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Au-Yeung WTM, Miller L, Wu CY, Beattie Z, Nunnerley M, Hanna R, Gothard S, Wild K, Kaye J. Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review. Interact J Med Res 2024; 13:e56452. [PMID: 39121471 PMCID: PMC11344188 DOI: 10.2196/56452] [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: 01/16/2024] [Revised: 05/27/2024] [Accepted: 06/28/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers' burden, and lower health care cost. OBJECTIVE In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. METHODS Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. RESULTS A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. CONCLUSIONS The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system.
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Affiliation(s)
- Wan-Tai M Au-Yeung
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Lyndsey Miller
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Michael Nunnerley
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Psychology, Portland State University, Portland, OR, United States
| | - Remonda Hanna
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Fariborz Maseeh Department of Mathematics and Statistics, Portland State University, Portland, OR, United States
| | - Sarah Gothard
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Katherine Wild
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Wabe N, Huang G, Silva SM, Nguyen AD, Seaman K, Raban MZ, Gates P, Day R, Close JCT, Lord SR, Westbrook JI. A Longitudinal Study of the Use and Effects of Fall-Risk-Increasing Drugs in Residential Aged Care. J Am Med Dir Assoc 2024; 25:105074. [PMID: 38857685 DOI: 10.1016/j.jamda.2024.105074] [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: 12/01/2023] [Revised: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Fall-risk-increasing drugs (FRIDs)-psychotropics and cardiovascular disease (CVD) drugs-may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes. DESIGN A retrospective longitudinal cohort study. SETTING AND PARTICIPANTS A total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia. METHOD The outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes. RESULTS A total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics-low CVDs use (16.7%, n = 701); group 2, low psychotropics-high CVDs (25.0%, n = 1054); group 3, high psychotropics-high CVDs (41.0%, n = 1723); and group 4, high psychotropics-low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high. CONCLUSIONS AND IMPLICATIONS Our findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Sandun M Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Peter Gates
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ric Day
- St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia; School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Cho E, Lee JY, Yang M, Jang J, Cho J, Kim MJ. Symptom-specific non-pharmacological interventions for behavioral and psychological symptoms of dementia: An umbrella review. Int J Nurs Stud 2024; 159:104866. [PMID: 39163681 DOI: 10.1016/j.ijnurstu.2024.104866] [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: 01/24/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Non-pharmacological interventions are considered the first-line treatment for managing the behavioral and psychological symptoms of dementia. Given the heterogeneous characteristics of these symptoms, which vary for each individual and tend to fluctuate, a symptom-specific approach is necessary for providing individualized non-pharmacological interventions for people with dementia. However, clear guidelines regarding the appropriate types of interventions for individual symptoms or clusters of behavioral and psychological symptoms of dementia are lacking. OBJECTIVES The aim of this umbrella review was to summarize the current evidence on non-pharmacological interventions for behavioral and psychological symptoms of dementia and provide guidance for determining the appropriate types of interventions for each behavioral and psychological symptom of dementia. DESIGN An umbrella review of systematic reviews and/or meta-analyses. METHODS The Cochrane methodology for umbrella reviews was employed for this review, and the review protocol was registered. PubMed, CINAHL, Embase, PsycINFO, and Cochrane databases were searched for relevant reviews using the 'population, intervention, control, and outcomes' formulation. Two reviewers independently screened the extracted articles for eligibility. The quality of each selected review was independently assessed by the two reviewers using A Measurement Tool to Assess Systematic Reviews 2. The results were narratively synthesized and categorized according to each symptom. RESULTS Thirty-five systematic reviews, 71 % of which were also meta-analyses, were included in this review. The methodologies employed in the included reviews were significantly heterogeneous. The qualities of the reviews ranged from low to moderate. Diverse types of non-pharmacological interventions were identified in the reviews, with music therapy being the most frequently discussed. Among the various symptoms, depression was most frequently addressed, followed by overall symptoms, agitation, anxiety, sleep problems, and apathy. Music therapy was found to be effective for improving both overall and specific symptoms, including depression and anxiety. Notably, relatively weak evidence supports the effectiveness of exercise in addressing each symptom. Aromatherapy could be considered for agitation, whereas reminiscence may be effective in managing overall and specific symptoms, such as depression. CONCLUSIONS The results showed that the evidence of symptom-specific effectiveness of non-pharmacological interventions varied across the different behavioral and psychological symptoms of dementia, highlighting the need for a symptom-specific approach in future research. Furthermore, future research is needed to facilitate the development of symptom-specific guidelines that can enhance the quality of individualized dementia care. REGISTRATION Registered with PROSPERO (number: CRD42022340930) on November 9, 2022.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Ji Yeon Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea; School of Nursing, Inha University, Incheon, Republic of Korea
| | - Minhee Yang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Jiyoon Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea; Nell Hodgson Woodruff School of Nursing, Emory University
| | - Jungwon Cho
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Min Jung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea; Research Institute of AI and Nursing Science, College of Nursing, Gachon University, Incheon, Republic of Korea.
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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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Wang HJ, Chinna-Meyyappan A, Feldman OJ, Lanctôt KL. Emerging therapies for treatment of agitation, psychosis, or apathy in Alzheimer's disease. Expert Opin Emerg Drugs 2024:1-15. [PMID: 38822731 DOI: 10.1080/14728214.2024.2363215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Agitation, psychosis, and apathy are prevalent and highly distressing neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD) that have been linked to numerous negative outcomes, including increased mortality, worsened cognitive decline, and caregiver burden. Current treatments for AD-associated agitation, namely atypical antipsychotics, provide some benefits but may increase the risk of serious adverse events and death. Meanwhile, no pharmacotherapies have been approved by regulatory agencies for the treatment of psychosis or apathy in AD. Over the past decade, many new and repurposed drugs have emerged as potential therapeutic options for managing these challenging NPS. AREAS COVERED This review aims to provide a comprehensive summary of pharmacotherapies that have recently been investigated in phase 2 and 3 clinical trials for the treatment of agitation, psychosis, or apathy in AD. EXPERT OPINION Novel atypical antipsychotics, serotonergic antidepressants, cannabinoids, and dextromethorphan combination drugs have shown promising results for alleviating agitation. Pimavanserin appears to be the most effective emerging therapy for psychosis, while methylphenidate has demonstrated good efficacy for apathy. Further research on biomarkers of NPS severity and treatment response, as well as continued improvements in methodological approaches are needed to advance the field.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Arun Chinna-Meyyappan
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Oriel J Feldman
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [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: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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van de Beek SH, Erdal A, Husebø BS, Vislapuu M, Achterberg WP, Caljouw MAA. Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial). J Am Med Dir Assoc 2024; 25:847-852.e3. [PMID: 38403273 DOI: 10.1016/j.jamda.2024.01.012] [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: 08/02/2023] [Revised: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE This study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. DESIGN Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). SETTING AND PARTICIPANTS A total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. METHODS Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. RESULTS A total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034). CONCLUSION AND IMPLICATIONS Pain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.
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Affiliation(s)
- Sifra H van de Beek
- Department of Internal Medicine, Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Ethics and Law, Leiden University Medical Center, Leiden, the Netherlands; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Ane Erdal
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebø
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Maarja Vislapuu
- Department of Global Public Health and Primary Care, Center for Elderly and Nursing Home Medicine (SEFAS), Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
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Konno R, Suzuki M, Hosomi A, Lizarondo L, Stern C. Assisted bathing of older adults with dementia: a mixed methods systematic review update. JBI Evid Synth 2024; 22:518-559. [PMID: 38054221 DOI: 10.11124/jbies-23-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This review update aimed to determine the best strategies for assisted bathing or showering for older adults with dementia. INTRODUCTION Assisted bathing is a high-risk activity, as it can trigger agitated behaviors. Assisted bathing of older adults with dementia can create caregiver challenges and stress. INCLUSION CRITERIA This review update considered quantitative, qualitative, and mixed methods studies that investigated, firstly, older adults with dementia who required assistance with bathing and, secondly, their caregivers and family members who provided this assistance. The quantitative component considered randomized controlled trials and quasi-experimental studies testing interventions for reducing agitated behaviors in older adults with dementia during bathing, as well as perceived confidence or satisfaction in caregivers. The qualitative component considered studies that reported on experiences of clients or caregivers during the bathing process. METHODS A JBI mixed methods review was conducted following the convergent segregated approach. The review considered studies published between 1990 and March 11, 2022. The databases searched were PubMed, CINAHL, and Embase. Gray literature was also searched. Two independent reviewers screened titles and abstracts. Full texts were retrieved for studies that met the inclusion criteria and were assessed further for eligibility. Two reviewers independently assessed the quality of included studies and extracted data using the standardized JBI tools. Due to methodological and clinical heterogeneity, the results were presented narratively in the quantitative section. For the qualitative component, meta-synthesis was conducted following the JBI approach of meta-aggregation. Finally, evidence from the 2 components was integrated following the convergent segregated approach. RESULTS Ten quantitative and 4 qualitative studies were included. The methodological quality was poor to moderate in the quantitative studies and moderate to high in the qualitative studies. Results from 3 quantitative studies suggested that providing training to caregivers on person-centered bathing reduced agitated behaviors in older adults with dementia. Other interventions did not show conclusive evidence of their effectiveness in any outcomes of interest. Two synthesized findings highlighted i) the importance of working within each person's reality by having the skills and knowledge required to deliver person-centered assistance and ii) the challenges experienced by caregivers, such as lack of support, time pressure, and safety-related fears. The integrated evidence showed that the quantitative and qualitative components complemented each other to promote the training of caregivers to deliver person-centered bathing. DISCUSSION Integrated findings can help inform an evidence-based strategy utilizing a person-centered bathing approach to reduce agitated behaviors in older adults with dementia. Due to the limited number of eligible studies, and the clinical and methodological heterogeneity of included quantitative studies, no statistical pooling was possible. More studies are needed, particularly intervention studies with high methodological quality. CONCLUSIONS This review update suggests that providing caregivers with person-centered bathing training should be encouraged prior to bathing older adults with dementia. Caregivers should have the knowledge and skills, such as relevant assessment and communication skills, enabling them to provide effective bathing experiences to older adults living with dementia. Organizations should provide caregivers with appropriate resources and training for bathing older adults with dementia. REVIEW REGISTRATION PROSPERO CRD42020208048. SUPPLEMENTAL DIGITAL CONTENT A Japanese-language version of the abstract of this review is available as supplemental digital content 1: http://links.lww.com/SRX/A37 .
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Affiliation(s)
- Rie Konno
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Miyuki Suzuki
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Akiyo Hosomi
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Konno R, Suzuki M, Hosomi A, Lizarondo L, Stern C. Ending the battle of bathing for people with dementia. JBI Evid Synth 2024; 22:513-514. [PMID: 38600644 DOI: 10.11124/jbies-24-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Rie Konno
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Miyuki Suzuki
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Akiyo Hosomi
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Das S, Singh S, Kaur G, Sharma S. Quality of patient-oriented online information on treatment of dementia: A comparative assessment of web pages in English and Hindi language. Indian J Psychiatry 2024; 66:352-359. [PMID: 38778845 PMCID: PMC11107923 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_506_23] [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: 07/07/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
Background Management of dementia involves a multidisciplinary approach which also requires active participation from family members and caregivers. Thus, having easy access to information about dementia care is pertinent. Internet-based information is an emerging method for the same. Aim To perform a comparative assessment of patient-oriented online information available on treatment of dementia over web pages in English and Hindi language. Methods Observational study was conducted online through a general internet search engine (www.google.com). Web pages containing patient-oriented online information on treatment of dementia in English and Hindi were reviewed to assess their content and quality, esthetics, and interactivity. Appropriate descriptive and inferential statistics were conducted using the Statistical Package for the Social Sciences. Results A total of 70 web pages met the eligibility criteria. Content quality assessed using the DISCERN score was significantly higher for English web pages compared to Hindi web pages (P < 0.01). About 72.4% (21/29) of English and only 9.8% (4/41) of Hindi web pages had a total DISCERN score of 40 or above, indicating good quality. For esthetics, the median score for English pages was significantly higher than for Hindi web pages (P < 0.01). The web pages with Health On Net (HON) certification had significantly better content quality. Conclusion Our study revealed a scarcity of good quality online information about dementia and its treatment, especially in the Hindi language. English language websites showed better content quality than Hindi websites. HON Code label might be used as an indicator of better content quality for online resources informing on dementia treatment by lay people.
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Affiliation(s)
- Subhash Das
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
- Formerly at Government Medical College and Hospital, Chandigarh, India
| | - Swarndeep Singh
- Formerly at Government Medical College and Hospital, Chandigarh, India
- Department of Psychiatry, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Gurneet Kaur
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Sanya Sharma
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
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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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Chan WC, Wang WF, Tung YC, Chang MC, Chan HT, Jhang KM. Influence of care modes and social resources on psychotropic medication use in community-dwelling dementia patients. Front Psychiatry 2024; 14:1196801. [PMID: 38293597 PMCID: PMC10824929 DOI: 10.3389/fpsyt.2023.1196801] [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: 04/12/2024] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background Optimal use of psychotropic medications for people living with dementia is important. By finding potentially modifiable factors, dementia care teams may find solutions to achieve the appropriate use of psychotropic drugs. Objective This study aimed to elucidate patient and caregiver factors associated with the use of psychotropic drugs listed in the potentially inappropriate medications (PIMs) in community-dwelling people with dementia. Methods This cross-sectional study enrolled 808 patients newly diagnosed with dementia, and their caregivers, from a dementia clinic at Changhua Christian Hospital. Patient and caregiver characteristics, care mode, and social resource usage were recorded. Multivariate logistic regression was used to identify factors associated with prescribing psychotropic medications. Results Of all the participants, 39.1% used at least one of psychotropic medication categorized as PIM. Patients with frontotemporal dementia, with behavior or psychological symptoms, or cared by sole foreign care workers; caregivers with higher depression scores, employed or non-spouse caregivers carried a higher risk of prescription of psychotropic medications listed in PIMs. Conclusion Psychotropic drug prescriptions are associated with patient and caregiver factors. Therefore, implementing appropriate interventions, especially those targeting potentially modifiable factors, is important to reduce psychotropic medication use.
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Affiliation(s)
- Wei-Chieh Chan
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Chun Tung
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hong-Ting Chan
- Department of Long-Term Care Medicine, Puli Christian Hospital, Nantou, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
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Kim D, Choi YR, Lee YN, Chang SO. How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study. Nurs Health Sci 2024. [PMID: 38163765 DOI: 10.1111/nhs.13079] [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: 07/05/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Young-Rim Choi
- Research professor, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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Galankin TL, Bespalov AY, Moebius HY. Clusterization of Behavioral and Psychological Symptoms of Dementia as Assessed by Neuropsychiatric Inventory: A Case Against the Use of Principal Component Analysis. J Alzheimers Dis 2024; 98:1483-1491. [PMID: 38578888 DOI: 10.3233/jad-231008] [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: 04/07/2024]
Abstract
Background The term Behavioral and Psychological Symptoms of Dementia (BPSD) covers a group of phenomenologically and medically distinct symptoms that rarely occur in isolation. Their therapy represents a major unmet medical need across dementias of different types, including Alzheimer's disease. Understanding of the symptom occurrence and their clusterization can inform clinical drug development and use of existing and future BPSD treatments. Objective The primary aim of the present study was to investigate the ability of a commonly used principal component analysis to identify BPSD patterns as assessed by Neuropsychiatric Inventory (NPI). Methods NPI scores from the Aging, Demographics, and Memory Study (ADAMS) were used to characterize reported occurrence of individual symptoms and their combinations. Based on this information, we have designed and conducted a simulation experiment to compare Principal Component analysis (PCA) and zero-inflated PCA (ZI PCA) by their ability to reveal true symptom associations. Results Exploratory analysis of the ADAMS database revealed overlapping multivariate distributions of NPI symptom scores. Simulation experiments have indicated that PCA and ZI PCA cannot handle data with multiple overlapping patterns. Although the principal component analysis approach is commonly applied to NPI scores, it is at risk to reveal BPSD clusters that are a statistical phenomenon rather than symptom associations occurring in clinical practice. Conclusions We recommend the thorough characterization of multivariate distributions before subjecting any dataset to Principal Component Analysis.
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Davis ER, Aggar C, Bissett M. Nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting: An integrative review. J Clin Nurs 2023; 32:7970-7978. [PMID: 37795921 DOI: 10.1111/jocn.16891] [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: 03/10/2023] [Revised: 08/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
AIM To review existing research on nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting. BACKGROUND When people living with dementia are admitted to hospital, they often experience an exacerbation of behavioural and psychological symptoms of dementia. Pharmacological interventions are often used to manage behavioural and psychological symptoms of dementia despite the low success rate and the heightened risk of morbidity and mortality. Low-cost alternatives that are implementable at the bedside are nonpharmacological interventions such as tactile activity interventions. DESIGN An integrative review of the literature. METHODS Four databases were searched using the PRISMA framework to guide the search and screening. Eligible studies were identified and the quality of each was evaluated using the Mixed Method Appraisal Tool. Thematic analysis was conducted to identify and analyse key themes across all articles. The PRISMA checklist was used to evaluate the current study. RESULTS Seven studies examined the use of tactile activity interventions to reduce the behavioural and psychological symptoms of dementia and the barriers and facilitators to implementation. CONCLUSION There is limited evidence exploring tactile activity interventions for reducing behavioural and psychological symptoms of dementia in acute hospital settings. Individualised approaches in combination with staffing expertise appear central to implementation. RELEVANCE TO CLINICAL PRACTICE Acute hospital settings can result in increased behavioural and psychological symptoms of dementia which can be distressing for patients and family and challenging for nursing staff. Tactile activity interventions may offer a low resource bedside option to support people with dementia in acute health settings. PATIENT OR PUBLIC CONTRIBUTION No direct patient or public contribution to the review.
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Affiliation(s)
- Erin Rachel Davis
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
- Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Christina Aggar
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
- Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Michelle Bissett
- Southern Cross University, Southern Cross Drive, Bilinga, Queensland, Australia
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [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: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Chejor P, Atee M, Cain P, Whiting D, Morris T, Porock D. Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service. BMC Geriatr 2023; 23:729. [PMID: 37950203 PMCID: PMC10636936 DOI: 10.1186/s12877-023-04447-3] [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: 04/17/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. METHODS This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. RESULTS Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. CONCLUSION This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Mustafa Atee
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
- The Dementia Centre, HammondCare, Osborne Park, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
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Vuic B, Milos T, Tudor L, Nikolac Perkovic M, Konjevod M, Nedic Erjavec G, Farkas V, Uzun S, Mimica N, Svob Strac D. Pharmacogenomics of Dementia: Personalizing the Treatment of Cognitive and Neuropsychiatric Symptoms. Genes (Basel) 2023; 14:2048. [PMID: 38002991 PMCID: PMC10671071 DOI: 10.3390/genes14112048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Dementia is a syndrome of global and progressive deterioration of cognitive skills, especially memory, learning, abstract thinking, and orientation, usually affecting the elderly. The most common forms are Alzheimer's disease, vascular dementia, and other (frontotemporal, Lewy body disease) dementias. The etiology of these multifactorial disorders involves complex interactions of various environmental and (epi)genetic factors and requires multiple forms of pharmacological intervention, including anti-dementia drugs for cognitive impairment, antidepressants, antipsychotics, anxiolytics and sedatives for behavioral and psychological symptoms of dementia, and other drugs for comorbid disorders. The pharmacotherapy of dementia patients has been characterized by a significant interindividual variability in drug response and the development of adverse drug effects. The therapeutic response to currently available drugs is partially effective in only some individuals, with side effects, drug interactions, intolerance, and non-compliance occurring in the majority of dementia patients. Therefore, understanding the genetic basis of a patient's response to pharmacotherapy might help clinicians select the most effective treatment for dementia while minimizing the likelihood of adverse reactions and drug interactions. Recent advances in pharmacogenomics may contribute to the individualization and optimization of dementia pharmacotherapy by increasing its efficacy and safety via a prediction of clinical outcomes. Thus, it can significantly improve the quality of life in dementia patients.
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Affiliation(s)
- Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Tina Milos
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Vladimir Farkas
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatry, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (B.V.); (T.M.); (L.T.); (M.N.P.); (M.K.); (G.N.E.); (V.F.)
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Liu CC, Lin CY, Liu CH, Chang KC, Wang SK, Wang JY. Bidirectional association between major depressive disorder and dementia: Two population-based cohort studies in Taiwan. Compr Psychiatry 2023; 127:152411. [PMID: 37722203 DOI: 10.1016/j.comppsych.2023.152411] [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: 06/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk. METHODS We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009-2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009-2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55-2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35-2.59). CONCLUSIONS This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan.
| | - Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Linsen Chinese Medicine Branch, Taipei, Taiwan; Institute of Health and Welfare Policy, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taiwan; Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei City, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Kai Wang
- Department of Pediatrics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan.
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Yeh WC, Hsu CY, Li KY, Chien CF, Huang LC, Yang YH. Association between subclinical epileptiform discharge and the behavioral and psychological symptoms in patients with Alzheimer's dementia. Int J Geriatr Psychiatry 2023; 38:e6013. [PMID: 37817385 DOI: 10.1002/gps.6013] [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: 04/06/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with Alzheimer's disease (AD), causing burdens on caregivers. Behavioral and psychological symptoms of dementia and subclinical epileptiform discharge (SED) increased with the disease course of AD. However, the interaction between them was still unknown. The present study aimed to evaluate the associations between SED and BPSD. METHODS/DESIGN Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10-20 system scalp electroencephalography (EEG) for 13 min was performed to detect SED. Behavioral and psychological symptoms of dementia was assessed by neuropsychiatric inventory (NPI) questionnaires. The occurrence of BPSD subsyndromes was compared between patients with and without SED. RESULTS Two hundred sixty-three adult patients qualified for the inclusion criteria and were enrolled in this study. The mean age of patients was 80.2 years, and approximately 62% were women. 17.1% of patients showed SED on EEG. Apathy was the most commonly reported BPSD subsyndrome in this cohort. There was no significant difference in the prevalence of BPSD between patients with and without SED. (75.6% vs. 67.4%, p = 0.2806). However, the NPI score of irritability subsyndrome was significantly higher in the SED (+) group (2.6 ± 3.7 vs. 1.2 ± 2.7, p = 0.0028). In addition, subclinical epileptiform discharge in the frontal lobe was associated with a considerably higher occurrence of hyperactivity subsyndrome, including irritability. CONCLUSIONS SED may not be a direct cause of BPSD, but the presence of SED may affect the manifestation of BPSD.
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Affiliation(s)
- Wei-Chih Yeh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Post-baccalaureate Medicine, Kaohsiung Medical, University, Kaohsiung, Taiwan
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21
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Bishara D, Riaz S, Sauer J, Mueller C, Gee S, Taylor D, Wilcha RJ, Edwards M, Beehuspoteea N, Mallia AMB, Brook J, Balasundaram B, Harwood D, Funnell N, Strydom A, Stewart R. A tool for safer prescribing in vulnerable adults: the continuing development of the Medichec app and website. BJPsych Bull 2023:1-7. [PMID: 37671832 DOI: 10.1192/bjb.2023.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
AIMS AND METHOD Adverse effects are a common concern when prescribing and reviewing medication, particularly in vulnerable adults such as older people and those with intellectual disability. This paper describes the development of an app giving information on side-effects, called Medichec, and provides a description of the processes involved in its development and how drugs were rated for each side-effect. Medications with central anticholinergic action, dizziness, drowsiness, hyponatraemia, QTc prolongation, bleeding and constipation were identified using the British National Formulary (BNF) and frequency of occurrence of these effects was determined using the BNF, product information and electronic searches, including PubMed. RESULTS Medications were rated using a traffic light system according to how commonly the adverse effect was known to occur or the severity of the effect. CLINICAL IMPLICATIONS Medichec can facilitate access to side-effects information for multiple medications, aid clinical decision-making, optimise treatment and improve patient safety in vulnerable adults.
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Affiliation(s)
- Delia Bishara
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sahar Riaz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Justin Sauer
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siobhan Gee
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Taylor
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robyn-Jenia Wilcha
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Millie Edwards
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nirja Beehuspoteea
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Anne Marie Bonnici Mallia
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Brook
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Harwood
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicola Funnell
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Strydom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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22
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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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23
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Md Hussin NS, Karuppannan M, Gopalan Y, Tan KM, Gnanasan S. Exploration of non-pharmacological interventions in the management of behavioural and psychological symptoms of dementia. Singapore Med J 2023; 64:497-502. [PMID: 34600449 PMCID: PMC10476919 DOI: 10.11622/smedj.2021125] [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: 01/28/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Introduction Behavioural and psychological symptoms of dementia (BPSD) are considered integral parts of dementia. While pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended as the first line of treatment in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD and the strategies and barriers to implementing them in secondary care facilities in Malaysia. Methods A qualitative study design was employed. Data were collected through observations and semi-structured interviews of 12 caregivers and 11 people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes, and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis. Results Some personalised non-pharmacological interventions, such as physical exercise, music therapy, reminiscence therapy and pet therapy, were conducted in several nursing care centres. Collaborative care from the care providers and family members was found to be an important facilitating factor. The lack of family support led to care providers carrying additional workload beyond their job scope. Other barriers to non-pharmacological interventions were cultural and language differences between the care providers and PWD, inadequate staff numbers and training, and time constraints. Conclusion Although non-pharmacological approaches have been used to some extent in Malaysia, continuous education and training of healthcare providers and the family members of PWD is needed to overcome the challenges to their successful implementation.
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Affiliation(s)
- Nur Sabiha Md Hussin
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
| | - Yogheswaran Gopalan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
| | - Kit Mun Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shubashini Gnanasan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
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24
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Bélanger-Dibblee M, Pham Thi-Desmarteau S, Jacques MC, Tremblay H, Roy-Desruisseaux J. The Experiences, Needs, and Solutions of Caregivers of Patients With Behavioral and Psychological Symptoms of Dementia Living in Residential and Long-Term Care Centers. QUALITATIVE HEALTH RESEARCH 2023; 33:871-883. [PMID: 37271946 PMCID: PMC10426249 DOI: 10.1177/10497323231173854] [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: 06/06/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) pose great challenges for the caregivers during the evolution of the disease with impacts on patients, caregivers, and healthcare providers. Caregivers often remain very present and involved once the difficult decision has been made to relocate the person to a residential and long-term care center (centre d'hébergement de soins de longue durée [CHSLD] in Quebec). The experience of caregivers about BPSD management in CHSLDs remains poorly understood. The aim of this study is to explore the needs and experience of caregivers of patients with BPSD living in CHSLDs, as well as the solutions they suggest to better manage BPSD in CHSLDs. We carried out this qualitative interpretive descriptive study with six focus groups, including 32 caregivers, in Quebec, Canada. Data analysis identified six themes: (1) the transition period between home and the CHSLD; (2) the lack of knowledge about BPSD; (3) the approach to BPSD by healthcare professionals; (4) the lack of communication; (5) defining the caregiver's role in the healthcare team; and (6) the caregiver's need for respite. These results offer relevant avenues to improve collaborative practices with caregivers in CHSLDs involved in the care of people with BPSD.
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Affiliation(s)
| | | | | | - Hubert Tremblay
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
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25
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Pozzi FE, Calì L, Ferrarese C, Appollonio I, Tremolizzo L. Assessing behavioral and psychological symptoms of dementia: a comprehensive review of current options and future perspectives. FRONTIERS IN DEMENTIA 2023; 2:1226060. [PMID: 39082001 PMCID: PMC11285590 DOI: 10.3389/frdem.2023.1226060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/29/2023] [Indexed: 08/02/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous set of challenging disturbances of behavior, mood, perception, and thought that occur in almost all patients with dementia. A huge number of instruments have been developed to assess BPSD in different populations and settings. Although some of these tools are more widely used than others, no single instrument can be considered completely satisfactory, and each of these tools has its advantages and disadvantages. In this narrative review, we have provided a comprehensive overview of the characteristics of a large number of such instruments, addressing their applicability, strengths, and limitations. These depend on the setting, the expertise required, and the people involved, and all these factors need to be taken into account when choosing the most suitable scale or tool. We have also briefly discussed the use of objective biomarkers of BPSD. Finally, we have attempted to provide indications for future research in the field and suggest the ideal characteristics of a possible new tool, which should be short, easy to understand and use, and treatment oriented, providing clinicians with data such as frequency, severity, and triggers of behaviors and enabling them to find appropriate strategies to effectively tackle BPSD.
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Affiliation(s)
- Federico Emanuele Pozzi
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Luisa Calì
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ildebrando Appollonio
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lucio Tremolizzo
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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26
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Dero K, van Alphen SPJ, Hoogenhout E, Rossi G. The role of maladaptive personality in behavioural and psychological symptoms in dementia. Int J Geriatr Psychiatry 2023; 38:e5971. [PMID: 37462412 DOI: 10.1002/gps.5971] [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: 07/26/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although research demonstrated a significant link between premorbid normative personality traits and the severity of behavioural and psychological symptoms in dementia (BPSD) and associated emotional distress of the caregiver, little is known about the relationship of BPSD symptoms and associated distress with maladaptive traits. METHOD Informants (N = 182) of Dutch nursing home residents with dementia aged 65+, completed the Neuropsychiatric Inventory Questionnaire to assess the severity of BPSD and associated emotional distress. Premorbid maladaptive personality traits were evaluated using informant versions of a brief version of the Personality Inventory for Diagnostic and Statistical manual of Mental Disorders-5 (PID-5-BF), and two age-specific personality measures, the Informant Personality Questionnaire (HAP), and Gerontological Personality disorder Scale. Relationships between premorbid personality and BPSD were investigated with correlational and ordinal regression analyses. RESULTS BPSD severity and distress were associated with medium sized correlations to Negative Affectivity, Antagonism and indications of personality disorder presence. The emotional distress also correlated with a medium effect with Detachment. Higher scores on maladaptive personality traits increased the odds of higher BPSD severity and distress. CONCLUSION Results found with age-specific personality measures were in line with results found with other measures of (mal)adaptive traits. Several maladaptive personality traits had a significant relationship with the BPSD severity and associated emotional distress. We therefore encourage to implement personality assessment within BPSD treatment strategies. This way care becomes more person-focused and more tailored to the specific needs of patients and caregivers.
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Affiliation(s)
- Kato Dero
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | | | - Gina Rossi
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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27
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Wang HJ, Kusumo RW, Kiss A, Tennen G, Marotta G, Viaje S, Lanctôt KL. Characterizing PRN Use of Psychotropic Medications for Acute Agitation in Canadian Long-Term Care Residents with Dementia Before and During COVID-19. J Alzheimers Dis Rep 2023; 7:575-587. [PMID: 37313488 PMCID: PMC10259051 DOI: 10.3233/adr-230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023] Open
Abstract
Background Agitation is a disabling neuropsychiatric symptom of dementia. Pro re nata (PRN) injections of psychotropics can be administered for severe acute agitation, but little is known about the frequency of their actual use. Objective Characterize actual use of injectable PRN psychotropics for severe acute agitation in Canadian long-term care (LTC) residents with dementia and compare use before and during the COVID-19 pandemic. Methods Residents from two Canadian LTC facilities with orders for PRN haloperidol, olanzapine, or lorazepam between January 1, 2018- May 1, 2019 (i.e., pre-COVID-19) and January 1, 2020- May 1, 2021 (i.e., COVID-19) were identified. Electronic medical records were reviewed to document PRN injections of psychotropic medications and collect data on reason and demographic characteristics. Descriptive statistics were used to characterize frequency, dose, and indications of use, and multivariate regression models were used to compare use between time periods. Results Of the 250 residents, 45 of 103 (44%) people in the pre-COVID-19 period and 85 of 147 (58%) people in the COVID-19 period with standing orders for PRN psychotropics received ≥1 injections. Haloperidol was the most frequently used agent in both time periods (74% (155/209 injections) pre-COVID-19; 81% (323/398 injections) during COVID-19). Residents in the COVID-19 period were almost two times more likely to receive injections compared with those in the pre-COVID-19 period (odds ratio = 1.96; 95% CI = 1.15-3.34; p = 0.01). Conclusion Our results suggest that use of PRN injections increased in LTC during the pandemic and contribute to the mounting evidence that agitation worsened during that time.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Raphael W. Kusumo
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gayla Tennen
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Giovanni Marotta
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Geriatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Shirley Viaje
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Krista L. Lanctôt
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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28
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Du H, Bo L, Lai X, Zhu H, Huo X. Network meta-analysis of comparative efficacy of animal-assisted therapy vs. pet-robot therapy in the management of dementia. Front Aging Neurosci 2023; 15:1095996. [PMID: 37323139 PMCID: PMC10264590 DOI: 10.3389/fnagi.2023.1095996] [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: 11/11/2022] [Accepted: 04/21/2023] [Indexed: 06/17/2023] Open
Abstract
Objective This network meta-analysis aimed to compare and rank the efficacy of animal-assisted therapy (AAT) and pet-robotic therapy (PRT) in the management of dementia. Methods Relevant studies were identified by searching PubMed, EMBASE, the Cochrane Library, SCOPUS, and Web of Science (WoS) until October 13, 2022. Traditional meta-analysis was first conducted based on the random-effects model, then random network meta-analysis was conducted to determine the relative efficacy and rank probability of AAT and PRT. Results Nineteen randomized controlled trials (RCTs) were included in this network meta-analysis. Network meta-analysis revealed that PRT marginally benefited agitation alleviation compared with control (standard mean difference [SMD]: -0.37, 95% confidence interval [95%CI]: -0.72 to -0.01) although both AAT and PRT did not improve cognitive function, reduce depression, and improve Quality of Life (QoL). The SUCRA probabilities indicated that PRT ranked better than AAT in agitation, cognitive function, and QoL, although there were no differences between the two therapies. Conclusion The present network meta-analysis reveals that PRT may help alleviate agitated behaviors in people with dementia. However, future studies are warranted to establish evidence of the effectiveness of PRT and further evaluate the differences between different robot types in managing dementia.
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Affiliation(s)
- Hongdi Du
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Bo
- 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
| | - Hongwei Zhu
- 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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29
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Hung YH, Wang WF, Chang MC, Jhang KM. Case Management-based Collaborative Care Model Associated with improvement in neuropsychiatric outcomes in community-dwelling people living with dementia. BMC Geriatr 2023; 23:339. [PMID: 37259035 DOI: 10.1186/s12877-023-04024-8] [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: 12/31/2022] [Accepted: 05/07/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND This study aimed to explore the association between adherence of collaborative care model and short-term deterioration of BPSD after controlling patient and caregiver factors. METHODS This retrospective case-control study enrolled 276 participants who were newly diagnosed with dementia and BPSD. A dementia collaborative care team interviewed patients and caregivers to form a care plan and provided individualized education or social resource referrals. A multivariate logistic regression model with backward selection was used to test factors associated with BPSD deterioration, defined as worse neuropsychiatric inventory (NPI) scores 1 year after joining the care model. RESULTS Male sex (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.25-0.84) and higher clinical dementia rating scale sum of boxes scores (CDR-SOB) (OR = 0.90; 95% CI = 0.83-0.98) were protective factors, whereas spouse caregivers and withdrawals from the care model (OR = 3.42; 95% CI = 1.28-9.15) were risk factors for BPSD deterioration. CONCLUSIONS Our study showed that both patient and caregiver factors were associated with deterioration of BPSD. The case manager-centered dementia collaborative care model is beneficial for the management of BPSD. Healthcare systems may consider implementing a case management model in clinical dementia care practice.
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Affiliation(s)
- Yu-Hsuan Hung
- School of Medicine, Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
- , No. 135 Nanxiao St, Changhua City, 500, Taiwan.
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Alexandri F, Papadopoulou L, Tsolaki A, Papantoniou G, Athanasiadis L, Tsolaki M. The Effect of Cannabidiol 3% on Neuropsychiatric Symptoms in Dementia - Six-Month Follow-Up. Clin Gerontol 2023:1-8. [PMID: 37153956 DOI: 10.1080/07317115.2023.2209563] [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] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To investigate the beneficial outcomes of giving cannabidiol (CBD) 3% over a six-month period in the BPSD, the management of which is a crucial issue for everyday clinical praxis and to compare the progress in BPSD of patients who receive Cannabidiol 3% with those who follow usual medical treatment (UMT) in everyday clinical praxis. METHODS A total of 20 PwD with severe BPSD were recruited from the database of Alzheimer Hellas with NPI score >30. Ten of them were assigned to UMT, while ten were assigned to a six-month treatment with CBD drops. The follow-up assessment was performed with NPI, both clinically and by structured telephone interview. RESULTS The follow-up assessment with NPI showed significant improvement of the BPSD in all our patients who received CBD, and no or limited improvement in the second group, regardless of the underlying neuropathology of dementia. CONCLUSIONS We suggest that CBD may be a more effective and safe choice for managing BPSD than the typical intervention. Future large randomized clinical trials are needed to re-assure these findings. CLINICAL IMPLICATIONS Healthcare professionals should consider incorporating CBD 3% into their practices to reduce BPSD in PwD. Regular assessments are necessary to ensure long-term effectiveness.
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Affiliation(s)
- Foteini Alexandri
- Neurosciences and Neurodegenerative Diseases, Postgraduate Course, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Lydia Papadopoulou
- Neurosciences and Neurodegenerative Diseases, Postgraduate Course, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Anthoula Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (Alzheimer Hellas), Thessaloniki, Greece
- 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Georgia Papantoniou
- Department of Early Childhood Education, Faculty of Education Science, University of Ioannina, Ioannina, Greece
| | - Loukas Athanasiadis
- 1st Department of Psychiatry, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
| | - Magda Tsolaki
- Neurosciences and Neurodegenerative Diseases, Postgraduate Course, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
- Greek Association of Alzheimer's Disease and Related Disorders (Alzheimer Hellas), Thessaloniki, Greece
- 1st Department of Neurology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Makedonia, Greece
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Akhter R, Sun W, Quevedo AJU, Lemonde M, Liscano R, Horsburgh S. Healthcare professionals' perception of using a web-based reminiscence therapy to support person with dementia during the COVID-19 pandemic. Aging Clin Exp Res 2023; 35:1127-1138. [PMID: 37009966 PMCID: PMC10068196 DOI: 10.1007/s40520-023-02394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Reminiscence therapy (RT) is the most common non-pharmacological treatment for dementia care. The therapy stimulates the senses to evoke memories having the potential to reduce Behavioral and Psychological Symptoms of Dementia (BPSD). Digital RT, such as web-based reminiscence therapy (WBRT), has the potential to support dementia care and reduce the caregiving burden. AIMS This study aimed to explore healthcare professionals (HCPs) perceptions of utilizing WBRT in institutionalized settings to support persons with dementia during the COVID-19 pandemic. METHODS A qualitative phenomenological descriptive study was adopted and guided by Graham's Knowledge to Action framework. Online training on the use of WBRT was conducted, followed by interviews with HCPs. RESULTS Four major themes were identified on the potential use of WBRT in dementia care, including usability and efficacy, impact on caregiving, capability of reducing BPSD, and. feasibility during COVID-19 social distancing. DISCUSSION This study recognized the potential use of WBRT to support the person with dementia during the pandemic in institutionalized settings. CONCLUSION The knowledge generated from this study will guide the future application of WBRT to support dementia care in diverse healthcare settings.
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Affiliation(s)
- Rabia Akhter
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | | | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Ramiro Liscano
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| | - Sheri Horsburgh
- Geriatric Psychiatry Unit, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
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Murphy KS, Atkinson DM, Starks J. The Importance of Person-Centered Approaches to Managing Behavioral and Psychological Symptoms of Dementia: A Case Report. Cureus 2023; 15:e37387. [PMID: 37182008 PMCID: PMC10171880 DOI: 10.7759/cureus.37387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common and associated with increased morbidity and mortality in dementia. In this report, we describe a patient with severe BPSD who was effectively managed with a variety of non-pharmacologic strategies. A 70-year-old Navy veteran and retired commercial flooring business owner with a history of dementia was admitted to the hospital with aggressive behavior. He was no longer manageable by his family. He required intermittent use of restraints and multiple antipsychotics during hospitalization. He spent much of his time crawling on the floor, "working" on floor tiles, which was often difficult for staff to safely accommodate. However, with time, interprofessional staff identified signs of distress and developed strategies to safely engage the patient's current perception of his situation. This case highlights how BPSD may be driven by a person's identities and roles from earlier stages of life. Approaching and managing these symptoms flexibly can enhance dementia care.
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Affiliation(s)
- Kayla S Murphy
- Psychiatry, University of Minnesota, Minneapolis, USA
- Psychiatry, The University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - David M Atkinson
- Psychiatry/Geriatric Psychiatry, Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, USA
- Psychiatry/Geriatric Psychiatry, University of Minnesota, Minneapolis, USA
| | - Jamie Starks
- Neurology/Behavioral Neurology, Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, USA
- Neurology/Behavioral Neurology, University of Minnesota, Minneapolis, USA
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Brown P, Harrison Dening K. Assessing and managing agitation as a symptom of dementia. Nurs Older People 2023; 35:e1433. [PMID: 36883890 DOI: 10.7748/nop.2023.e1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/09/2023]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least well understood in terms of identification and management. Furthermore, agitation as a symptom of dementia is often confused with agitation as a way of expressing an emotion or unmet need. Psychosocial interventions are recommended to support the person with dementia and their family carers to manage agitation as a symptom of dementia, as well as other BPSD, in a person-centred manner. Some psychosocial interventions for managing agitation as a symptom of dementia have shown benefits, but further investigation of the usefulness of a range of interventions is needed. This article discusses the assessment and management of agitation as a symptom of dementia and illustrates their application through a case study.
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Affiliation(s)
- Pat Brown
- Dementia UK, London, England and PhD student, University College London, London, England
| | - Karen Harrison Dening
- Dementia UK, London, England and honorary professor of dementia nursing, De Montfort University, Leicester, England
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The Cognitive Daisy (COG-D) for improving care for residents with dementia in care homes: protocol of a feasibility RCT. Pilot Feasibility Stud 2023; 9:34. [PMID: 36869406 PMCID: PMC9983230 DOI: 10.1186/s40814-023-01256-8] [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: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Cognitive problems associated with dementia affect a large proportion of older adults living in residential care. Knowledge of cognitive impairments is important for providing person-centred care (PCC). The impact of specific cognitive impairments on residents' needs is often overlooked in dementia training and information about residents' individual cognitive profiles are frequently underspecified in care-plans, potentially undermining the delivery of PCC. This can lead to reduced resident quality of life and increased distressed behaviours-a major cause of staff stress and burnout. The COG-D package was developed to fill this gap. Daisies provide a visual representation of a resident's individual cognitive strengths and weaknesses in a colourful flower (Daisy) representing five cognitive domains. By viewing a resident's Daisy, care-staff can flexibly adjust in-the-moment care-decisions and can consult Daisies in care-plans for longer-term planning. The primary aim of this study is to assess the feasibility of implementing the COG-D package in residential care homes for older adults. METHODS/DESIGN This 24-month feasibility cluster randomized controlled trial involves a 6-month intervention of the use of Cognitive Daisies in 8-10 residential care homes for older adults after training of care staff on the use of Cognitive Daisies in daily care (basic training) and on conducting the COG-D assessments with residents (advanced training). The key feasibility outcomes include % residents recruited, % COG-D assessments completed, and % staff completing the training. Candidate outcome measures for residents and staff will be obtained at baseline, and at 6 and 9 months post-randomization. COG-D assessments of residents will be repeated 6 months after the first assessment. A process evaluation will assess intervention implementation and barriers and facilitators to this through care-plan audits, interviews and focus groups with staff, residents, and relatives. Feasibility outcomes will be analysed against progression criteria to a full trial. DISCUSSION The results of this study will provide important information about the feasibility of using COG-D in care homes and will inform the design of a future large-scale cluster RCT to assess the effectiveness and cost-effectiveness of the COG-D intervention in care homes. TRIAL REGISTRATION This trial was registered on 28/09/2022 (ISRCTN15208844) and is currently open to recruitment.
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Kobayashi M, Katayama M, Hayashi T, Hashiyama T, Iyanagi T, Une S, Honda M. Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study. BMJ Open 2023; 13:e065477. [PMID: 36868602 PMCID: PMC9990644 DOI: 10.1136/bmjopen-2022-065477] [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] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme. DESIGN A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians' responses to an open-ended questionnaire administered after the training. SETTING An acute care hospital. PARTICIPANTS A total of 23 physicians. INTERVENTIONS In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI. MAIN OUTCOME MEASURES The primary outcomes were the physicians' eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians' empathy and burnout scores. RESULTS The proportion of the duration of the participants' single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians' perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients' condition; changes in clinical management; professionalism; team building and personal accomplishments. CONCLUSIONS Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000044288; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).
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Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Division of Geriatric Medicine, Rochester Regional Health System, Rochester, New York, USA
| | - Mitsuya Katayama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Tomofumi Hayashi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Takuhiro Hashiyama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Toshinori Iyanagi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Saki Une
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
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Su CC, Yang YHK, Cheng CL, Lai ECC, Hsieh CY, Chen CH, Lin HJ, Sung SF, Chen YW. Incidence, prescription patterns and risk factors of antipsychotic initiation in elderly stroke survivors. Int J Geriatr Psychiatry 2023; 38:e5892. [PMID: 36802350 DOI: 10.1002/gps.5892] [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: 11/10/2022] [Accepted: 02/19/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Epidemiological data regarding antipsychotic initiation in elderly patients with stroke are limited. We aimed to investigate the incidence, prescription patterns and determinants of antipsychotic initiation in elderly patients with stroke. METHODS We conducted a retrospective cohort study to identify patients aged above 65 years who had been admitted for stroke from the National Health Insurance Database (NHID). The index date was defined as the discharge date. The incidence and prescription pattern of antipsychotics were estimated using the NHID. To evaluate the determinants of antipsychotic initiation, the cohort identified from the NHID was linked to the Multicenter Stroke Registry (MSR). Demographics, comorbidities and concomitant medications were obtained from the NHID. Information including smoking status, body mass index, stroke severity and disability was retrieved by linking to the MSR. The outcome was antipsychotic initiation after the index date. Hazard ratios for antipsychotic initiation were estimated using the multivariable Cox model. RESULTS In terms of prognosis, the first 2 months after a stroke was the highest-risk period for antipsychotic use. A high burden of coexisting diseases carried an increased risk of antipsychotic use; in particular, chronic kidney disease (CKD) had the highest adjusted hazard ratio (aHR = 1.73; 95% CI 1.29-2.31) as compared with other risk factors. Furthermore, stroke severity and disability were significant risk factors for antipsychotic initiation. CONCLUSIONS Our study indicated that elderly stroke patients with chronic medical conditions, particularly CKD, and a higher stroke severity and disability were at greater risk of psychiatric disorders during the first 2 months after a stroke. CLINICAL TRIAL REGISTRATION NA.
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Affiliation(s)
- Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Lan Cheng
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan.,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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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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Relationship Between Dementia Knowledge and Occupational Strain Among Staff of Residential Facilities for Older Adults: A Cross-sectional Survey. AGEING INTERNATIONAL 2023. [DOI: 10.1007/s12126-023-09523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
AbstractWorking with people living with dementia in residential facilities for older adults can be challenging, and this is exacerbated when staff have a limited understanding of dementia. However, the relationship between knowledge of dementia and strain in caring for people with dementia among residential facility staff is unclear. This cross-sectional study investigated the relationship between dementia knowledge and strain in caring for people with dementia. A questionnaire containing the Dementia Knowledge Assessment and Strain in Dementia Care Scales was administered in 2017 and 2019 to 141 staff in three southern Australian residential facilities for older adults. Bivariate and hierarchical regression analysis examined inter-scale relationships and the power of dementia strain to explain knowledge variance. It was found that staff had substantial gaps in dementia knowledge (mean score 32/50) and low strain in dementia care (mean score 4/16). A positive relationship was found between higher dementia knowledge and greater strain in dementia care (rs = 0.319, p < .001), particularly with feeling that residents are not receiving appropriate care from colleagues (Factor 1 Frustrated Empathy; rs = 0.392, p < .001). Frustrated Empathy explained a significant amount of variance in dementia knowledge beyond demographic variables. The findings suggest that more comprehensive dementia knowledge is associated with higher strain in care of people with dementia, particularly in the context of perceived lapses in the quality of care provided by colleagues. Arguably, organisational-wide dementia education to address identified gaps should be supported by facilitating staff enaction of their knowledge to improve care.
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Noroozian M, Vahabi Z, Hooshyari Z, Etesam F, Tarighatnia H. Validation study of the Persian version of behavioral pathology in Alzheimer's Disease Rating scale (BEHAVE-AD) and the empirical BHAVE-AD (E-BEHAVE-AD). APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773017 DOI: 10.1080/23279095.2023.2175680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) are observed in more than 90% of patients with Alzheimer's disease (AD). BPSDs are remediable if detected early and managed appropriately. Behavioral Pathology in Alzheimer's disease Rating Scale (BEHAVE-AD) and Empirical BEHAVE-AD (E-BEHAVE-AD) were designed to identify BPSD. The aim of this study is to validate and prepare BEHAVE-AD and E-BEHAVE-AD in Persian language for clinical and research applications. METHOD 120 patients were selected through a combination of intentional and convenience sampling. All participants should fulfill the NINCDS-ADRDA Work Group criteria for a clinical diagnosis of Alzheimer's disease. Functional Assessment Staging Tool (FAST) was used to determine the rate of AD progression. All patients were evaluated using the BEHAVE-AD and E-BEHAVE-AD questionnaires, as well as the Persian version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Mini-Mental State Examination (MMSE). The Content Validity Index (CVI) is determined based on the compatibility of the Persian and the original version of the two scales according to the opinion of expert panels. Correlation of MMSE with BEHAVE-AD and E-BEHAVE-AD as well as the BPSD pattern on AD progression continuum by FAST were considered as indices of construct validity. Concurrent validity was estimated by correlating NPI-Q scores with BEHAVE-AD and E-BEHAVE-AD scores. For both scales, interrater reliability was extracted as a reliability index. RESULTS Pearson correlation coefficients for the BEHAVE-AD scale were as follows: with NPI-Q (r = 0.77, p-value <0.01), with MMSE (r = -0.34, p-value <0.01), indicating concurrent and construct validity, respectively. The result for E-BEHAVE-AD was as follows: with NPI-Q-total (r = 0.59, p-value <0.01), and with MMSE (r = 0.31, p-value <0. 01). BEHAVE-AD and E-BEHAVE-AD scores increased in parallel with AD severity according to FAST, but not on the most severe AD stage. The area under the curve was estimated to be 0.84 (p-value <0.001) for BEHAVE-AD and 0.78 (p-value <0.001) for E-BEHAVE-AD. Correlation between BEHAVE-AD and E-BEHAVE-AD scores ranged from 0.45 to 0.63. The inter-rater reliability index ranged from 0.88 to 0.99 for BEHAVE-AD and from 0.74 to 0.95 for E-BEHAVE-AD. CONCLUSIONS The Persian version of BEHAVE-AD and E-BEHAVE-AD is valid and reliable for the assessment of BPSD in patients with AD.
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Affiliation(s)
- Maryam Noroozian
- Department of Psychiatry, Cognitive Neurology and Neuropsychiatry Division, Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Vahabi
- Memory and Behavioral Neurology Division, Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farnaz Etesam
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Helya Tarighatnia
- Memory and Behavioral Neurology Division, Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Ardelean A, Redolat R. Supporting Behavioral and Psychological Challenges in Alzheimer Using Technology: A Systematic Review. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2172900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A. Ardelean
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
| | - R. Redolat
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
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Boafo J, David D, Wu B, Brody AA, Sadarangani T. "The Sun Came Up Because You Got Here…": A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia. J Appl Gerontol 2023; 42:147-159. [PMID: 36165422 DOI: 10.1177/07334648221128283] [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: 01/18/2023] Open
Abstract
In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.
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Affiliation(s)
| | - Daniel David
- 15935New York University College of Nursing, New York, NY, USA
| | - Bei Wu
- 5894New York University, New York, NY, USA
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Zagórska A, Czopek A, Fryc M, Jaromin A, Boyd BJ. Drug Discovery and Development Targeting Dementia. Pharmaceuticals (Basel) 2023; 16:151. [PMID: 37259302 PMCID: PMC9965722 DOI: 10.3390/ph16020151] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 08/04/2023] Open
Abstract
Dementia, most often associated with neurodegenerative diseases, affects millions of people worldwide, predominantly the elderly. Unfortunately, no treatment is still available. Therefore, there is an urgent need to address this situation. This review presents the state of the art of drug discovery and developments in targeting dementia. Several approaches are discussed, such as drug repurposing, the use of small molecules, and phosphodiesterase inhibitors. Furthermore, the review also provides insights into clinical trials of these molecules. Emphasis has been placed on small molecules and multi-target-directed ligands, as well as disease-modifying therapies. Finally, attention is drawn to the possibilities of applications of nanotechnology in managing dementia.
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Affiliation(s)
- Agnieszka Zagórska
- Department of Medicinal Chemistry, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Anna Czopek
- Department of Medicinal Chemistry, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Monika Fryc
- Department of Medicinal Chemistry, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Anna Jaromin
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wrocław, Joliot-Curie 14a, 50-383 Wrocław, Poland
| | - Ben J. Boyd
- Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, VIC 3052, Australia
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Kapustin D, Zarei S, Wang W, Binns MA, McLaughlin PM, Abrahao A, Black SE, Borrie M, Breen D, Casaubon L, Dowlatshahi D, Finger E, Fischer CE, Frank A, Freedman M, Grimes D, Hassan A, Jog M, Kwan D, Lang A, Levine B, Mandzia J, Marras C, Masellis M, Orange JB, Pasternak S, Peltsch A, Pollock BG, Rajji TK, Roberts A, Sahlas D, Saposnik G, Seitz D, Shoesmith C, Southwell A, Steeves TDL, Sunderland K, Swartz RH, Tan B, Tang-Wai DF, Tartaglia MC, Troyer A, Turnbull J, Zinman L, Kumar S. Neuropsychiatric Symptom Burden across Neurodegenerative Disorders and its Association with Function. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:347-358. [PMID: 36637224 DOI: 10.1177/07067437221147443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPS) are prevalent in neurodegenerative disorders, however, their frequency and impact on function across different disorders is not well understood. We compared the frequency and severity of NPS across Alzheimer's disease (AD) (either with mild cognitive impairment or dementia), Cerebrovascular disease (CVD), Parkinson's disease (PD), frontotemporal dementia (FTD), and amyotrophic lateral sclerosis (ALS), and explored the association between NPS burden and function. METHODS We obtained data from Ontario Neurodegenerative Disease Research Initiative (ONDRI) that included following cohorts: AD (N = 111), CVD (N = 148), PD (N = 136), FTD (N = 50) and ALS (N = 36). We compared the frequency and severity of individual NPS (assessed by the neuropsychiatric inventory questionnaire) across cohorts using generalized estimating equations and analysis of variance. Second, we assessed the relationship of NPS burden with instrumental (iADLs) and basic (ADLs) activities of living across cohorts using multivariate linear regression while adjusting for relevant demographic and clinical covariates. RESULTS Frequency of NPS varied across cohorts (χ2(4) = 34.4, p < .001), with post-hoc tests showing that FTD had the greatest frequency as compared to all other cohorts. The FTD cohort also had the greatest severity of NPS (H(4) = 34.5, p < .001). Further, there were differences among cohorts in terms of the association between NPS burden and ADLs (F(4,461) = 3.1, p = 0.02). Post-hoc comparisons suggested that this finding was driven by the FTD group, however, the differences did not remain significant following Bonferroni correction. There were no differences among cohorts in terms of the association between NPS burden and IADLs. CONCLUSIONS NPS frequency and severity are markedly greater in FTD as compared to other neurodegenerative diseases. Further, NPS burden appears to be associated differently with function across neurodegenerative disorders, highlighting the need for individualized clinical interventions.
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Affiliation(s)
- Daniel Kapustin
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shadi Zarei
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- 7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Malcolm A Binns
- Dalla Lana School of Public Health, 7938University of Toronto, Toronto, ON, Canada.,Rotman Research Institute at Baycrest Health Sciences, Toronto, ON, Canada
| | | | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, 71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, 71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 7938University of Toronto, Toronto, ON, Canada
| | | | - David Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Leanna Casaubon
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Institute and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Corinne E Fischer
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Andrew Frank
- 6363University of Ottawa, Ottawa, ON, Canada.,152971Bruyere Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute at Baycrest Health Sciences, Toronto, ON, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Institute and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Research Institute, 26627Northern Ontario School of Medicine, ON, Canada
| | - Mandar Jog
- University of Western Ontario, London, ON, Canada
| | - Donna Kwan
- 4257Queen's University, Kingston, ON, Canada
| | - Anthony Lang
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disesase and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Brian Levine
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Connie Marras
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disesase and the Morton and Gloria Shulman Movement Disorders Centre, University Health Network, Toronto, ON, Canada
| | - Mario Masellis
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, 71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada
| | - Joseph B Orange
- Canadian Centre for Activity and Aging, Western University, ON, Canada
| | - Stephen Pasternak
- University of Western Ontario, London, ON, Canada.,Robarts Research Institute and the Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada
| | | | - Bruce G Pollock
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Angela Roberts
- School of Communication, Northwestern University, Evanston, Illinois, USA.,School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | | | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Dallas Seitz
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christen Shoesmith
- Division of Neurology, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, ON, Canada
| | | | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,6363University of Ottawa, Ottawa, ON, Canada
| | - Kelly Sunderland
- Rotman Research Institute at Baycrest Health Sciences, Toronto, ON, Canada
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute at Baycrest Health Sciences, Toronto, ON, Canada
| | - David F Tang-Wai
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada.,Toronto Western Hospital, University Health Network Memory Clinic, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, 7938University of Toronto, Toronto, ON, Canada
| | - Angela Troyer
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, ON, Canada
| | | | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, 71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), 7938University of Toronto, Toronto, ON, Canada
| | | | - Sanjeev Kumar
- 7938Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,7978Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Ang CS, Yuen AZD. A qualitative study of dementia caregivers' lived experiences in Singapore. Home Health Care Serv Q 2023; 42:124-141. [PMID: 36594495 DOI: 10.1080/01621424.2022.2164540] [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: 01/04/2023]
Abstract
Globally, the number of people living with dementia is expected to triple by 2050 owing primarily to the aging population. Dementia is a chronic and progressive disease that affects an estimated 5-8% of the general population aged 60 and above at any given time. This qualitative study aimed to investigate caregivers' overall perceptions, challenges, and coping strategies in dementia care in Singapore. Purposive sampling was used to select the study's sample. Eight Singaporeans were interviewed in semi-structured, in-depth interviews. Three themes emerged from the data analysis for each research question: overall perceptions (i.e. less freedom, strained family relationships, and improved self-competency), challenges (i.e. managing dementia symptoms, emotional drain, and decision-making), and coping mechanisms (i.e. making time for myself, religious belief, and seeking external support). Knowing about these challenges and coping mechanisms allows practitioners to help caregivers to reduce personal struggles, thus improving the patient's and caregiver's quality of life.
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Affiliation(s)
- Chin-Siang Ang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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45
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Lin RS, Yu DS, Chau PH, Li PW, Ismail Z. Reliability and Validity of the Traditional Chinese Version of the Mild Behavioral Impairment - Checklist Among Persons With Mild Cognitive Impairment - A Validation Study. J Geriatr Psychiatry Neurol 2023; 36:26-38. [PMID: 35430911 DOI: 10.1177/08919887221093363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the reliability and validity of the traditional Chinese version of the Mild Behavioral Impairment Checklist (MBI-C) among Hong Kong Chinese with mild cognitive impairment (MCI). METHODS A total of 172 participants were recruited from 2 community facilities. Cronbach's alpha (α) was calculated to evaluate internal consistency. Intra-class correlation coefficient (ICC) was used to measure 2-week test-retest reliability. Construct validity was evaluated by conducting exploratory factor analysis to identify the internal structure of MBI-C, and assessing the correlation between theoretically related constructs, including objective and subjective cognitive impairment, neurotic personality, social supports, and maladaptive coping. Concurrent validity was assessed by its correlation with Neuropsychiatric Inventory Questionnaire (NPI-Q). RESULTS The results revealed good internal consistency and test-retest reliability of the MBI-C. Item analysis identified 4 items with low item-to-total correlations. The EFA identified a seven-factor structure. Hypothesis testing identified its significant correlations with subjective cognitive impairment, neurotic personality, social supports, and maladaptive coping. Concurrent validity was supported by its significant correlation with the NPI-Q. CONCLUSIONS The traditional Chinese version of MBI-C is a valid and reliable outcome measure to assess the severity of neuropsychiatric symptoms of the MCI population.
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Affiliation(s)
- Rose Sy Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Doris Sf Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Pui H Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Polly Wc Li
- School of Nursing, Li Ka Shing Faculty of Medicine, 71020University of Hong Kong, Hong Kong
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, 2129University of Calgary, Calgary, AB, Canada
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Ashley L, Surr C, Kelley R, Price M, Griffiths AW, Fowler NR, Giza DE, Neal RD, Martin C, Hopkinson JB, O'Donovan A, Dale W, Koczwara B, Spencer K, Wyld L. Cancer care for people with dementia: Literature overview and recommendations for practice and research. CA Cancer J Clin 2022; 73:320-338. [PMID: 36512303 DOI: 10.3322/caac.21767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.
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Affiliation(s)
- Laura Ashley
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, Leeds, UK
| | - Mollie Price
- School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Nicole R Fowler
- Indiana University Center for Aging Research at Regenstrief Institute, Indianapolis, Indiana, USA
| | - Dana E Giza
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - William Dale
- Center for Cancer and Aging, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre & Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Efficacy and safety of simultaneous rTMS-tDCS over bilateral angular gyrus on neuropsychiatric symptoms in patients with moderate Alzheimer's disease: A prospective, randomized, sham-controlled pilot study. Brain Stimul 2022; 15:1530-1537. [PMID: 36460293 DOI: 10.1016/j.brs.2022.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Treating neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) remains highly challenging. Noninvasive brain stimulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) is of considerable interest in this context. OBJECTIVE To investigate the efficacy and safety of a novel technique involving simultaneous application of rTMS and tDCS (rTMS-tDCS) over bilateral angular gyrus (AG, P5/P6 electrode site) for AD-related NPS. METHODS Eighty-four AD patients were randomized to receive rTMS-tDCS, single-rTMS, single-tDCS, or sham stimulation for 4 weeks, with evaluation at week-4 (W4, immediately after treatment) and week-12 (W12, follow-up period) after initial examination. Primary outcome comprising Neuropsychiatric Inventory (NPI) score and secondary outcomes comprising mini-mental state examination (MMSE), AD assessment scale-cognitive subscale (ADAS-cog), and Pittsburgh sleep quality index (PSQI) scores were collected and analyzed by a two-factor (time and treatment), mixed-design ANOVA. RESULTS rTMS-tDCS produced greater improvement in NPI scores than single-tDCS and sham at W4 and W12 (both P < 0.017) and trended better than single-rTMS (W4: P = 0.058, W12: P = 0.034). rTMS-tDCS improved MMSE scores compared with single-tDCS at W4 (P = 0.011) and sham at W4 and W12 (both P < 0.017). rTMS-tDCS also significantly improved PSQI compared with single-rTMS and sham (both P < 0.017). Interestingly, rTMS-tDCS-induced NPI/PSQI improvement was significantly associated with MMSE/ADAS-cog improvement. tDCS- and/or rTMS-related adverse events appeared slightly and briefly. CONCLUSIONS rTMS-tDCS application to bilateral AG can effectively improve AD-related NPS, cognitive function, and sleep quality with considerable safety.
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Vaillant-Ciszewicz AJ, Quin C, Michel E, Sacco G, Guerin O. La réalité virtuelle personnalisée sur les troubles de l’humeur en établissement d’hébergement pour personnes âgées dépendantes et unité de soin de longue durée : étude de cas chez un résident présentant des troubles cognitifs modérés. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2022. [DOI: 10.1016/j.amp.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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49
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O'Connor CMC, Fisher A, Cheung SC, Caga J, Piguet O. Supporting behaviour change in younger-onset dementia: mapping the needs of family carers in the community. Aging Ment Health 2022; 26:2252-2261. [PMID: 34424808 DOI: 10.1080/13607863.2021.1966744] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Almost 10% of people with dementia experience a younger-onset of disease (before 65 years). Changes in behaviour are common, as are delays in diagnosis and limited access to appropriate support and services. This study aimed to explore the specific behaviour support needs of families living with younger-onset dementia. METHODS Seventy-one families of people with younger-onset dementia were surveyed to understand the experience of family carers regarding difficult-to-manage behaviour changes, confidence in identifying and implementing behaviour support strategies, use of specific behaviour support strategies, and use of formal and informal support services regarding behaviour changes. RESULTS Survey responses were received from family members of people living with behavioural variant frontotemporal dementia (n = 28), semantic dementia (n = 17), and Alzheimer's disease (n = 23). Over 90% of family carers reported difficult-to-manage behaviours which fell into four main domains: (1) aggression, (2) compulsive behaviour, (3) disinhibition and inappropriate social behaviour, and (4) apathy. A range of preventative and responsive strategies, with an emphasis on de-escalation strategies were identified and carers reported variable confidence in managing behaviour changes or in accessing formal support strategies. CONCLUSIONS Difficult-to-manage behaviour changes in community-dwelling people with younger-onset dementia are common. The existing agency of families should be recognised and built upon with better access to specific behaviour support services to increase competence and confidence in providing behaviour support and ultimately improve quality of life for them and their family member with dementia.
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Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences Adelaide, Flinders University, Adelaide, Australia
| | - Sau Chi Cheung
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Jashelle Caga
- Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
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50
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Muñoz-Contreras MC, Segarra I, López-Román FJ, Galera RN, Cerdá B. Role of caregivers on medication adherence management in polymedicated patients with Alzheimer's disease or other types of dementia. Front Public Health 2022; 10:987936. [PMID: 36353281 PMCID: PMC9638151 DOI: 10.3389/fpubh.2022.987936] [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: 07/06/2022] [Accepted: 10/07/2022] [Indexed: 01/26/2023] Open
Abstract
Background Alzheimer's disease (AD) and other dementia patients may have severe difficulties to ensure medication adherence due to their generally advanced age, polymedicated and multi-pathological situations as well as certain degree of cognitive impairment. Thus, the role of patient caregivers becomes crucial to warrantee treatment compliance. Purpose To assess the factors associated to patients and caregivers on medication adherence of patients with AD and other types of dementia as well as the degree of caregiver satisfaction with respect to treatment. Methods An observational, descriptive, cross-sectional study among the caregivers of 100 patients with AD and other types of dementia of the "Cartagena and Region Association of Relatives of Patients with Alzheimer's Disease and other Neurodegenerative Diseases" was conducted to assess patient and caregiver factors that influence medication adherence evaluated with the Morisky-Green-Levine test. Results Overall, adherence to treatment was 71%, with similar proportions between male and female patients. Greater adherence was found in married or widowed patients (49.3%), first degree (85.9%) or female (81.7%) caregivers but lower in AD patients (75.9%). Multivariate analysis showed a statistically significant positive association between non-adherence and male sex of the caregiver (OR 3.512 [95%IC 1.124-10.973]), dementia (OR 3.065 [95%IC 1.019-9.219]), type of caregiver (non-first-degree relative) (OR 0.325 [95%IC 0.054-0.672]) and civil status of the patient (OR 2.011 [95%IC 1.155-3.501]) favorable for married or widowed patients. No or week association was found with gender, age, education level, number of drugs used or polymedicated status of the patient. Caregivers considered the use (90%) and administration (91%) of the treatment easy or very easy and rarely interfered with their daily life, especially for female caregivers (p = 0.016). Finally, 71% indicated that they were satisfied or very satisfied with the treatment received by the patient. Conclusions Caregivers influence therapeutic management with predictors for improved adherence including female gender and first-degree kinship, together with patient's marital status. Thus, training caregivers about the disease and the importance of medication adherence in AD patients may ensure optimal treatment.
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Affiliation(s)
- María Cristina Muñoz-Contreras
- Hospital Pharmacy, Hospital La Vega, Murcia, Spain,‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
| | - Ignacio Segarra
- ‘Pharmacokinetics, Patient Care and Translational Bioethics' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain,Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,*Correspondence: Ignacio Segarra
| | - Francisco Javier López-Román
- Health Sciences Department, UCAM – Catholic University of Murcia, Guadalupe, Spain,Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | | | - Begoña Cerdá
- Department of Pharmacy, Faculty of Pharmacy, UCAM – Catholic University of Murcia, Guadalupe, Spain,‘Nutrition, Oxidative Stress and Bioavailability' Research Group, UCAM – Catholic University of Murcia, Murcia, Spain
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