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Martyr A, Gamble LD, Hunt A, Quinn C, Morris RG, Henderson C, Allan L, Opdebeeck C, Charlwood C, Jones RW, Pentecost C, Kopelman MD, Thom JM, Matthews FE, Clare L. Differences in trajectories of quality of life according to type of dementia: 6-year longitudinal findings from the IDEAL programme. BMC Med 2024; 22:265. [PMID: 38915081 PMCID: PMC11197262 DOI: 10.1186/s12916-024-03492-y] [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: 01/11/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND People with different types of dementia may have distinct symptoms and experiences that affect their quality of life. This study investigated whether quality of life varied across types of dementia and over time. METHODS The participants were 1555 people with mild-to-moderate dementia and 1327 carers from the IDEAL longitudinal cohort study, recruited from clinical services. As many as possible were followed for up to 6 years. Diagnoses included were Alzheimer's disease, vascular dementia, mixed Alzheimer's and vascular dementia, Parkinson's disease dementia, dementia with Lewy bodies, and frontotemporal dementia. Self- and informant-rated versions of the Quality of Life in Alzheimer's Disease scale were used. A joint model, incorporating a mixed effects model with random effects and a survival model to account for dropout, was used to examine whether quality of life varied by dementia type at the time of diagnosis and how trajectories changed over time. RESULTS The strongest associations between dementia type and quality of life were seen around the time of diagnosis. For both self-ratings and informant ratings, people with Parkinson's disease dementia or dementia with Lewy bodies had lower quality of life scores. Over time there was little change in self-rated scores across all dementia types (- 0.15 points per year). Informant-rated scores declined over time (- 1.63 points per year), with the greatest decline seen in ratings by informants for people with dementia with Lewy bodies (- 2.18 points per year). CONCLUSIONS Self-rated quality of life scores were relatively stable over time whilst informant ratings showed a steeper decline. People with Parkinson's disease dementia or dementia with Lewy bodies report particularly low levels of quality of life, indicating the importance of greater attention to the needs of these groups.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, UK.
| | - Anna Hunt
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Louise Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Carol Opdebeeck
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Catherine Charlwood
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Michael D Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeanette M Thom
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle Upon Tyne, UK
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Moreno-Martin P, Minobes-Molina E, Carbó-Cardeña A, Masó-Aguado M, Solé-Casals M, Torrents-Solé M, Bort-Roig J, Amblàs-Novellas J, Gómez-Batiste X, Jerez-Roig J. Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study. Healthcare (Basel) 2024; 12:810. [PMID: 38667572 PMCID: PMC11050254 DOI: 10.3390/healthcare12080810] [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: 02/13/2024] [Revised: 03/22/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.
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Affiliation(s)
- Pau Moreno-Martin
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain
| | - Aina Carbó-Cardeña
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montse Masó-Aguado
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montserrat Solé-Casals
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
| | | | - Judit Bort-Roig
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Sport and Physical Activity Research Group, Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Xavier Gómez-Batiste
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
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Tabira T, Hotta M, Maruta M, Ikeda Y, Shimokihara S, Han G, Yamaguchi T, Tanaka H, Ishikawa T, Ikeda M. Characteristic of process analysis on instrumental activities of daily living according to the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease. Int Psychogeriatr 2024; 36:188-199. [PMID: 35838312 DOI: 10.1017/s1041610222000552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To clarify the characteristic of impaired and unimpaired Instrumental Activities of daily living (IADL) processes with the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease (AD) using the Process Analysis of Daily Activity for Dementia (PADA-D). DESIGN Cross-sectional study. SETTING 13 medical and care centers in Japan. PARTICIPANTS 115 community-dwelling older adults with AD. METHODS The severity of cognitive impairment was classified by Mini-Mental State Examination (20 ≥ mild group, 20 < moderate group ≥ 10, 10 < severe group), and IADL scores and eight IADL items in PADA-D were compared among three groups after adjusting for covariates. Rate of five feasible processes included in each IADL of PADA-D was compared. RESULTS IADL score showed a decrease in independence with the severity of AD except for Use modes of transportation and Managing finances, which was especially pronounced in Shopping (F = 25.58), Ability to use the telephone (F = 16.75), and Managing medication (F = 13.1). However, when the PADA-D was examined by process, some processes that were impaired and unimpaired with the severity of cognitive impairment were clear. For example, Plan a meal was impaired (ES = 0.29) with the severity, but Prepare the food was not in Cooking performance. CONCLUSIONS We suggested that detailed process analysis in IADLs can clarify the characteristic of processes that are impaired and unimpaired with the severity of cognitive impairment in older adults with AD living in the community. Our findings may be useful for rehabilitation and care in IADL to continue living at home.
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Affiliation(s)
- Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University, 2-2, Yamadaoka, Osaka, 565-0871, Japan
| | - Michio Maruta
- Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Yuriko Ikeda
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Suguru Shimokihara
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Gwanghee Han
- Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Tomoharu Yamaguchi
- Department of Rehabilitation, Gunma University of Health and Welfare, 2-12-2, Honmachi, Maebashi, Gunma, 371-0023, Japan
| | - Hiroyuki Tanaka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30, Habikino, Osaka, 583-8555, Japan
| | - Tomohisa Ishikawa
- Department of Psychiatry, Arao Kokoronosato Hospital, 1992, Arao-city, Kumamoto, 864-0041, Japan
- Department of Neuropsychiatry, Kumamoto University Hospital, 1-1-1, Chuo-ku, Honjo, Kumamoto, 860-8566, Japan
- Faculty of Life Sciences, Kumamoto University, 1-1-1, Chuo-ku, Kuhonji, Kumamoto, 862-0976, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University, 2-2, Yamadaoka, Osaka, 565-0871, Japan
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Li JR, Tsai CF, Huang MH, Lee JJ, Wang WF, Huang LC, Hsu CC, Lin YS, Kuo YS, Fuh JL. Predictors of live-in migrant caregiver employment for people with dementia in Taiwan. J Chin Med Assoc 2024; 87:219-225. [PMID: 38305484 DOI: 10.1097/jcma.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND With the increasing number of individuals with dementia, families have hired an increasing number of live-in migrant caregivers (LIMCs). Currently, limited evidence is available regarding the influence of long-term care resource utilization on the hiring of LIMCs for caring for individuals with dementia in Taiwan. METHODS We recruited individuals with dementia who did not hire LIMCs and their primary family caregivers from nine hospitals in Taiwan as baseline. Multivariable logistic regression was used to evaluate the utilization of long-term care resources for individuals with dementia and other factors that may affect the decision to hire LIMCs. RESULTS The users of non-long-term care resources had the highest likelihood of hiring LIMCs (odds ratio [OR] = 4.24, 95% CI, 2.30-7.84). Compared with spouses, nonimmediate family caregivers (OR = 3.40, 95% CI, 1.16-9.90) were significantly more likely to hire LIMCs. A higher likelihood of hiring LIMCs was observed for those with Lewy body dementia compared with other individuals (OR = 2.31, 95% CI, 1.03-5.14). Compared with individuals who did not hire LIMCs, those who hired LIMCs exhibited higher scores on the Neuropsychiatric Inventory (NPI) and higher severity of individual NPI items. CONCLUSION Hiring LIMCs is strongly correlated with the utilization of non-long-term care resources and is influenced by the dynamics between individuals with dementia and their primary family caregivers. A higher likelihood of hiring LIMCs was observed for individuals with Lewy body dementia and individuals with elevated NPI scores compared with their counterparts. Given these observations, various support strategies and interventions should be tailored to the specific requirements of individuals with dementia and their families.
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Affiliation(s)
- Jia-Ru Li
- Division of Geriatric Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chia-Fen Tsai
- Division of Geriatric Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mao-Hsuan Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC
- Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan, ROC
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan, ROC
| | - Yung-Shuan Lin
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Shan Kuo
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jong-Ling Fuh
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Wilson M, Doyle J, Turner J, Nugent C, O’Sullivan D. Designing technology to support greater participation of people living with dementia in daily and meaningful activities. Digit Health 2024; 10:20552076231222427. [PMID: 38235415 PMCID: PMC10793193 DOI: 10.1177/20552076231222427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Background People living with dementia should be at the center of decision-making regarding their plans and goals for daily living and meaningful activities that help promote health and mental well-being. The human-computer interaction community has recently begun to recognize the need to design technologies where the person living with dementia is an active rather than a passive user of technology in the management of their care. Methods Data collection comprised semi-structured interviews and focus groups held with dyads of people with early-stage dementia (n = 5) and their informal carers (n = 4), as well as health professionals (n = 5). This article discusses findings from the thematic analysis of this qualitative data. Results Analysis resulted in the construction of three main themes: (1) maintaining a sense of purpose and identity, (2) learning helplessness and (3) shared decision-making and collaboration. Within each of the three main themes, related sub-themes were also constructed. Discussion There is a need to design technologies for persons living with dementia/carer dyads that can support collaborative care planning and engagement in meaningful activities while also balancing persons living with dementia empowerment and active engagement in self-management with carer support.
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Affiliation(s)
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Ireland
| | - Jonathan Turner
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
| | - Ciaran Nugent
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
| | - Dympna O’Sullivan
- ASCNet Research Group, Department of Computer Science, Technological University Dublin, Ireland
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Plassman BL, Ford CB, Smith VA, DePasquale N, Burke JR, Korthauer L, Ott BR, Belanger E, Shepherd-Banigan ME, Couch E, Jutkowitz E, O’Brien EC, Sorenson C, Wetle TT, Van Houtven CH. Elevated Amyloid-β PET Scan and Cognitive and Functional Decline in Mild Cognitive Impairment and Dementia of Uncertain Etiology. J Alzheimers Dis 2024; 97:1161-1171. [PMID: 38306055 PMCID: PMC11034799 DOI: 10.3233/jad-230950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Elevated amyloid-β (Aβ) on positron emission tomography (PET) scan is used to aid diagnosis of Alzheimer's disease (AD), but many prior studies have focused on patients with a typical AD phenotype such as amnestic mild cognitive impairment (MCI). Little is known about whether elevated Aβ on PET scan predicts rate of cognitive and functional decline among those with MCI or dementia that is clinically less typical of early AD, thus leading to etiologic uncertainty. OBJECTIVE We aimed to investigate whether elevated Aβ on PET scan predicts cognitive and functional decline over an 18-month period in those with MCI or dementia of uncertain etiology. METHODS In 1,028 individuals with MCI or dementia of uncertain etiology, we evaluated the association between elevated Aβ on PET scan and change on a telephone cognitive status measure administered to the participant and change in everyday function as reported by their care partner. RESULTS Individuals with either MCI or dementia and elevated Aβ (66.6% of the sample) showed greater cognitive decline compared to those without elevated Aβ on PET scan, whose cognition was relatively stable over 18 months. Those with either MCI or dementia and elevated Aβ were also reported to have greater functional decline compared to those without elevated Aβ, even though the latter group showed significant care partner-reported functional decline over time. CONCLUSIONS Elevated Aβ on PET scan can be helpful in predicting rates of both cognitive and functional decline, even among cognitively impaired individuals with atypical presentations of AD.
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Affiliation(s)
- Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Laura Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R. Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Megan E. Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Elyse Couch
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Eric Jutkowitz
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Emily C. O’Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Corinna Sorenson
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Terrie T. Wetle
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Courtney H. Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
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7
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Toya S, Hashimoto M, Manabe Y, Yamakage H, Ikeda M. Factors Associated with Quality of Life in Patients with Dementia with Lewy Bodies: Additional Analysis of a Cross-Sectional Study. J Alzheimers Dis 2024; 100:525-538. [PMID: 38875033 PMCID: PMC11307033 DOI: 10.3233/jad-231302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
Background Quality of life (QOL) and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers are important factors to consider when developing treatment strategies. Objective To investigate factors associated with QOL in patients with DLB, and to examine factors associated with activities of daily living (ADL) if ADL was associated with QOL. Methods We previously conducted a questionnaire survey study to investigate the treatment needs of patients with DLB and their caregivers. This pre-specified additional analysis evaluated the Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form-8 for QOL, and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II total score for ADL. Results In total, 231 patient- caregiver pairs and 38 physicians were included. Multivariable analysis of QOL showed that the MDS-UPDRS Part II total score (standard regression coefficient [β], - 0.432) was associated with the PCS, and presence of depression (β, - 0.330) was associated with the MCS. The severity of postural instability/gait disorder (PIGD) (β, 0.337) and rigidity (β, 0.266), presence of hallucinations (β, 0.165), male sex (β, 0.157), and use of "short stay" or "small-scale, multifunctional home care" (β, 0.156) were associated with worsened ADL. Conclusions In patients with DLB, QOL was negatively impacted by severity of ADL disability and depression, and ADL was negatively impacted by severity of PIGD and rigidity, hallucinations, male sex, and use of "short stay" or "small-scale, multifunctional home care."
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Affiliation(s)
- Shunji Toya
- Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yuta Manabe
- Department of Advanced Clinical Medicine, Division of Dementia and Geriatric Medicine, Kanagawa Dental University School of Dentistry, Yokosuka, Japan
| | - Hajime Yamakage
- Insight Clinical Development Group, 3H Medi Solution Inc., Tokyo, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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André AD, Martins P. Exo Supportive Devices: Summary of Technical Aspects. Bioengineering (Basel) 2023; 10:1328. [PMID: 38002452 PMCID: PMC10669745 DOI: 10.3390/bioengineering10111328] [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: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement (for rehabilitation applications). There have been several studies on using exosuits with this purpose in mind. So, the current review offers a critical perspective and a detailed analysis of the steps and key decisions involved in the conception of an exoskeleton. Choices such as design aspects, base materials (structure), actuators (force and motion), energy sources (actuation), and control systems will be discussed, pointing out their advantages and disadvantages. Moreover, examples of exosuits (full-body, upper-body, and lower-body devices) will be presented and described, including their use cases and outcomes. The future of exoskeletons as possible assisted movement solutions will be discussed-pointing to the best options for rehabilitation.
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Affiliation(s)
- António Diogo André
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Faculty of Engineering, University of Porto (FEUP), 4200-465 Porto, Portugal
| | - Pedro Martins
- Associated Laboratory of Energy, Transports and Aeronautics (LAETA), Biomechanic and Health Unity (UBS), Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
- Aragon Institute for Engineering Research (i3A), Universidad de Zaragoza, 50018 Zaragoza, Spain
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9
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Levitan EB, Goyal P, Ringel JB, Soroka O, Sterling MR, Durant RW, Brown TM, Bowling CB, Safford MM. Myocardial infarction and physical function: the REasons for Geographic And Racial Differences in Stroke prospective cohort study. BMJ PUBLIC HEALTH 2023; 1:e000107. [PMID: 37920711 PMCID: PMC10618954 DOI: 10.1136/bmjph-2023-000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Objective To examine associations between myocardial infarction (MI) and multiple physical function metrics. Methods Among participants aged ≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities of daily living (IADL), activities of daily living (ADL), gait speed, chair stands, and Short Form-12 physical component summary (PCS) were assessed after approximately 10 years of follow-up. We examined associations between MI and physical function (no MI [n = 9,472], adjudicated MI during follow-up [n = 288, median 4.7 years prior to function assessment], history of MI at baseline [n = 745], history of MI at baseline and adjudicated MI during follow-up [n = 70, median of 6.7 years prior to function assessment]). Models were adjusted for sociodemographic characteristics, health behaviours, depressive symptoms, cognitive impairment, body mass index, diabetes, hypertension, and urinary albumin to creatinine ratio. We examined subgroups defined by age, gender, and race. Results The average age at baseline was 62 years old, 56% were women, and 35% Black. MI was significantly associated with worse IADL and ADL scores, IADL dependency, chair stands, and PCS, but not ADL dependency or gait speed. For example, compared to participants without MI, IADL scores (possible range 0-14, higher score represents worse function) were greater for participants with MI during follow-up (difference: 0.37 [95% CI 0.16, 0.59]), MI at baseline (0.26 [95% CI 0.12, 0.41]), and MI at baseline and follow-up (0.71 [95% CI 0.15, 1.26]), p < 0.001. Associations tended to be greater in magnitude among participants who were women and particularly Black women. Conclusion MI was associated with various measures of physical function. These decrements in function associated with MI may be preventable or treatable.
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Affiliation(s)
- Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Parag Goyal
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Madeline R. Sterling
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Raegan W. Durant
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C. Barrett Bowling
- Department of Veterans Affairs, Durham Geriatrics Research Education and Clinical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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10
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Keramat SA, Lee V, Patel R, Hashmi R, Comans T. Cognitive impairment and health-related quality of life amongst older Australians: evidence from a longitudinal investigation. Qual Life Res 2023; 32:2911-2924. [PMID: 37289356 PMCID: PMC10473991 DOI: 10.1007/s11136-023-03449-3] [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] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Australia's population is steadily growing older, with older persons expected to make up over 20% of the population by 2066. Ageing is strongly associated with a significant drop in cognitive ability, ranging from mild cognitive impairment to severe cognitive impairment (dementia). This study examined the association between cognitive impairment and health-related quality of life (HRQoL) in older Australians. METHODS Two waves of longitudinal data from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey were utilised, with the age cut-off for older Australians defined as above 50. The final analysis included 10,737 person-year observations from 6892 unique individuals between 2012 and 2016. This study utilised the Backwards Digit Span (BDS) test and Symbol Digit Modalities test (SDMT) to assess cognitive function. HRQoL was measured using the physical and mental component summary scores of the SF-36 Health Survey (PCS and MCS). Additionally, HRQoL was measured using health state utility values (SF-6D score). A longitudinal random-effects GLS regression model was used to analyse the association between cognitive impairment and HRQoL. RESULTS This study found that approximately 89% of Australian adults aged 50 or older had no cognitive impairment, 10.16% had moderate cognitive impairment, and 0.72% had severe cognitive impairment. This study also found that moderate and severe cognitive impairment were both negatively associated with HRQoL. Older Australians with moderate cognitive impairment scored worse on the PCS (β = - 1.765, SE = 0.317), MCS (β = - 1.612, SE = 0.326), and SF-6D (β = - 0.024, SE = 0.004) than peers without cognitive impairment given other covariates reference categories remain constant. Older adults experiencing severe cognitive had lower PCS (β = - 3.560, SE = 1.103), and SF-6D (β = - 0.034, SE = 0.012) scores compared to their counterparts with no cognitive impairment given other covariates reference categories remain constant. CONCLUSION We found evidence that HRQoL is negatively associated with cognitive impairment. Our findings will be beneficial for the future cost-effectiveness intervention targeted at reducing cognitive impairment since it provides information on the disutility associated with moderate and severe cognitive impairment.
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Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
| | - Vanessa Lee
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rajat Patel
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rubayyat Hashmi
- The Australian Centre for Housing Research, The University of Adelaide, Adelaide, Australia
| | - Tracy Comans
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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11
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Rakutt MJ, Mace RA, Conley CEW, Stone AV, Duncan ST, Greenberg J, Landy DC, Vranceanu AM, Jacobs CA. Association of Osteoarthritis and Functional Limitations With Cognitive Impairment Among Older Adults in the United States. J Aging Health 2023; 35:643-650. [PMID: 36680455 PMCID: PMC10940858 DOI: 10.1177/08982643231153459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Given overlapping pathophysiology, this study sought to assess the association between osteoarthritis (OA), functional impairment, and cognitive impairment in the aging population. Methods: The National Health and Nutrition Examination Survey was used to identify participants >60 years of age. We analyzed multivariable associations of grouped participants that underwent cognitive function testing using linear and logistic regression, adjusting for sex, age, race, and ethnicity. Results: Of 2776 identified participants representing a population of 50,242,917, 40% did not report OA or functional limitations; 21% had OA but not functional limitations; 15% did not have OA but had functional limitations; 17% had OA and related functional limitations; and 7% had OA and non-arthritic functional limitations. OA was not independently associated with cognitive impairment. Contrarily, functional limitations were associated with cognitive impairment regardless of OA diagnosis. Discussion: Cognitive impairment is not associated with OA, but rather functional limitations, potentially guiding future intervention.
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Affiliation(s)
| | - Ryan A. Mace
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Caitlin E. W. Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | - Austin V. Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | - Stephen T. Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | | | - David C. Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | | | - Cale A. Jacobs
- Massachusetts General Brigham Sports Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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12
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Scheerbaum P, Graessel E, Boesl S, Hanslian E, Kessler CS, Scheuermann JS. Are Protective Activities and Limitations in Practical Skills of Daily Living Associated with the Cognitive Performance of People with Mild Cognitive Impairment? Baseline Results from the BrainFit-Nutrition Study. Nutrients 2023; 15:3519. [PMID: 37630709 PMCID: PMC10459420 DOI: 10.3390/nu15163519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Limitations in daily living have not yet been described adequately for mild cognitive impairment (MCI). In this study, we investigated first, time spent on protective activities (social, mental, and physical) and second, limitations in practical skills of daily living, both for people with MCI. We used baseline data from 270 individuals who participated in the randomized controlled trial BrainFit-Nutrition. The Montreal Cognitive Assessment (MoCA) was used to identify people with MCI. Participants were asked how much time they spent engaged in social, mental, and physical activities each week. Furthermore, the Bayer-ADL scale was used to quantify deficits in activities of daily living (ADLs). Regarding protection, the number of hours spent engaged in the three activity areas was significantly correlated with the cognitive performance in people with MCI. Social activities were positively associated with current cognitive performance. Concerning the limitations in practical skills of daily living, older and more cognitively impaired individuals were affected. Memory and orientation appear to be among the first practical skills of daily living that become impaired in people with MCI. Treatment recommendations for people with MCI include an increase in social, mental, and physical activities as well as the promotion of a healthy lifestyle.
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Affiliation(s)
- Petra Scheerbaum
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.S.)
| | - Elmar Graessel
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.S.)
| | - Sophia Boesl
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.S.)
| | - Etienne Hanslian
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, 14109 Berlin, Germany
| | - Julia-Sophia Scheuermann
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.S.)
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13
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Speckemeier C, Niemann A, Weitzel M, Abels C, Höfer K, Walendzik A, Wasem J, Neusser S. Assessment of innovative living and care arrangements for persons with dementia: a systematic review. BMC Geriatr 2023; 23:464. [PMID: 37525120 PMCID: PMC10391868 DOI: 10.1186/s12877-023-04187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Alternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents' quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects. METHODS Searches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute. RESULTS A total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct. DISCUSSION The positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations' preferences with regards to housing in the event of dementia.
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Affiliation(s)
- C Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - A Niemann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - M Weitzel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - C Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - K Höfer
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - A Walendzik
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - J Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - S Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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14
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Lee JE, Kang HW, Jung SA, Lee SY, Kim JY, Lee DE, Jeong JH, Jung IC, Cho E. The effects of herbal medicine (Jujadokseo-hwan) on quality of life in patients with mild cognitive impairment: Cost-effectiveness analysis alongside randomized controlled trial. Integr Med Res 2023; 12:100914. [PMID: 36632128 PMCID: PMC9826841 DOI: 10.1016/j.imr.2022.100914] [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: 08/16/2022] [Revised: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Mild cognitive impairment (MCI), the early stage of dementia, requires effective intervention for symptom management and improving patients' quality of life (QoL). Jujadokseo-hwan (JDH) is a Korean herbal medicine prescription used to improve MCI symptoms, such as memory deficit. This study evaluates the improvement in QoL through JDH. Alongside a clinical trial, it estimates the cost-effectiveness of JDH, compared to placebo, for MCI over 24 weeks. Methods Changes in QoL were measured using the EuroQol-5 Dimensions (EQ-5D) and Korean version QoL-Alzheimer's Disease (KQOL-AD). Direct medical and non-medical costs were surveyed and incremental cost-effectiveness ratios (ICER) per QALY for JDH were produced. Results In total, 64 patients were included in the economic evaluation (n = 35 in JDH, n = 29 in placebo). In the JDH group, EQ-5D and KQOL-AD improved by 0.020 (p = .318) and 3.40 (p = .011) over 24 weeks, respectively. In the placebo group, they increased by 0.001 (p=.920) and 1.07 (p=.130), respectively. The ICER was KRW 76,400,000 per QALY and KRW 108,000 per KQOL-AD for JDH, compared to the placebo group. Conclusion JDH is not considered a cost-effective treatment option compared with placebo; however, it positively affects QoL improvement in patients with MCI.
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Affiliation(s)
- Ji-Eun Lee
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
| | - Hyung Won Kang
- Department of Neuropsychiatry, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sun-A Jung
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
| | - So-Young Lee
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.,Department of Neuropsychiatry, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Da Eun Lee
- Department of Neuropsychiatry, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Jin-Hyung Jeong
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.,Department of Neuropsychiatry, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea.,Department of Neuropsychiatry, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea.,Corresponding authors at: Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, 34520, Republic of Korea (I. C. Jung); College of Pharmacy, Sookmyung Women's University, Cheongpa-ro 47-gil, 100, Yongsan-gu, Seoul, 04310, Republic of Korea (E. Cho)
| | - Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea,Corresponding authors at: Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, 34520, Republic of Korea (I. C. Jung); College of Pharmacy, Sookmyung Women's University, Cheongpa-ro 47-gil, 100, Yongsan-gu, Seoul, 04310, Republic of Korea (E. Cho)
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15
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Gutiérrez-Cruz C, Del-Cuerpo I, García-Ramos A, Muñoz-López S, Rubio-Cabeza J, Roman-Espinaco A. Effect of the environmental factor of coexistence on the physical condition of people with mild and moderate intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:585-593. [PMID: 36814055 DOI: 10.1111/jar.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The main objective of this study was to compare the physical condition of people with intellectual disabilities living in residential homes (RH; restricted residential environment) versus independent homes (IH; family houses while performing paid work). The effect of gender on physical condition was also evaluated separately for each group. METHOD Sixty individuals with mild to moderate intellectual disability, 30 living in RH and 30 living in IH, participated in this study. The RH and IH groups were homogeneous in terms of gender distribution (17 males and 13 females) and intellectual disability level. Body composition, postural balance, and static and dynamic force were considered as dependent variables. RESULTS The IH group performed better in the postural balance and dynamic force tests compared to the RH group, but no significant differences between the groups were observed for any body composition or static force variable. Women in both groups tended to have better postural balance than men, while men presented higher dynamic force. CONCLUSIONS The IH group presented a higher physical fitness compared to RH group. This result emphasises the need to increase the frequency and intensity of the physical activity sessions commonly programed for individuals living in RH.
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Affiliation(s)
- Carmen Gutiérrez-Cruz
- Department of Didactics of Musical and Corporal Expression, University of Granada, Granada, Spain.,Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
| | - Indya Del-Cuerpo
- Department of Physical Education and Sport, University of Granada, Granada, Spain
| | - Amador García-Ramos
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain.,Department of Sports Sciences and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Saray Muñoz-López
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
| | - José Rubio-Cabeza
- Hermanas Hospitalarias, Fundación Purísima Concepción de Granada, Granada, Spain
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16
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Braz de Oliveira MP, Moreira Padovez RDFC, Serrão PRMDS, de Noronha MA, Cezar NODC, Andrade LPD. Effectiveness of physical exercise at improving functional capacity in older adults living with Alzheimer's disease: a systematic review of randomized controlled trials. Disabil Rehabil 2023; 45:391-402. [PMID: 35171074 DOI: 10.1080/09638288.2022.2037744] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the effects of physical exercise at improving functional capacity in older adults living with Alzheimer's disease (AD). METHODS Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until January 2021. Randomized controlled trials (RCTs) that reported functional capacity outcomes were included. The evidence was assessed using the GRADE approach. RESULTS Thirteen RCTs were included, involving 811 older adults living with AD. Multimodal exercise (ME), aerobic exercise (AE), and resistance exercise (RE) were used. The interventions were mainly supervised by caregivers. The evidence was low and with effect for activities of daily living (ADLs), moderate and with no effect for mobility and very low and with no effect for muscle strength, postural balance and flexibility after treatment with ME, moderate and with no effect for cardiorespiratory function and ADLs after treatment with AE. It was not possible to synthesize any type of evidence for RE. CONCLUSIONS Multimodal exercise promotes improvements in functional capacity (ADLs). Therefore, the practice of physical exercise can be recommended for older adults living with AD. The involvement of the caregiver in the physical exercises should also be considered, as it could enhance the benefits of exercise for these older adults.Implications for rehabilitationHealthcare providers with clinical knowledge regarding physical exercise should promote, prescribe and support the daily practice of physical exercises for older adults living with Alzheimer's disease (AD).The involvement of caregivers in home-based physical exercise programs should be considered, as it could enhance the benefits of such programs for these older adults.It is important to consider the degree of cognitive impairment in older adults living with AD when outlining goals for the improvement in functional capacity through physical exercise.Multimodal exercise involving aerobic training, postural balance, muscle strengthening, and flexibility is capable of promoting an improvement in functional capacity (activities of daily living) for these older adults.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | | | - Larissa Pires de Andrade
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
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17
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Begde A, Jain M, Hogervorst E, Wilcockson T. Does physical exercise improve the capacity for independent living in people with dementia or mild cognitive impairment: an overview of systematic reviews and meta-analyses. Aging Ment Health 2022; 26:2317-2327. [PMID: 34951548 PMCID: PMC9662184 DOI: 10.1080/13607863.2021.2019192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To summarise existing systematic reviews which assessed the effects of physical exercise on activities of daily living, walking, balance and visual processing in people with dementia or mild cognitive impairment. METHODS In this overview of systematic reviews and meta-analyses, seven electronic databases were searched to identify eligible reviews published between January 2015 and April 2021. RESULTS A total of 30 systematic reviews were identified and included in the overview. The most frequent type of exercise for the intervention group was multimodal exercises. Mind-body exercises, exergames, dance intervention and aerobic exercise were other exercise types. Most of the reviews reported that exercise is significantly effective for improving activities of daily living (SMD 95%CI, from 0.27 to 1.44), walking (SMD 95%CI, from 0.08 to 2.23), balance (SMD 95%CI, from 0.37 to 2.24) and visuospatial function (SMD 95%CI, from 0.16 to 0.51), which are among the most leading determinants of independent living in individuals with dementia or mild cognitive impairment. CONCLUSION Evidence has shown that exercise (especially multicomponent exercise programmes including cognitive, physical and multitasking exercises) with sufficient intensity improves the activities of daily living skills. Exercise also improves walking, balance and visual processing, which can provide a more independent life for people with dementia and mild cognitive impairment. Cognitively impaired people should therefore be encouraged to exercise regularly in order to be more independent. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2019192.
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Affiliation(s)
- Ahmet Begde
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK,CONTACT Ahmet Begde
| | - Manisha Jain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Thomas Wilcockson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Shimokihara S, Tabira T, Hotta M, Tanaka H, Yamaguchi T, Maruta M, Han G, Ikeda Y, Ishikawa T, Ikeda M. Differences by cognitive impairment in detailed processes for basic activities of daily living in older adults with dementia. Psychogeriatrics 2022; 22:859-868. [PMID: 36184572 DOI: 10.1111/psyg.12894] [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: 06/03/2022] [Revised: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Impairment of activities of daily living in patients with dementia has a fundamental and lasting impact on their quality of life and requires a detailed assessment. This study investigated to clarify characteristic of basic activities of daily living (BADL) processes with the severity of cognitive impairment in community-dwelling older adults with dementia using the Process Analysis of Daily Activity for Dementia (PADA-D). METHODS Participants were recruited from outpatient departments of 24 hospitals, daycare centres, and home rehabilitation services in Japan. The severity of cognitive impairment was determined using the Mini-mental State Examination (mild: score ≥ 20; moderate: 10 ≤ score < 20; severe: score < 10). Patient's BADL were assessed according to the PADA-D by observation of the occupational therapist and interviews with family members. Basic information and the scores of BADL items of the PADA-D were compared between the three groups. Subsequently, we compared the percentage of independent or non-independent processes included in the sub-items of BADL in the PADA-D. RESULTS A total of 143 patients were included in the analysis. Performance on BADL was shown to decrease significantly with increasing severity of cognitive impairment. The percentage of all BADL processes performed ranged from 58% to 100% in mild, 38% to 97% in moderate, and 0% to 88% in severe. Some of the processes included in BADL of PADA-D showed no significant differences in independence between the three groups. DISCUSSION/CONCLUSION Most BADL processes differed with respect to different independence rates depending on the severity of cognitive impairment of the older adults with dementia. However, some BADL processes were not associated with the severity of cognitive impairment. Our findings may suggest that a detailed BADL assessment of patients with dementia is useful in terms of caregiver education to avoid excessive caregiving and in predicting BADL impairment.
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Affiliation(s)
- Suguru Shimokihara
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Tomoharu Yamaguchi
- Department of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
| | - Michio Maruta
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.,Unit of Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Gwanghee Han
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.,Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Yuriko Ikeda
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Tomohisa Ishikawa
- Department of Psychiatry, Arao Kokoronosato Hospital, Kumamoto, Japan.,Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan.,Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
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Kim HJ, Jeong SY, Kang SJ. Knowledge-Based Remote E-Coaching Framework Using IoT Devices for In-Home ADL Rehabilitation Treatment of Degenerative Brain Disease Patients. SENSORS (BASEL, SWITZERLAND) 2022; 22:7957. [PMID: 36298308 PMCID: PMC9612111 DOI: 10.3390/s22207957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
The activities of daily living (ADL) ability level of an elderly patient is an important indicator in determining the patient's degree of degenerative brain disease and is mainly evaluated through face-to-face interviews with doctors and patients in hospitals. It is impossible to determine the exact ADL ability of a patient through such a temporary interview, and the pursuit of accurate ADL ability evaluation technology is a very important research task worldwide. In this paper, in order to overcome the limitations of the existing ADL evaluation method mentioned above, first of all, a self-organized IoT architecture in which IoT devices autonomously and non-invasively measure a patient's ADL ability within the context of the patient's daily living place was designed and implemented. Second, a remote rehabilitation treatment concept for enhancing the patient's ADL ability we call an "e-coaching framework", in which a doctor remotely gives an instruction in a specific ADL scenario, and the patient's ability to understand and perform the instruction can be measured on-line and in real time, was additionally developed on top of the self-organized IoT architecture. In order to verify the possibility of remote rehabilitation treatment through the proposed architecture, various remotely directed ADL scenarios were performed and the accuracy of the measurements was verified.
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Affiliation(s)
- Hyo-Jung Kim
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu 41566, Korea
| | - Seol-Young Jeong
- Software Education Institute, Kyungpook National University, Daegu 41566, Korea
| | - Soon-Ju Kang
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu 41566, Korea
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20
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Halonen P, Enroth L, Jämsen E, Vargese S, Jylhä M. Dementia and Related Comorbidities in the Population Aged 90 and Over in the Vitality 90+ Study, Finland: Patterns and Trends From 2001 to 2018. J Aging Health 2022; 35:370-382. [PMID: 36256914 PMCID: PMC10150268 DOI: 10.1177/08982643221123451] [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: 11/16/2022]
Abstract
OBJECTIVES To examine trends in the prevalence of dementia and related comorbidities among the oldest old. METHODS Six repeated cross-sectional surveys were conducted between 2001 and 2018, each including all inhabitants aged over 90 in Tampere, Finland (n = 5386). Co-occurring conditions and their time trends among participants with dementia were examined using logistic regression and generalized estimating equations. RESULTS The prevalence of dementia decreased from 47% in 2007 to 41% in 2018. Throughout the study period, depression was more common among people with dementia compared to those without. The prevalence of hypertension, diabetes, and osteoarthritis increased and the prevalence of depression decreased among people with dementia. The mean number of comorbidities increased from 2.0 in 2001 to 2.3 in 2018. DISCUSSION Dementia remains highly prevalent among the oldest old and it is accompanied by an increasing burden of comorbidities, posing a challenge to people with dementia, their caregivers, and care systems.
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Affiliation(s)
- Pauliina Halonen
- Faculty of Social Sciences (Health Sciences), 7840Tampere University, Tampere, Finland.,Gerontology Research Center, Tampere, Finland
| | - Linda Enroth
- Faculty of Social Sciences (Health Sciences), 7840Tampere University, Tampere, Finland.,Gerontology Research Center, Tampere, Finland
| | - Esa Jämsen
- Gerontology Research Center, Tampere, Finland.,Faculty of Medicine and Health Technology, 7840Tampere University, Tampere, Finland.,Department of Geriatrics, 7840Tampere University HospitalHospital, Tampere, Finland
| | - Saritha Vargese
- Faculty of Social Sciences (Health Sciences), 7840Tampere University, Tampere, Finland.,Gerontology Research Center, Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences), 7840Tampere University, Tampere, Finland.,Gerontology Research Center, Tampere, Finland
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21
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Jayakody S, Arambepola C. Determinants of quality of life among people with dementia: evidence from a South Asian population. BMC Geriatr 2022; 22:745. [PMID: 36096721 PMCID: PMC9469587 DOI: 10.1186/s12877-022-03443-3] [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: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia has become a public health priority along with population aging worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) has become the desired outcome for people with dementia (PWD). AIM The current study aimed to determine the factors associated with 'good QOL' in people with dementia in the Sri Lankan setting. METHODS An unmatched case-control study was conducted to identify the factors associated with 'good QoL. Cases in the study included dementia patients having 'good' QOL, whereas controls were those having 'poor' or 'average' QOL. Both cases and controls were selected from the same patient base at a premier tertiary care state hospital in Colombo District, Sri Lanka. They were identified using the validated DEMQOL (Dementia Specific Quality of Life) tool, adhering to strict eligibility criteria. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors for 'good QOL' adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI). RESULTS The study sample consisted of 64 cases and 208 controls. After adjusting for confounders, education up to GCE O/Level and above (OR = 4.02; 95% CI = 2.97, 12.0), ever employed (OR = 3.21; 95% CI = 1.59, 11.06), good social functioning (OR = 4.14; 95% CI = 3.39, 16.46), mild functional impairment (OR = 1.77; 95% CI = 1.13, 9.67), little or no caregiver burden (OR = 2.96; 95% CI = 1.86, 10.94), absence of apathy (OR = 2.22; 95% CI = 1.27, 12.48) and absence of irritability (OR = 2.17; 95% CI = 1.72, 10.34) were found to be significantly associated with 'good QOL'. 60% of the variance of 'good' QOL among PWD was explained by the factors in the final model. CONCLUSIONS AND RECOMMENDATIONS: The identified determinants of 'good QOL' clearly show how the QOL improvement interventions need to be planned. Accordingly, such programmes should be primarily focused on strategies to improve PWDs' ADL (Activities of Daily living), reduce and manage neuropsychiatric symptoms effectively and to promote activities enhancing social functioning, and plan programmes to address caregiver burden.
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Affiliation(s)
- Surangi Jayakody
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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22
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Fastame MC, Mulas I, Putzu V, Asoni G, Viale D, Mameli I, Pau M. The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35981564 DOI: 10.1080/23279095.2022.2111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The term "Activities of Daily Living" (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63-93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34-56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.
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Affiliation(s)
- Maria Chiara Fastame
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Ilaria Mulas
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Valeria Putzu
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Gesuina Asoni
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Daniela Viale
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Irene Mameli
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
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23
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Hjort Telhede E, Arvidsson S, Karlsson S, Ivarsson A. Weighted Blankets' Effect on the Health of Older People Living in Nursing Homes. Geriatrics (Basel) 2022; 7:geriatrics7040079. [PMID: 36005255 PMCID: PMC9408528 DOI: 10.3390/geriatrics7040079] [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: 06/17/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: An increasingly aging population is a global phenomenon. While considered a positive step forward, vulnerability to age-related health problems increases along with the ageing population. The aim of the study was to investigate weighted blankets’ effect on health regarding quality of life (QoL), sleep, nutrition, cognition, activities of daily living ADL and medication in older people living in nursing homes. Methods: In total, 110 older people were involved in an intervention with weighted blankets, and 68 older people completed the intervention. Measures before and after were performed regarding quality of life; QoL-AD, EQ-VAS, sleep; MISS, nutrition; MNA, cognition; S -MMSE (ADL) and medication. Comparative statistical analyses were applied. Results: After intervention with weighted blankets, health in general, such as QoL, improved. Sleep also improved significantly, especially with respect to waking up during the night. Nutrition was enhanced, health as a cognitive ability improved, and medication in the psychoanaleptic group decreased. The effect size varied between small and large. Conclusions: A weighted blanket seems to be an effective and safe intervention for older people in nursing homes, as several improvements were made regarding the health of older people.
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24
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Variations of Sensorimotor Representation (Structure): The Functional Interplay between Object Features and Goal-Directed Grasping Actions. Brain Sci 2022; 12:brainsci12070873. [PMID: 35884679 PMCID: PMC9312880 DOI: 10.3390/brainsci12070873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/10/2022] Open
Abstract
This study investigated the structure of sensorimotor representations during goal-directed grasping actions and explored their relationship with object features. Sixteen 3D-printed spheres that varied in size (i.e., a diameter of 20 mm, 40 mm, 60 mm, 80 mm) and weight (i.e., 40 g, 52 g, 76 g, 91 g) were used as experimental stimuli. The Structural Dimensional Analysis of Mental Representation (SDA-M) method was used to assess the sensorimotor representation structure during grasping. Participants were instructed in each trial to weigh, lift, or transport sets of two different spheres and to judge the similarity of the objects’ features, taking into account the executed grasping movement. Each participant performed a total of 240 trials, and object presentation was randomized. The results suggest that the functional interplay between object features and goal-directed actions accounts for the significant variations in the structure of sensorimotor representations after grasping. Specifically, the relevance of the perceived objects’ size and weight is closely interrelated to the grasping task demands and movement dynamics of the executed action. Our results suggest that distinct sensorimotor representations support individual grasping actions according to top-down influences modulated by motor intentions, functional task demands, and task-relevant object features.
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25
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Chan ML, Eng CW, Gilsanz P, Whitmer RA, Mungas D, Meyer O, Farias ST. Prevalence of Instrumental Activities of Daily Living Difficulties and Associated Cognitive Predictors Across Racial/Ethnic Groups: Findings From the KHANDLE Study. J Gerontol B Psychol Sci Soc Sci 2022; 77:885-894. [PMID: 34486659 PMCID: PMC9071392 DOI: 10.1093/geronb/gbab163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Cognitive functioning is associated with instrumental activity of daily living (IADL) performance among older adults. The present study examines potential differences in the prevalence of IADL difficulty and association with cognition across diverse groups. METHOD Participants included 455 non-Hispanic Whites, 395 Blacks, 370 Asians, and 296 Latinos aged 65 years and older without a current dementia diagnosis from the Kaiser Healthy Aging and Diverse Life Experience cohort. Participants' self-reported IADL functioning and cognition was measured across episodic memory and executive functioning. RESULTS Older age, male gender, and being Black were associated with more IADL difficulties. Executive functioning showed a stronger association with IADLs than memory, and it was independent of health status, whereas memory was not. In joint models including both cognitive domains, executive functioning remained a significant predictor of IADL difficulty, but memory did not. Results for both cognitive domains were attenuated with self-rated health added to the joint model. These relationships did not significantly differ across racial/ethnic groups. CONCLUSIONS Our study supports previous work suggesting that Black older adults are at increased risk for IADL disability. This is the first study we are aware of that examined the association between specific cognitive domains and IADL performance across multiple racial/ethnic groups. Findings indicate that cognitive functioning has similar associations with self-reported IADL disability across diverse groups, and that executive functioning plays a particularly important role in IADL disability among older adults without dementia; however, health status largely attenuates the relationship between IADL difficulty and cognition.
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Affiliation(s)
- Michelle L Chan
- Department of Neurology, University of California, Davis, California, USA
| | - Chloe W Eng
- Department of Epidemiology and Translational Science, University of California, San Francisco, California, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Dan Mungas
- Department of Neurology, University of California, Davis, California, USA
| | - Oanh Meyer
- Department of Neurology, University of California, Davis, California, USA
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26
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An Instrumented Apartment to Monitor Human Behavior: A Pilot Case Study in the NeuroTec Loft. SENSORS 2022; 22:s22041657. [PMID: 35214560 PMCID: PMC8875023 DOI: 10.3390/s22041657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
For patients suffering from neurodegenerative disorders, the behavior and activities of daily living are an indicator of a change in health status, and home-monitoring over a prolonged period of time by unobtrusive sensors is a promising technology to foster independent living and maintain quality of life. The aim of this pilot case study was the development of a multi-sensor system in an apartment to unobtrusively monitor patients at home during the day and night. The developed system is based on unobtrusive sensors using basic technologies and gold-standard medical devices measuring physiological (e.g., mobile electrocardiogram), movement (e.g., motion tracking system), and environmental parameters (e.g., temperature). The system was evaluated during one session by a healthy 32-year-old male, and results showed that the sensor system measured accurately during the participant’s stay. Furthermore, the participant did not report any negative experiences. Overall, the multi-sensor system has great potential to bridge the gap between laboratories and older adults’ homes and thus for a deep and novel understanding of human behavioral and neurological disorders. Finally, this new understanding could be utilized to develop new algorithms and sensor systems to address problems and increase the quality of life of our aging society and patients with neurological disorders.
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27
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Sabo B, Abdullahi A, Badaru UM, Saeys W, Truijen S. Predictors of high dose of massed practice following stroke. Transl Neurosci 2022; 13:181-190. [PMID: 35903752 PMCID: PMC9285765 DOI: 10.1515/tnsci-2022-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study is to determine the factors that affect patients' ability to carry out high dose of massed practice. Methods Patients with stroke were included in the study if they had no severe impairment in motor and cognitive functions. Dose of massed practice, motor function, perceived amount and quality of use of the arm in the real world, wrist and elbow flexors spasticity, dominant hand stroke, presence of shoulder pain, and central post-stroke pain were assessed on the first day. Dose of massed practice was assessed again on the second day. The data were analyzed using descriptive statistics and linear multiple regression. Results Only motor function (β = -0.310, r = 0.787, P < 0.001), perceived amount of use (β = 0.300, r = 0.823; 95% CI = 0.34-107.224, P = 0.049), severity of shoulder pain (β = -0.155, r = -0.472, P = 0.019), wrist flexors spasticity (β = -0.154, r = -0.421, P = 0.002), age (β = -0.129, r = -0.366, P = 0.018), dominant hand stroke (β = -0.091, r = -0.075, P = 0.041), and sex (β = -0.090, r = -0.161, P = 0.036) significantly influenced patients' ability to carry out high dose of massed practice. Conclusion Many factors affect patients' ability to carry out high dose of massed practice. Understanding these factors can help in designing appropriate rehabilitation.
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Affiliation(s)
- Bishir Sabo
- Department of Physiotherapy, Bayero University Kano, 70001 Kano, Nigeria.,Department of Physiotherapy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, 70001 Kano, Nigeria.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
| | | | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
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28
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Burks HB, des Bordes JKA, Chadha R, Holmes HM, Rianon NJ. Quality of Life Assessment in Older Adults with Dementia: A Systematic Review. Dement Geriatr Cogn Disord 2021; 50:103-110. [PMID: 34167127 DOI: 10.1159/000515317] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ from those in relatively younger adults. The aim was to conduct a systematic review of the literature to determine how QOL was assessed in adults, 65 years and older with dementia, and identify factors that influence the reported scores. METHODS A systematic review of full-text articles addressing QOL in older adults with dementia, published in English from January 1995 to September 2020, was conducted using PubMed and PsycINFO. We included studies that assessed QOL and involved participants 65 years and older. Studies were evaluated for inclusion by 2 independent pairs of reviewers. We assessed the quality of the studies using the Joanna Briggs Institute's Critical Appraisal Checklist. Study characteristics and findings were summarized. Analysis was by narrative synthesis. We identified social and clinical factors influencing QOL scores. RESULTS Of the 1,010 articles identified, 19 met the inclusion criteria. These 19 studies involved 6,279 persons with dementia, with sample sizes from 32 to 1,366. Mean age of participants ranged from 77.1 to 86.6 years. Five measurement tools were identified; Quality of Life in Alzheimer Disease (QOL-AD), Alzheimer Disease-Related Quality of Life (ADRQL), Quality of Life in Late-Stage Dementia (QUALID), QUALIDEM (a dementia-specific QOL tool), and DEMQOL (health-related QOL for people with dementia). Self-ratings of QOL were higher than proxy ratings. Factors commonly influencing self-ratings of QOL included depression, functional impairment, and polypharmacy. Common factors that influenced proxy ratings included functional impairment, presence of neuropsychiatric symptoms, cognitive impairment, and caregiver burden. CONCLUSION In evaluating QOL in dementia, self- and proxy reports may complement each other to ensure that all perspectives are addressed.
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Affiliation(s)
- Helen B Burks
- Department of Internal Medicine, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Jude K A des Bordes
- Department of Family and Community Medicine, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Riya Chadha
- Department of Internal Medicine, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Holly M Holmes
- Department of Internal Medicine, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Nahid J Rianon
- Department of Internal Medicine, UTHealth McGovern Medical School, Houston, Texas, USA.,Department of Family and Community Medicine, UTHealth McGovern Medical School, Houston, Texas, USA
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29
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Hong YG, Kim HC, Jeon H, An SB, Lee JY, Lee JJ, Kim KJ, Kim CO, Shin DA, Yi S, Kim KN, Yoon DH, Kim TW, Ha Y. Association of frailty with regional sagittal spinal alignment in the elderly. J Clin Neurosci 2021; 96:172-179. [PMID: 34836786 DOI: 10.1016/j.jocn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
The degenerative changes in the spine of the frail elderly gradually exacerbate the alignment of the spine as the degeneration progresses. This study was conducted to assess the relationship between frailty and spine sagittal alignment measured in terms of global, cervical, thoracic, and lumbo-pelvic parameters. In total, 101 patients aged 75 years and older hospitalized for spine surgery were prospectively enrolled. We evaluated spinal sagittal parameters by dividing them into global (C7 sagittal vertical axis [SVA] and T1 pelvic angle [T1PA]), cervical (the C2-7 Cobb angle, Jackson line, and C2-7 plumb line), thoracic (thoracic kyphosis [TK]), and lumbo-pelvic (pelvic tilt [PT] and pelvic incidence minus lumbar lordosis value [PI-LL]). Patient characteristics; the Fatigue, Resistance, Ambulation, Illness, Loss of Weight (FRAIL) scale; and sagittal spinal parameters were included in the analysis. Multiple regression analysis was performed to identify associations between the FRAIL scale and sagittal spinal parameters. The FRAIL scale showed correlations with global sagittal parameters (C7 SVA [β = 0.225, p = 0.029] and T1PA [β = 0.273, p = 0.008]) and lumbo-pelvic parameters (PT [β = 0.294, p = 0.004] and PI-LL [β = 0.323, p = 0.001). Cervical and thoracic parameters were not directly associated with the FRAIL scale. LL and PI-LL were associated with TK, and TK was associated with cervical parameters (the C2-7 Cobb angle, Jackson line and C2-7 plumb line). In conclusion, frailty status could be an important factor that influences sagittal spinal alignment in the elderly. In this study, it was found that frailty mainly affected the balance of lumbo-pelvic alignment, and consequently affected the balance of the whole spine.
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Affiliation(s)
- Yun Gi Hong
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyung-Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyeongseok Jeon
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Ji Yeon Lee
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jong Joo Lee
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea; Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea.
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Roheger M, Kalbe E, Corbett A, Brooker H, Ballard C. Predictors of activities of daily living in heathy older adults: Who benefits most from online cognitive training? Brain Behav 2021; 11:e2388. [PMID: 34661996 PMCID: PMC8613408 DOI: 10.1002/brb3.2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the course of activities of daily living (IADL) functioning and possible predictors of performance changes in healthy older adults conducting either a General Cognitive Training (GCT) or a Reasoning Cognitive Training (ReaCT) or no training (control group, CG) over a period of 6 weeks, 3 months, and 6 months. SETTING AND PARTICIPANTS An online, home-based GCT and ReaCT including n = 2913 healthy participants (GCT: n = 1096; ReaCT: n = 1022; CG: n = 794) aged 60 years and older. METHODS Multilevel analysis were calculated to explore the nature of our outcome variables of IADL part A (independence) and part B (difficulty of tasks), and to detect possible predictors for participants' performance on IADL after CT. RESULTS The random slopes models fitted better for the outcomes IADL Part B in the GCT group (χ2 (2) = 18.78, p < .01), and both IADL Part A and Part B in the ReaCT group (χ2 (2) = 28.57, p < .01; χ2 (2) = 63.38, p < .01, respectively), indicating different changes over time for individual participants. Female sex was a significant predictor of IADL change in the ReaCT group, showing that females benefited most in both IADL scores (IADL A: 0.01, p < .01; IADL B: 0.004, p < .01). No other significant predictors for IADL changes were identified. CONCLUSION AND IMPLICATION The particular effectiveness in women is of clinical relevance, as IADL is typically more impaired in women than in men in advanced age. Following a personalized medicine approach, identifying predictors of non-pharmacological intervention success is of utmost importance.
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Affiliation(s)
- Mandy Roheger
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anne Corbett
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Brooker
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Clive Ballard
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Tian Q, Studenski SA, An Y, Kuo PL, Schrack JA, Wanigatunga AA, Simonsick EM, Resnick SM, Ferrucci L. Association of Combined Slow Gait and Low Activity Fragmentation With Later Onset of Cognitive Impairment. JAMA Netw Open 2021; 4:e2135168. [PMID: 34792590 PMCID: PMC8603083 DOI: 10.1001/jamanetworkopen.2021.35168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Among older people, slow walking is an early indicator of risk for Alzheimer disease (AD). However, studies that have assessed this association have not considered that slow walking may have different causes, some of which are not necessarily associated with higher AD risk. OBJECTIVE To evaluate whether low activity fragmentation among older adults with slow gait speed indicates neurological causes of slow walking that put these individuals at higher risk of AD. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study performed survival analyses using data from the Baltimore Longitudinal Study of Aging. Participants included 520 initially cognitively normal persons aged 60 years or older. New diagnoses of mild cognitive impairment (MCI) or AD were adjudicated during a mean (SD) follow-up of 7.3 (2.7) years. Initial assessment of gait speed and activity fragmentation occurred from January 3, 2007, to May 11, 2015, with follow-up completed on December 31, 2020. Data were analyzed from February 1 to May 15, 2021. EXPOSURES Gait speed for 6 m and activity fragmentation assessed by accelerometry. MAIN OUTCOMES AND MEASURES Associations of gait speed, activity fragmentation, and their interaction with incident MCI/AD were evaluated using Cox proportional hazards models, adjusted for covariates. RESULTS Among the 520 participants (265 women [51.0%]; 125 Black participants [24.0%]; 367 White participants [70.6%]; mean [SD] age, 73 [8] years), MCI/AD developed in 64 participants. Each 0.05-m/s slower gait was associated with a 7% increase in risk of developing MCI/AD (hazard ratio [HR], 1.07 [95% CI, 1.00-1.15]; P = .04). Activity fragmentation alone was not associated with MCI/AD risk (HR, 0.83 [95% CI, 0.56-1.23]; P = .35), but there was a significant interaction between gait speed and activity fragmentation (HR, 0.92 [95% CI, 0.87-0.98]; P = .01). At low activity fragmentation (-1 SD), each 0.05-m/s slower gait speed was associated with a 19% increase in hazard of developing MCI/AD (HR, 1.19 [95% CI, 1.07-1.32]), whereas at higher activity fragmentation (+1 SD), gait speed was not associated with MCI/AD (HR, 1.01 [95% CI, 0.93-1.10]). Among participants with slow gait, higher activity fragmentation was associated with higher odds of having lower extremity osteoarthritis (odds ratio, 1.31 [95% CI, 1.01-1.69]) and less decline in pegboard dominant hand performance (β = 0.026 [SE, 0.009]; P > .05). CONCLUSIONS AND RELEVANCE These findings suggest that frequent rests among older adults with slow gait speed are associated with lower risk of future MCI/AD and that this behavioral strategy is associated with a lower likelihood of subclinical neurological impairment.
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Affiliation(s)
- Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephanie A. Studenski
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Pei-Lun Kuo
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jennifer A. Schrack
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Eleanor M. Simonsick
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Compensatory and Lifestyle-Based Brain Health Program for Subjective Cognitive Decline: Self-Implementation versus Coaching. Brain Sci 2021; 11:brainsci11101306. [PMID: 34679371 PMCID: PMC8534077 DOI: 10.3390/brainsci11101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Although recent studies have explored the potential of multidomain brain health programs, there is a dearth of literature on operationalizing this research to create a clinical treatment program specifically for subjective cognitive decline (SCD). Patients seen by geriatricians in primary care and by behavioral neurology services at our institution presenting with SCD were recruited via a patient-appropriate flyer. After all participants had a 1-h brain health consultation with a neuropsychologist and were provided with program materials, they were randomized to attend a 10-week intervention designed to support program implementation (N = 10) or the control group of implementing the program on their own (N = 11). The program included (1) a calendar-based executive and memory support system for compensatory training and (2) training in healthy lifestyle. There were no significant differences between groups for any outcomes. Participants across both groups showed significant improvements with moderate effect sizes in compensatory strategy use, anxiety symptoms, and daily functioning, which were sustained through 6-month follow-up. They also increased physical activity by the end of the intervention period but did not sustain this through 6-month follow-up. Our pilot study demonstrates preliminary feasibility of a cognitive compensatory and lifestyle-based brain health program. Additional research is recommended to further develop two potentially scalable implementation strategies—coaching and self-implementation after brief consultation.
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Yang R, Xu D, Wang H, Xu J. Longitudinal trajectories of physical functioning among Chinese older adults: the role of depressive symptoms, cognitive functioning and subjective memory. Age Ageing 2021; 50:1682-1691. [PMID: 34228776 DOI: 10.1093/ageing/afab135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Maintaining physical functioning (i.e. mobility, activities of daily living [ADLs], instrumental activities of daily living [IADLs]) in older adults is essential for independent living. However, little is known about how longitudinal trajectories of physical functioning differ by varying levels of depressive symptoms, subjective memory impairment and cognitive functioning. We aimed to examine whether, and to what degree, the rate of change in physical functioning over time was associated with depressive symptoms, subjective memory and cognitive functioning. DESIGN A correlational longitudinal design. METHODS The sample included 5,519 older adults (mean age = 68.13 years) from the China Health and Retirement Longitudinal Study (three waves: 2011-15) who self-reported their depressive symptoms, subjective memory impairment and physical functioning. Cognitive functioning was assessed through interview-based tests. RESULTS There were significant increases in mobility impairment (β = 0.27, P < 0.001), ADLs impairment (β = 0.05, P < 0.001) and IADLs impairment (β = 0.03, P = 0.006) over time. Compared with the mean score at baseline in 2011, the mobility, ADLs and IADLs impairment increased by 13.32, 10.57 and 4.34% for every 2 years, respectively. Those with high depressive symptoms had accelerated rates of mobility (β = 0.212, P < 0.001), ADLs (β = 0.104, P < 0.001) and IADLs impairment (β = 0.076, P = 0.002). Those with poorer cognitive functioning had more rapid rates of mobility impairment. In contrast, those with differing levels of subjective memory impairment did not experience different physical functioning trajectories. CONCLUSIONS High depressive symptoms and poor cognitive functioning may be precursors to rapid declines in physical functioning. Proactive screening for these precursors may attenuate physical decline among Chinese older adults.
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Affiliation(s)
- Rumei Yang
- Nanjing Medical University School of Nursing, Nanjing, Jiangsu 211166, China
| | - Dongjuan Xu
- Purdue University School of Nursing, West Lafayette, IN 47907-2069, USA
| | - Haocen Wang
- Department of Health and Kinesiology, Texas A&M University, College station, TX 77845, USA
| | - Jiayun Xu
- Purdue University School of Nursing, West Lafayette, IN 47907-2069, USA
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Magistro D, Carlevaro F, Magno F, Simon M, Camp N, Kinrade N, Zecca M, Musella G. Effects of 1 Year of Lifestyle Intervention on Institutionalized Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7612. [PMID: 34300062 PMCID: PMC8303470 DOI: 10.3390/ijerph18147612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years; SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services.
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Affiliation(s)
- Daniele Magistro
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (N.K.)
| | - Fabio Carlevaro
- Polo Universitario Asti Studi Superiori (Uni-Astiss), 14100 Asti, Italy; (F.C.); (F.M.); (M.S.); (G.M.)
| | - Francesca Magno
- Polo Universitario Asti Studi Superiori (Uni-Astiss), 14100 Asti, Italy; (F.C.); (F.M.); (M.S.); (G.M.)
- Dipartimento di Scienze della Vita e Biologia dei Sistemi, University of Torino, 10124 Torino, Italy
| | - Martina Simon
- Polo Universitario Asti Studi Superiori (Uni-Astiss), 14100 Asti, Italy; (F.C.); (F.M.); (M.S.); (G.M.)
| | - Nicola Camp
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (N.K.)
| | - Noel Kinrade
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (N.K.)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, UK;
| | - Giovanni Musella
- Polo Universitario Asti Studi Superiori (Uni-Astiss), 14100 Asti, Italy; (F.C.); (F.M.); (M.S.); (G.M.)
- Dipartimento di Scienze della Vita e Biologia dei Sistemi, University of Torino, 10124 Torino, Italy
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Yates JA, Stanyon MR, Redley M, Coleston-Shields DM. Conceptualizing Dementia Crisis and Preferences for Resolution: A Public Perspective. J Prim Care Community Health 2021; 11:2150132720925946. [PMID: 32450753 PMCID: PMC7252359 DOI: 10.1177/2150132720925946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Crisis intervention services for people with dementia in the United Kingdom are poorly defined with no standardized model of working. This may be due to the lack of a clear conceptualization of dementia crisis, resulting in variation in national service delivery. Methods: This study employed a novel public engagement questionnaire data collection technique with 57 participants to gain an updated perspective on the concept of health-related crisis from the point of view of the public. Results: Analysis revealed crisis as a transformational moment that may arrive unexpectedly but could also be the culmination of a sequence of events. Crisis resolution requires external and expert help, and associated feelings of panic and despair can engender the task of resolution by oneself insurmountable. Conclusions: Participants had clear expectations of crisis intervention services, with initial practical and emotional support to reduce risks, and a person-centered approach with family involvement.
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Affiliation(s)
- Jennifer A Yates
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, The University of Nottingham, Nottingham, UK
| | - Miriam R Stanyon
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, The University of Nottingham, Nottingham, UK
| | - Marcus Redley
- School of Health Sciences, The University of East Anglia, Norwich, UK
| | - Donna Maria Coleston-Shields
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, The University of Nottingham, Nottingham, UK
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36
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Jung H, Tanaka S, Iwamoto Y, Yamasaki M, Tanaka R. Relationship between Mobility-Related Activities of Daily Living and Health-Related Quality of Life among Healthy Older Adults: A Cross-Sectional Study Using Structural Equation Modeling. Gerontol Geriatr Med 2021; 7:23337214211013166. [PMID: 34026928 PMCID: PMC8120528 DOI: 10.1177/23337214211013166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To develop a conceptual model that confirms whether mobility-related activities of daily living (ADLs) abilities are strongly associated with reduced health-related quality of life (HRQOL) in older adults. Methods: A total of 153 participants (63 men, 90 women) were analyzed. The mobility-related ADL survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. The Japanese version (v1.2) of the Medical Outcomes Study 36-item Short-Form Health Survey was administered to evaluate HRQOL. Structural equation modeling was performed to test a hypothetical model: mobility-related ADL abilities would influence HRQOL. Results: The chi-square value was not significant (chi-square = 9.463, p = .305), and goodness-of-fit values were high, implying that the model was validated; goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.949; comparative fit index, 0.996; and root mean square error of approximation, 0.035. Results showed that mobility-related ADL abilities influenced the physical health including physical function and general health in HRQOL. Conclusions: This study developed the conceptual model confirming the influence of mobility-related ADL abilities especially on physical health. Further intervention studies on instructions/training for physical activity of healthy older adults should assess this causal relationship.
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Affiliation(s)
- Hungu Jung
- Hiroshima University, Higashi-Hiroshima City, Japan.,Hiroshima Bunka Gakuen University, Akigunsakacho, Japan
| | | | - Yuji Iwamoto
- Hiroshima University, Higashi-Hiroshima City, Japan
| | | | - Ryo Tanaka
- Hiroshima University, Higashi-Hiroshima City, Japan
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Ashbourne J, Boscart V, Meyer S, Tong CE, Stolee P. Health care transitions for persons living with dementia and their caregivers. BMC Geriatr 2021; 21:285. [PMID: 33926380 PMCID: PMC8086075 DOI: 10.1186/s12877-021-02235-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Persons with dementia are likely to require care from various health care providers in multiple care settings, necessitating navigation through an often-fragmented care system. This study aimed to create a better understanding of care transition experiences from the perspectives of persons living with dementia and their caregivers in Ontario, Canada, through the development of a theoretical framework. METHODS Constructivist grounded theory guided the study. Seventeen individual caregiver interviews, and 12 dyad interviews including persons with dementia and their caregivers, were recorded and transcribed verbatim. The data were coded using NVivo 10 software; analysis occurred iteratively until saturation was reached. RESULTS A theoretical framework outlining the context, processes, and influencing factors of care transitions was developed and refined. Gaining an in-depth understanding of the complex care transitions of individuals with dementia and their caregivers is an important step in improving the quality of care and life for this population. CONCLUSION The framework developed in this study provides a focal point for efforts to improve the health care transitions of persons living with dementia.
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Affiliation(s)
- Jessica Ashbourne
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Veronique Boscart
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, N2G 4M4, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Catherine E Tong
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Jian ZH, Li CP, Chiu EC. Ecological, convergent, and discriminative validities of the cognitive abilities screening instrument in people with dementia. Medicine (Baltimore) 2021; 100:e25225. [PMID: 33726020 PMCID: PMC7982157 DOI: 10.1097/md.0000000000025225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined. PURPOSE This study designed to investigate these 3 validities of the CASI in people with dementia. METHODS Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity. RESULTS The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42-0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45-0.93). The t-test results revealed significant differences (P < .05) in the CASI total score and other domains except for the short-term memory domains. Four domains of the CASI showed noticeable ceiling effects (22.4-39.7%). CONCLUSIONS The CASI has adequate ecological validity, good convergent validity, and acceptable discriminative validity in people with dementia. The 5 domains with nonsignificant differences or ceiling effects should only be used with caution to distinguish people with dementia.
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Affiliation(s)
- Zi-Hua Jian
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei
| | - Chih-Ping Li
- Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei
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Nakhla MZ, Banuelos D, Pagán C, Gavarrete Olvera A, Razani J. Differences between episodic and semantic memory in predicting observation-based activities of daily living in mild cognitive impairment and Alzheimer's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1499-1510. [PMID: 33689539 DOI: 10.1080/23279095.2021.1893172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Individuals with mild cognitive impairment (MCI) can often progress into Alzheimer's Disease (AD). Research suggests that decline in episodic memory and semantic memory, as well as functional abilities, can be sensitive in predicting disease progression. This study aimed to (a) investigate episodic and semantic memory performance differences between AD and MCI, (b) determine if memory performance predicts observation-based activities of daily living (ADLs), and (c) explore whether semantic memory mediates the relationship between episodic memory and ADLs. Fifty-eight AD, 53 MCI, and 72 healthy control participants were administered the Rey-O, California Verbal Learning Test, Animal Fluency Test, Boston Naming Test, and Direct Assessment of Functional Status (DAFS). The results revealed, first, that AD participants performed significantly lower than the MCI participants across semantic memory and episodic memory tasks, with the exception of the Boston Naming Test. Second, hierarchical-stepwise regression analyses found that semantic memory significantly predicted DAFS orientation, communication, and financial skills in AD, but episodic memory predicted shopping skills. Furthermore, semantic memory significantly predicted DAFS transportation skills in AD and MCI. Third, within the overall sample, semantic memory mediated the relationship between episodic memory and ADLs. Taken together, the findings suggest decline in semantic memory (as measured by confrontational naming and category fluency) and episodic memory (as measured by list and complex visual design learning and recall) may lead to decline in different and specific aspects of functional abilities in AD and MCI.
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Affiliation(s)
- Marina Z Nakhla
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, California State University, Northridge, CA, USA
| | - Dayana Banuelos
- Department of Psychology, California State University, Northridge, CA, USA
| | - Carolyn Pagán
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychology, Queens College at the City University of New York, New York, NY, USA
| | - Alice Gavarrete Olvera
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychology, Queens College at the City University of New York, New York, NY, USA
| | - Jill Razani
- Department of Psychology, California State University, Northridge, CA, USA
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40
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Raj SE, Mackintosh S, Fryer C, Stanley M. Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review. Am J Occup Ther 2021; 75:7501205060p1-7501205060p27. [PMID: 33399054 DOI: 10.5014/ajot.2020.040782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. OBJECTIVE This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients' performance of daily occupations and reduced caregiving burden and improved caregivers' sense of competence. DATA SOURCES Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. STUDY SELECTION AND DATA COLLECTION Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. FINDINGS From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. CONCLUSIONS AND RELEVANCE Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers' sense of competence. Further research on leisure and home management occupations is warranted. WHAT THIS ARTICLE ADDS The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.
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Affiliation(s)
- Sujatha E Raj
- Sujatha E. Raj, BOT, MSc(OT), is PhD Candidate, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia;
| | - Shylie Mackintosh
- Shylie Mackintosh, PhD, MSc, BAppSc(Physio), is Associate Professor and Dean of Allied Health Programs, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Caroline Fryer
- Caroline Fryer, PhD, Grad Dip (Clin Epi), BAppSc(Physio), is Senior Lecturer, Physiotherapy Program, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- Mandy Stanley, PhD, MSc(OT), BAppSc(OT), is Associate Professor, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Feger DM, Willis SL, Thomas KR, Marsiske M, Rebok GW, Felix C, Gross AL. Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study. Front Neurol 2020; 11:550577. [PMID: 33192982 PMCID: PMC7642324 DOI: 10.3389/fneur.2020.550577] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/09/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group. Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty. Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.
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Affiliation(s)
- Danielle M Feger
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelsey R Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California San Diego School of Health Sciences, La Jolla, CA, United States
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - George W Rebok
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Alden L Gross
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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42
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Yates J, Stanyon M, Challis D, Coleston-Shields DM, Dening T, Hoe J, Jawahar K, Lloyd-Evans B, Moniz-Cook E, Poland F, Streater A, Trigg E, Orrell M. Developing a model of best practice for teams managing crisis in people with dementia: a consensus approach. BMC Psychiatry 2020; 20:505. [PMID: 33050901 PMCID: PMC7552369 DOI: 10.1186/s12888-020-02899-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia. METHODS The Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing). RESULTS One hundred sixty-five candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48 to 92/100. The median score for the crisis teams was 74.5 (range 67-92), and the median score for non-crisis teams was 60 (range 48-72). CONCLUSIONS With further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future.
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Affiliation(s)
- Jennifer Yates
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK.
| | - Miriam Stanyon
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | - David Challis
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | - Donna Maria Coleston-Shields
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | - Tom Dening
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | - Juanita Hoe
- Division of Nursing, City University London, London, UK
| | - Kaanthan Jawahar
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | | | | | | | - Amy Streater
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
- Research and Development, North East London NHS Foundation Trust, Ilford, UK
| | - Emma Trigg
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
| | - Martin Orrell
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham, NG7 2TU, UK
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van de Beek M, van Steenoven I, Ramakers IHGB, Aalten P, Koek HL, Olde Rikkert MGM, Manniën J, Papma JM, de Jong FJ, Lemstra AW, van der Flier WM. Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer's Disease. J Alzheimers Dis 2020; 70:389-397. [PMID: 31177218 PMCID: PMC6839497 DOI: 10.3233/jad-190041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer’s disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0–100) and the health-related Visual Analogue Scale (VAS, 0–100). Twenty-nine DLB patients (age 69±6), 68 AD patients (age 70±6), and 41 controls (age 70±5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: β±SE = -7.6±2.8, controls: β±SE = -7.9±3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (β±SE = 2.9±1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS β±SE = -1.8±0.3, EQ5D-utility β±SE = -3.7±0.4; DAD: VAS = 0.1±0.0, EQ5D-utility β±SE = 0.1±0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.
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Affiliation(s)
- Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger van Steenoven
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics & Radboud UMC Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Lai FHY, Yan EWH, Tsui WS, Yu KKY. A randomized control trial of activity scheduling for caring for older adults with dementia and its impact on their spouse care-givers. Arch Gerontol Geriatr 2020; 90:104167. [DOI: 10.1016/j.archger.2020.104167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/14/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023]
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Sanchez DL, Thomas KR, Edmonds EC, Bondi MW, Bangen KJ. Regional Hypoperfusion Predicts Decline in Everyday Functioning at Three-Year Follow-Up in Older Adults without Dementia. J Alzheimers Dis 2020; 77:1291-1304. [PMID: 32831202 DOI: 10.3233/jad-200490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increasing evidence indicates that cerebrovascular dysfunction may precede cognitive decline in aging and Alzheimer's disease (AD). Reduced cerebral blood flow (CBF) is associated with cognitive impairment in older adults. However, less is known regarding the association between CBF and functional decline, and whether CBF predicts functional decline beyond cerebrovascular and metabolic risk factors. OBJECTIVE To examine the association between regional CBF and functional decline in nondemented older adults. METHOD One hundred sixty-six (N = 166) participants without dementia from the Alzheimer's Disease Neuroimaging Initiative underwent neuropsychological testing and neuroimaging. Pulsed arterial spin labeling magnetic resonance imaging was acquired to quantify resting CBF. Everyday functioning was measured using the Functional Assessment Questionnaire at baseline and annual follow-up visit across three years. RESULTS Adjusting for age, education, sex, cognitive status, depression, white matter hyperintensity volume, cerebral metabolism, and reference (precentral) CBF, linear mixed effects models showed that lower resting CBF at baseline in the medial temporal, inferior temporal, and inferior parietal lobe was significantly associated with accelerated decline in everyday functioning. Results were similar after adjusting for conventional AD biomarkers, including cerebrospinal fluid (CSF) amyloid-β (Aβ) and hyperphosphorylated tau (p-tau) and apolipoprotein E (APOE) ɛ4 positivity. Individuals who later converted to dementia had lower resting CBF in the inferior temporal and parietal regions compared to those who did not. CONCLUSION Lower resting CBF in AD vulnerable regions including medial temporal, inferior temporal, and inferior parietal lobes predicted faster rates of decline in everyday functioning. CBF has utility as a biomarker in predicting functional declines in everyday life and conversion to dementia.
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Affiliation(s)
- Danielle L Sanchez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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46
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Tori K, Kalligeros M, Nanda A, Shehadeh F, van Aalst R, Chit A, Mylonakis E. Association between dementia and psychiatric disorders in long-term care residents: An observational clinical study. Medicine (Baltimore) 2020; 99:e21412. [PMID: 32756140 PMCID: PMC7402876 DOI: 10.1097/md.0000000000021412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.
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Affiliation(s)
| | | | - Aman Nanda
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School, Providence, RI
| | | | - Robertus van Aalst
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Ayman Chit
- Regional Epidemiology and Health Economics, Sanofi Pasteur, Swiftwater, PA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Ng R, Lim SQ, Saw SY, Tan KB. 40-Year Projections of Disability and Social Isolation of Older Adults for Long-Range Policy Planning in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4950. [PMID: 32659983 PMCID: PMC7399997 DOI: 10.3390/ijerph17144950] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 01/05/2023]
Abstract
Against a rapidly aging population, projections are done to size up the demand for long-term care (LTC) services for long-range policy planning. These projections are typically focused on functional factors such as disability. Recent studies indicate the importance of social factors, for example, socially isolated seniors living alone are more likely to be institutionalized, resulting in higher demand for LTC services. This is one the first known studies to complete a 40-year projection of LTC demand based on disability and social isolation. The primary micro dataset was the Retirement and Health Survey, Singapore's first nationally representative longitudinal study of noninstitutionalized older adults aged 45 to 85 with over 15,000 respondents. Disability prevalence across the mild to severe spectrum is projected to increase five-fold over the next 40 years, and the number of socially isolated elders living alone is projected to grow four-fold. Regression models of living arrangements revealed interesting ethnic differences: Malay elders are 2.6 times less likely to live alone than their Chinese counterparts, controlling for marital status, age, and housing type. These projections provide a glimpse of the growing demand for LTC services for a rapidly aging Singapore and underscore the need to shore up community-based resources to enable seniors to age-in-place.
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Affiliation(s)
- Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772, Singapore;
- Lloyds Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore 117602, Singapore
| | - Si Qi Lim
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772, Singapore;
| | - Su Ying Saw
- Ministry of Health, Singapore 169854, Singapore; (S.Y.S.); (K.B.T.)
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore 169854, Singapore; (S.Y.S.); (K.B.T.)
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Yap TL, Alderden J, Sabol VK, Horn SD, Kennerly SM. Real-time Positioning Among Nursing Home Residents Living With Dementia: A Case Study. Wound Manag Prev 2020; 66:16-22. [PMID: 32614327 PMCID: PMC10507611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dementia contributes to the development of pressure injuries (PrIs). PURPOSE This study describes the real-time body positions of 2 nursing home (NH) residents, residing in the United States and living with dementia, to inform development of PrI prevention strategies tailored to individual risk profiles. METHODS As part of a larger study, eligible residents were fitted with a triaxial accelerometer sensor placed on the anterior chest to monitor body positions 24-hours daily through a 4-week monitoring period. The current study used an observational, prospective design during routine repositioning events for 2 residents. A convenience sample of 2 residents from a single NH wing who were considered moderately at risk for PrI development (Braden Scale score 13-14) with a Brief Interview for Mental Status score in the severely impaired range were selected based on nursing staff recommendation. RESULTS Sensor data showed that both residents, although "chairfast" according to the Braden Scale, spent <5% in an upright position and the great majority of time reclining at an angle <50%. One (1) resident demonstrated a persistent side preference. CONCLUSIONS Wearable sensors are not a long-term solution for protecting those with dementia from PrI formation but do provide a crude picture of overall body positions throughout the 24-hour day that may inform individualized PrI prevention strategies. Studies including large samples of NH residents living with dementia are warranted.
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Affiliation(s)
- Tracey L Yap
- Duke University School of Nursing, Durham, North Carolina
| | - Jenny Alderden
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Susan D Horn
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Susan M Kennerly
- East Carolina University College of Nursing, Greenville, North Carolina
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Abstract
The current absence of a disease-modifying treatment for Alzheimer disease highlights the necessity for the benefits of nonpharmacological approaches. We aimed to investigate the effect of exercise in older patients with Alzheimer dementia.This is an observational, prospective cohort study in medical center. Eighty older patients with Alzheimer dementia, including 54 with mild dementia and 26 with moderate dementia, were followed up over 2 years. Patients were divided into exercise and no-exercise groups according to their weekly exercise habit. Mini-Mental State Examination (MMSE), clinical dementia rating (CDR), and senior fitness test were checked initially. We defined death and unexpected hospitalization as the outcomes.Age, sex, education years, and MMSE showed no significant differences between the groups (P > .05) in all patients. All the patients of the exercise group had significantly better left upper body strength, higher aerobic endurance, and left and right balance maintenance time than those of the no-exercise group (P < .05). There were no changes in hospitalization and mortality between the exercise and non-exercise groups during the 2-year follow-ups in all participants. However, in the mild and moderate dementia subgroups, age, sex, education years, and MMSE showed no significant differences between the groups (P > .05). The exercise group had significantly better lower body strength, left upper body strength, aerobic endurance, right upper body flexibility, lower body flexibility, balance maintenance, and agility than the no-exercise group in patients with mild dementia (P < .05). Moreover, the exercise group had significantly lesser unexpected hospitalization than the no-exercise group in the patients with mild dementia (P = .037).Despite the similarity in the status of dementia, exercise habit was found to be associated with a better senior fitness test score status. Hence, exercise can decrease unexpected hospitalization in patients with mild dementia but not those with total dementia.
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Affiliation(s)
- Ke-Hau Chen
- Department of Recreational Sport and Health Promotion, National Pingtung University of Science and Technology, Pingtung County
| | - Hsiu-Hui Chen
- National Kaohsiung University of Science and Technology Physical Education Office
| | - Lin Li
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Hui-chen Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Chien-Liang Chen
- Division of Nephrology, Kaohsiung Veterans General Hospital
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Does Telehealth Delivery of a Dyadic Dementia Care Program Provide a Noninferior Alternative to Face-To-Face Delivery of the Same Program? A Randomized, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:673-682. [PMID: 32234275 DOI: 10.1016/j.jagp.2020.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine whether delivery of a dyadic intervention using telehealth was noninferior to delivery of the same program using traditional face-to-face delivery through home visits. DESIGN We conducted a noninferiority randomized controlled trial. PARTICIPANTS Participants had a diagnosis of dementia, were living in the community, and had an informal caregiver who reported difficulties in managing activities of daily living or behavioral symptoms. INTERVENTION Participants were randomized to receive either telehealth or home visit delivery of the same intervention program. MEASUREMENTS The primary outcome was the Caregiving Mastery Index, secondary outcomes included caregiver's perceptions of change, activities of daily living function, and type and frequency of behavioral symptoms of persons living with dementia. Therapists delivering the intervention recorded the time spent delivering the intervention as well as travel time. RESULTS Sixty-three dyads were recruited and randomized. Both groups reported improvements for the primary outcome, however, these were not statistically significant. There were no significant differences between groups for the primary outcome (mean difference 0.09 (95% confidence interval -1.26 to 1.45) or the secondary outcomes at 4 months. Both groups reported significant improvements in caregiver's perceptions of change. The amount of time spent delivering the content of the program was similar between groups, however offering the intervention via telehealth significantly reduced travel time (mean 255.9 minutes versus mean 77.2 minutes, p <0.0001). CONCLUSION It is feasible to offer dyadic interventions via telehealth and doing so reduces travel time and results in similar benefits for families.
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