute of Technology , , No.58, Sec. 2, Sichuan Rd., Banqiao Dist., New Taipei City 220, Taipei , Taiwan, R.O.C
| | - Tzu-Hsin Huang
- g Graduate Institute of Nursing , Taipei Medical University , Taipei , Taiwan.,h Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , No.123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C
| | - Suh-Ing Hsieh
- i School of Nursing , University of Maryland at Baltimore , Baltimore , MD , USA.,j Nursing Department at Chang Gung University of Science and Technology, Taoyuan Chang Gung Memorial Hospital , N423, No. 261, Wenhwa 1st Road, Kweishan, Taoyuan , Taiwan, R.O.C
| | - Shu-Fen Chi
- k Department of Health Care Management , Chang Gung University , Taoyuan , Taiwan.,l Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , Nursing supervisor, No. 123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C
| | - Yen-Fang Chou
- m Department of Nursing , Chang Gung University , Taoyuan , Taiwan.,n Taoyuan Chang Gung Memorial Hospital, Nursing Department , Chang Gung Medical Foundation , Nursing supervisor, No.123, Dinghu Rd., Guishan Dist., Taoyuan , Taiwan, R.O.C
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Abstract
UNLABELLED ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan. METHOD Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator. RESULTS Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation. CONCLUSIONS Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.
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Effects of the Advanced Innovative Internet-Based Communication Education Program on Promoting Communication Between Nurses and Patients With Dementia. J Nurs Res 2017; 24:163-72. [PMID: 26376065 DOI: 10.1097/jnr.0000000000000109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Effective communication between nurses and patients with dementia promotes the quality of patient care by improving the identification of patient needs and by reducing the miscommunication-related frustration of patients and nurses. PURPOSE This study evaluates the effects of an advanced innovative Internet-based communication education (AIICE) program on nurses' communication knowledge, attitudes, frequency of assessing patient communication capacity, and communication performance in the context of care for patients with dementia. In addition, this study attempts to evaluate the indirect effects of this program on outcomes for patients with dementia, including memory and behavior-related problems and depressive symptoms. METHODS A quasi-experimental research design with a one-group repeated measure was conducted. Convenience sampling was used to recruit nurses from long-term care facilities in southern Taiwan. Data were analyzed using general estimating equations to compare changes over time across three points: baseline, fourth-week posttest, and 16th-week posttest. One hundred five nurses completed the AIICE program and the posttest surveys. RESULTS The findings indicate that nurses' communication knowledge, frequency in assessing patients' communication capacity, and communication performance had improved significantly over the baseline by either the 4th- or 16th-week posttest (p < .01). However, communication attitude showed no significant improvement in the posttest survey (p = .40). Furthermore, the findings indicate that the memory and behavior-related problems and the depressive symptoms of patients had decreased significantly by the 16th-week posttest (p = .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study showed that the AIICE program improves nurses' communication knowledge, frequency to assess patients' communication capacity, and communication performance and alleviates the memory and behavior-related problems and depressive symptoms of patients. The continuous communication training of nurses using the AIICE program is thus recommended.
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Chen LY, Lin YT, Chen LK, Loh CH. Person-centered dementia care for older veterans with dementia in Taiwan: Past, present and future. Geriatr Gerontol Int 2017; 17 Suppl 1:4-6. [DOI: 10.1111/ggi.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center; National Yang-Ming University; Taipei Taiwan
- Institute of Public Health; National Yang-Ming University; Taipei Taiwan
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
- Banciao Veterans Home; Banciao, New Taipei City Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center; National Yang-Ming University; Taipei Taiwan
- Center for Geriatrics and Gerontology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Ching-Hui Loh
- Department of Healthcare and Medical Care; Veterans Affairs Council; Taipei Taiwan
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Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, Chen TF, Lin KN, Tang LY, Lin CC, Wang PN. Comorbidity and dementia: A nationwide survey in Taiwan. PLoS One 2017; 12:e0175475. [PMID: 28403222 PMCID: PMC5389824 DOI: 10.1371/journal.pone.0175475] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/14/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Comorbid medical diseases are highly prevalent in the geriatric population, imposing hardship on healthcare services for demented individuals. Dementia also complicates clinical care for other co-existing medical conditions. This study investigated the comorbidities associated with dementia in the elderly population aged 65 years and over in Taiwan. METHODS We conducted a nationwide, population-based, cross-sectional survey; participants were selected by computerized random sampling from all 19 Taiwan counties between December 2011 and March 2013. After exclusion of incomplete or erroneous data, 8,456 subjects were enrolled. Of them, 6,183 were cognitively normal (control group), 1,576 had mild cognitive impairment (MCI), and 697 had dementia. We collected information about types of comorbidities (i.e., vascular risk factors, lung diseases, liver diseases, gastrointestinal diseases, and cancers), Charlson comorbidity index score, and demographic variables to compare subjects with normal cognition, MCI, and dementia. RESULTS Regardless of the cognitive condition, over 60% of the individuals in each group had at least one comorbid disease. The proportion of subjects possessing at least three comorbidities was higher in those with cognitive impairment (MCI 20.9%, dementia 27.3%) than in control group (15%). Hypertension and diabetes mellitus were the most common comorbidities. The mean number of comorbidities and Charlson comorbidity index score were greater in MCI and dementia groups than in control group. Logistic regression demonstrated that the comorbidities significantly associated with MCI and dementia were cerebrovascular disease (OR 3.35, CI 2.62-4.28), cirrhosis (OR 3.29, CI 1.29-8.41), asthma (OR 1.56, CI 1.07-2.27), and diabetes mellitus (OR 1.24, CI 1.07-1.44). CONCLUSION Multiple medical comorbid diseases are common in older adults, especially in those with cognitive impairment. Cerebrovascular disease, cirrhosis, asthma, and diabetes mellitus are important contributors to cognitive deterioration in the elderly. Efforts to lower cumulative medical burden in the geriatric population may benefit cognitive function.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Yu Yiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Yu Sun
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | | | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ker-Neng Lin
- Department of Psychology, Soo-Chow University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Yu Tang
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chung Gung University, Tao-Yuan, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
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Chang CC, Lin YF, Chiu CH, Liao YM, Ho MH, Lin YK, Chou KR, Liu MF. Prevalence and factors associated with food intake difficulties among residents with dementia. PLoS One 2017; 12:e0171770. [PMID: 28225776 PMCID: PMC5321470 DOI: 10.1371/journal.pone.0171770] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Few studies have examined the prevalence of food intake difficulties and their associated factors among residents with dementia in long-term care facilities in Taiwan. The purpose of the study was to identify the best cutoff point for the Chinese Feeding Difficulty Index (Ch-FDI), which evaluates the prevalence of food intake difficulties and recognizes factors associated with eating behaviors in residents with dementia. Methods and findings A cross-sectional design was adopted. In total, 213 residents with dementia in long-term care facilities in Taiwan were recruited and participated in this study. The prevalence rate of food intake difficulties as measured by the Chinese Feeding Difficulty Index (Ch-FDI) was 44.6%. Factors associated with food intake difficulties during lunch were the duration of institutionalization (beta = 0.176), the level of activities of daily living-feeding (ADL-Q1) (beta = -0.235), and the length of the eating time (beta = 0.416). Associated factors during dinner were the illuminance level (beta = -0.204), sound volume level (beta = 0.187), ADL-Q1 (beta = -0.177), and eating time (beta = 0.395). Conclusions Food intake difficulties may potentially be associated with multiple factors including physical function and the dining environment according to the 45% prevalence rate among dementia residents in long-term care facilities.
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Affiliation(s)
- Chia-Chi Chang
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yu-Fang Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Hui Chiu
- Center of General Education, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Mei Liao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsing Ho
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yen-Kuang Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Biostatistics Research Center, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Megan F. Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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The Prevalence and Incidence of Dementia Due to Alzheimer's Disease: a Systematic Review and Meta-Analysis. Can J Neurol Sci 2017; 43 Suppl 1:S51-82. [PMID: 27307128 DOI: 10.1017/cjn.2016.36] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Updated information on the epidemiology of dementia due to Alzheimer's disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD. METHODS The MEDLINE and EMBASE databases were searched from 1985 to 2012, as well as the reference lists of selected articles. Included articles had to provide an original population-based estimate for the incidence and/or prevalence of AD. Two individuals independently performed abstract and full-text reviews, data extraction and quality assessments. Random-effects models were employed to generate pooled estimates stratified by age, sex, diagnostic criteria, location (i.e., continent) and time (i.e., when the study was done). RESULTS Of 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 119 studies met the inclusion criteria. In community settings, the overall point prevalence of dementia due to AD among individuals 60+ was 40.2 per 1000 persons (CI95%: 29.1-55.6), and pooled annual period prevalence was 30.4 per 1000 persons (CI95%: 15.6-59.1). In community settings, the overall pooled annual incidence proportion of dementia due to AD among individuals 60+ was 34.1 per 1000 persons (CI95%: 16.4-70.9), and the incidence rate was 15.8 per 1000 person-years (CI95%: 12.9-19.4). Estimates varied significantly with age, diagnostic criteria used and location (i.e., continent). CONCLUSIONS The burden of AD dementia is substantial. Significant gaps in our understanding of its epidemiology were identified, even in a high-income country such as Canada. Future studies should assess the impact of using such newer clinical diagnostic criteria for AD dementia such as those of the National Institute on Aging-Alzheimer's Association and/or incorporate validated biomarkers to confirm the presence of Alzheimer pathology to produce more precise estimates of the global burden of AD.
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The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis. Can J Neurol Sci 2016; 43 Suppl 1:S3-S50. [DOI: 10.1017/cjn.2016.18] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionDementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia.MethodsThe MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection.ResultsOf 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males.ConclusionsDementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.
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Chen IH, Brown R, Bowers BJ, Chang WY. Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes. Res Nurs Health 2015; 38:342-56. [DOI: 10.1002/nur.21667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/10/2022]
Affiliation(s)
- I-Hui Chen
- Assistant Professor, Department of Nursing; Asia University; 500 Lioufeng Rd., Wufeng District, Taichung 41354 Taiwan
| | - Roger Brown
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Barbara J. Bowers
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Wen-Yin Chang
- Professor, Graduate Institute of Nursing, College of Nursing; Taipei Medical University; Taipei Taiwan
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Brink P, Kelley ML. Death in Long-term Care: A Brief Report Examining Factors Associated with Death within 31 Days of Assessment. Palliat Care 2015; 9:1-5. [PMID: 25674000 PMCID: PMC4315121 DOI: 10.4137/pcrt.s20347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The ability to estimate prognosis using administrative data has already been established. Research indicates that residents newly admitted to long-term care are at a higher risk of mortality. Studies have also examined mortality within 90 days or a year. Focusing on 31 days from assessment was important because it appears to be clinically useful for care planning in end-of-life; whereby, greater utility may come from identifying residents who are at risk of death within a shorter time frame so that advance care planning can occur. PURPOSE To examine risk of mortality within 31 days of assessment among long-term care residents using administrative health data. METHODS Administrative data were used to examine risk of mortality within 31 days of assessment among all long-term care residents in Ontario over a 12-month period. Data were provided by the Canadian Institute for Health Information using the Continuing Care Reporting System (CCRS), Discharge Abstract Database (DAD), and the National Ambulatory Care Reporting System (NACRS). RESULTS A number of diagnoses and health conditions predict death within 31 days. Diagnoses that hold an increased risk of mortality include pulmonary disease, diagnosis of cancer, and heart disease. Health conditions that lead to an increased likelihood of death include weight loss, dehydration, and shortness of breath. The presence of a fall within the last 30 days was also related to a higher risk of mortality. DISCUSSION Long-term care residents who lose weight, have persistent problems with hydration, and suffer from shortness of breath are at particular risk of death. The presence of advanced directives also predicts death within 31 days of assessment.
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Affiliation(s)
- Peter Brink
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Mary Lou Kelley
- Department of Social Work, Lakehead University, Thunder Bay, Ontario, Canada
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Vu M, Ciampi A, Sanche S, Richard S, de Raad M. Feasibility and Acceptability of a Delirium Prevention Program for Cognitively Impaired Long Term Care Residents: A Participatory Approach. J Am Med Dir Assoc 2014; 15:77.e1-9. [DOI: 10.1016/j.jamda.2013.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
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Wang JJ, Hsieh PF, Wang CJ. Long-term Care Nurses' Communication Difficulties with People Living with Dementia in Taiwan. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:99-103. [DOI: 10.1016/j.anr.2013.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 04/15/2013] [Accepted: 04/19/2013] [Indexed: 11/26/2022] Open
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A randomized controlled trial of dietetic interventions to prevent cognitive decline in old age hostel residents. Eur J Clin Nutr 2012; 66:1135-40. [DOI: 10.1038/ejcn.2012.117] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. Int Psychogeriatr 2010; 22:1025-39. [PMID: 20522279 DOI: 10.1017/s1041610210000608] [Citation(s) in RCA: 363] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The population of older adults in long-term care (LTC) is expected to increase considerably in the near future. An understanding of the prevalence of psychiatric disorders in LTC will help in planning mental health services for this population. This study reviews the prevalence of common psychiatric disorders in LTC populations. METHODS We searched electronic databases for studies on the prevalence of major psychiatric disorders in LTC using medical subject headings and key words. We only included studies using validated measures for diagnosing psychiatric disorders or psychiatric symptoms. Our review focused on the following psychiatric disorders: dementia, behavioral and psychological symptoms of dementia (BPSD), major depression, depressive symptoms, bipolar disorder, anxiety disorders, schizophrenia, and alcohol use disorders. We also determined the prevalence of psychiatric disorders in the U.S. LTC population using data from the 2004 National Nursing Home Survey (NNHS). RESULTS A total of 74 studies examining the prevalence of psychiatric disorders and psychological symptoms in LTC populations were identified including 30 studies on the prevalence of dementia, 9 studies on behavioral symptoms in dementia, and 26 studies on depression. Most studies involved few LTC facilities and were conducted in developed countries. Dementia had a median prevalence (58%) in studies while the prevalence of BPSD was 78% among individuals with dementia. The median prevalence of major depressive disorder was 10% while the median prevalence of depressive symptoms was 29% among LTC residents. There were few studies on other psychiatric disorders. Results from the 2004 NNHS were consistent with those in the published literature. CONCLUSIONS Dementia, depression and anxiety disorders are the most common psychiatric disorders among older adults in LTC. Many psychiatric disorders appear to be more prevalent in LTC settings when compared to those observed in community-dwelling older adults. Policy-makers and clinicians should be aware of the common psychiatric disorders in LTC and further research into effective prevention and treatments are required for this growing population.
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Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients. Int Psychogeriatr 2009; 21:1134-41. [PMID: 19735590 DOI: 10.1017/s1041610209990767] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) cause caregiver distress and earlier institutionalization. We compared the prevalence and characteristics of BPSD between institution residents and memory clinic outpatients with Alzheimer's disease (AD) to test the hypothesis that there is more BPSD among institution residents than among their outpatient counterparts. We assessed BPSD by interviewing the patients' principal caregivers, either family or professionals, using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Data from 138 patients with probable AD from the memory clinic and 173 residents with possible AD living in the long-term care facilities were collected. The diagnoses followed the NINCDS-ADRDA criteria. RESULTS BPSD profiles of the two groups were similar but not identical. The prevalence of at least one BPSD was high in both groups (community 81.9%, institution 74.9%). Activity disturbance was the most frequently reported BPSD in both groups (community 52.2%, institution 38.7%). Delusions, hallucinations, anxiety and aggressiveness were seen more frequently in memory clinic outpatients. The outpatients also had higher scores of BEHAVE-AD subscales in delusion/paranoid ideation, affective disturbance, and global rating of severity. With the increase of disease severity there were significantly more activity disturbance, psychosis, and aggressiveness in patients with AD. CONCLUSIONS Caregiver factor and institution effect were two possible reasons for the higher prevalence and the greater severity of BPSD in community patients. BPSD caused more distress to family caregivers than the professional caregivers. High levels of psychotropic prescriptions for patients living in the long-term care facilities may also play a role.
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López Mongil R, López Trigo JA, Castrodeza Sanz FJ, Tamames Gómez S, León Colombo T. [Prevalence of dementia in institutionalized patients. The RESYDEM study]. Rev Esp Geriatr Gerontol 2009; 44:5-11. [PMID: 19237028 DOI: 10.1016/j.regg.2008.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 06/02/2008] [Accepted: 06/04/2008] [Indexed: 05/27/2023]
Abstract
INTRODUCTION To determine the prevalence of dementia in nursing homes in Spain and to analyze the associated factors in an elderly population in the institutional setting. MATERIAL AND METHODS We performed a multicenter, cross-sectional, observational study of 852 residents of public, private and state-assisted nursing homes throughout Spain. Dementia was diagnosed according to the DSM-IV-TR clinical criteria. The Hughes Clinical Dementia Rating scale was used to measure global impairment or the global severity of dementia. Sociodemographic, clinical and neuropsychological variables, together with the pharmacological treatments prescribed to the participants, were recorded. RESULTS The overall prevalence of dementia was 61.7% (95% CI 58.4-65.1) and that of Alzheimer's disease was 16.9% (95% CI 14.3-19.5). Vascular dementia was found in 7.3% (95% CI 5.5-9.1). Female sex was independently associated with a greater frequency of dementia. The prevalence of dementia increased with age. Only 18.8% (95% CI 15.4-22.3) of the patients diagnosed with dementia received specific treatment for the disorder. CONCLUSIONS Two-thirds of the elderly persons living in nursing homes in Spain have dementia. Undertreatment of this disease is common. Increased awareness among health care professionals is important for the early diagnosis and appropriate management of dementia, which would represent a radical change in the approach to this disease.
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