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Plantinga A, Roodbol PF, van Munster BC, Finnema EJ. Nurses' perspectives on shared decision-making in the daily care of hospitalized patients with dementia: An exploratory qualitative study. J Adv Nurs 2024. [PMID: 38590041 DOI: 10.1111/jan.16107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
AIM Gain insight into the process of shared decision-making (SDM) in daily hospital care for patients with dementia from nurses' perspectives. DESIGN Explorative qualitative design. METHODS In-depth digital interviews were conducted with 14 registered nurses between June and November 2022. A phenomenological approach was applied using Colaizzi's seven-step method. RESULTS Five themes were identified in the data: (1) SDM in daily care: How shared decision-making is applied; (2) Nurses' perceptions and competence: How nurses perceive and manage SDM; (3) Nurses' roles and advocacy: The evolving roles of nurses and their advocacy efforts, (4) Recognition of dementia and its impact: How nurses recognize and manage dementia; and (5) Interventions to support SDM: Strategies and interventions to facilitate SDM. CONCLUSION This study highlights the complexity of SDM in patients with dementia. It demonstrates the importance of the involvement of relatives, omission of patient goals in discussions and perceived deficiencies of nurses. The early identification of dementia, evaluation of nuanced capacity and targeted communication are essential. Further research and enhanced training are required to improve care in this context. IMPACT Potential areas for further research on SDM in nurses involving patients with dementia include investigating the effects of integrating goal discussions into SDM training for nurses, overcoming barriers to SDM competence, and challenging the idea that SDM is solely the responsibility of physicians. These findings highlight the need for policies that encourage interdisciplinary collaboration, address misconceptions and recommend training programmes that focus on applying SDM to the daily care of patients with dementia, thereby improving the overall quality of patient care. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Annette Plantinga
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands
- University Center of Geriatric Medicine-Alzheimer Center Groningen, Groningen, The Netherlands
| | - Petrie F Roodbol
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- University Center of Geriatric Medicine-Alzheimer Center Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands
- Hanze University of Applied Science, Groningen, The Netherlands
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Brito DVC, Esteves F, Rajado AT, Silva N, Araújo I, Bragança J, Castelo-Branco P, Nóbrega C. Assessing cognitive decline in the aging brain: lessons from rodent and human studies. NPJ AGING 2023; 9:23. [PMID: 37857723 PMCID: PMC10587123 DOI: 10.1038/s41514-023-00120-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
As life expectancy continues to increase worldwide, age-related dysfunction will largely impact our societies in the future. Aging is well established to promote the deterioration of cognitive function and is the primary risk factor for the development of prevalent neurological disorders. Even in the absence of dementia, age-related cognitive decline impacts specific types of memories and brain structures in humans and animal models. Despite this, preclinical and clinical studies that investigate age-related changes in brain physiology often use largely different methods, which hinders the translational potential of findings. This review seeks to integrate what is known about age-related changes in the brain with analogue cognitive tests used in humans and rodent studies, ranging from "pen and paper" tests to virtual-reality-based paradigms. Finally, we draw parallels between the behavior paradigms used in research compared to the enrollment into clinical trials that aim to study age-related cognitive decline.
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Affiliation(s)
- D V C Brito
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - F Esteves
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - A T Rajado
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - N Silva
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
| | - I Araújo
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - J Bragança
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - P Castelo-Branco
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - C Nóbrega
- Algarve Biomedical Center-Research Institute (ABC-RI), Campus Gambelas, Bld.2, Faro, Portugal.
- Algarve Biomedical Center- (ABC), Campus Gambelas, Bld.2, Faro, Portugal.
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Gambelas Campus, Bld.2, Faro, Portugal.
- Champalimaud Research Program, Champalimaud Centre for the Unknown, Lisbon, Portugal.
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Clark CJ, Adler R, Xiang L, Shah SK, Cooper Z, Kim DH, Lin KJ, Hsu J, Lipsitz S, Weissman JS. Outcomes for patients with dementia undergoing emergency and elective colorectal surgery: A large multi-institutional comparative cohort study. Am J Surg 2023; 226:108-114. [PMID: 37031040 PMCID: PMC10330079 DOI: 10.1016/j.amjsurg.2023.03.012] [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: 01/10/2023] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Alzheimer's Disease and Related Dementias (ADRD) may result in poor surgical outcomes. The current study aims to characterize the risk of ADRD on outcomes for patients undergoing colorectal surgery. METHODS Colorectal surgery patients with and without ADRD from 2007 to 2017 were identified using electronic health record-linked Medicare claims data from two large health systems. Unadjusted and adjusted analyses were performed to evaluate postoperative outcomes. RESULTS 5926 patients (median age 74) underwent colorectal surgery of whom 4.8% (n = 285) had ADRD. ADRD patients were more likely to undergo emergent operations (27.7% vs. 13.6%, p < 0.001) and be discharged to a facility (49.8% vs 28.9%, p < 0.001). After multi-variable adjustment, ADRD patients were more likely to have complications (61.1% vs 48.3%, p < 0.001) and required longer hospitalization (7.1 vs 6.1 days, p = 0.001). CONCLUSIONS The diagnosis of ADRD is an independent risk factor for prolonged hospitalization and postoperative complications after colorectal surgery.
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Affiliation(s)
- Clancy J Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
| | - Rachel Adler
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lingwei Xiang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Samir K Shah
- Division of Vascular Surgery, Department of General Surgery, University of Florida, Gainesville, FL, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - John Hsu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Casey K, Sim E, Lavezza A, Iannuzzi K, Friedman LA, Hoyer EH, Young DL. Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool. Am J Occup Ther 2023; 77:24036. [PMID: 36764005 DOI: 10.5014/ajot.2023.050028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
IMPORTANCE Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment. OBJECTIVE To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care. DESIGN Prospective mixed methods. SETTING Acute care hospital. PARTICIPANTS Fifty adults. OUTCOMES AND MEASURES We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT-SF), the Activity Measure for Post-Acute Care "6-Clicks" Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT-SF and AM-PAC ACISF with those of the MoCA. RESULTS Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT-SF, and .86 for the AM-PAC ACISF. The BCAT-SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT-SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was <22. Administration time of the AM-PAC ACISF (1.0 min) was significantly less than that of the BCAT-SF (5.0 min) and the MoCA (13.3 min; p < .001). CONCLUSIONS AND RELEVANCE Each screen demonstrated acceptable reliability and construct validity. The AM-PAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting. What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.
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Affiliation(s)
- Kelly Casey
- Kelly Casey, OTD, OTR/L, BCPR, ATP, CPAM, is Acute Care Therapy Services Team Leader, Johns Hopkins Hospital, Baltimore, MD;
| | - Erin Sim
- Erin Sim, OTD, OTR/L, PMP, is Acute Care Team Coordinator, Johns Hopkins Hospital, Baltimore, MD
| | - Annette Lavezza
- Annette Lavezza, OTR/L, is Director, Inpatient Therapy Services, Johns Hopkins Hospital, Baltimore, MD; Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristen Iannuzzi
- Kristen Iannuzzi, OTD, OTR/L, BCPR, CPAM, is Occupational Therapist and Occupational Therapy Acute Care Fellow, Johns Hopkins Hospital, Baltimore, MD
| | - Lisa Aronson Friedman
- Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erik H Hoyer
- Erik H. Hoyer, MD, is Assistant Professor and Vice Chair for Quality and Safety, Department of Physical Medicine and Rehabilitation, and Member, Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Daniel L Young
- Daniel L. Young, PT, DPT, PhD, is Associate Professor, Department of Physical Therapy, University of Nevada; Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD; and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
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Amini R, Kawser B. Impact of the interaction between mild and mild‐to‐moderate cognitive impairment with chronic health problems on hospital admission among community‐dwelling older adults. Geriatr Gerontol Int 2020; 20:1213-1220. [DOI: 10.1111/ggi.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Reza Amini
- Department of Public Health and Health Sciences University of Michigan‐Flint Flint Michigan USA
| | - Bushra Kawser
- Department of Public Health and Health Sciences University of Michigan‐Flint Flint Michigan USA
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Amini R, Chee KH, Mendieta M, Parker S. Online engagement and cognitive function among older adults. Geriatr Gerontol Int 2019; 19:918-923. [DOI: 10.1111/ggi.13749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/30/2019] [Accepted: 07/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Reza Amini
- Department of Public Health and Health SciencesUniversity of Michigan‐Flint Flint Michigan USA
| | - Kyong Hee Chee
- Department of Sociology, College of Liberal ArtsTexas State University San Marcos Texas USA
| | - Maximiliano Mendieta
- Department of Public Health and Health SciencesUniversity of Michigan‐Flint Flint Michigan USA
| | - Shan Parker
- Department of Public Health and Health SciencesUniversity of Michigan‐Flint Flint Michigan USA
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