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Barreras Diaz TA, Esquer-Rochin M, Gutierrez-Garcia JO, Rodriguez LF. Design and Evaluation of a Technological Platform for Monitoring Patients with Dementia: Unifying Requirements from Mexican Day Centers. J Med Syst 2023; 47:30. [PMID: 36840849 PMCID: PMC9959949 DOI: 10.1007/s10916-023-01917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
The monitoring of patients with dementia who receive comprehensive care in day centers allows formal caregivers to make better decisions and provide better care to patients. For instance, cognitive and physical therapies can be tailored based on the current stage of disease progression. In the context of day centers of the Mexican Federation of Alzheimer, this work aims to design and evaluate Alzaid, a technological platform for assisting formal caregivers in monitoring patients with dementia. Alzaid was devised using a participatory design methodology that consisted in eliciting and validating requirements from 22 and 9 participants, respectively, which were unified to guide the construction of a high-fidelity prototype evaluated by 14 participants. The participants were formal caregivers, medical staff, and management. This work contributes a high-fidelity prototype of a technological platform for assisting formal caregivers in monitoring patients with dementia considering restrictions and requirements of four Mexican day centers. In general, the participants perceived the prototype as quite likely to be useful, usable, and relevant in the job of monitoring patients with dementia (p-value < 0.05). By evaluating and designing Alzaid that unifies requirements for monitoring patients of four day centers, this work is the first effort towards a standard monitoring process of patients with dementia in the context of the Mexican Federation of Alzheimer.
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Affiliation(s)
- Tania-Arisdelci Barreras Diaz
- Department of Computing and Design, Instituto Tecnológico de Sonora, 5 de Febrero 818-Sur, Ciudad Obregón, 85000 Sonora Mexico
| | - Marco Esquer-Rochin
- Department of Computing and Design, Instituto Tecnológico de Sonora, 5 de Febrero 818-Sur, Ciudad Obregón, 85000 Sonora Mexico
| | | | - Luis-Felipe Rodriguez
- Department of Computing and Design, Instituto Tecnológico de Sonora, 5 de Febrero 818-Sur, Ciudad Obregón, 85000 Sonora Mexico
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2
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Ydstebø AE. Hjemmeboende personer med demens: Hva påvirker deres livskvalitet og bruk av helse- og omsorgsressurser? TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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3
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Wasić C, Gräßel E, Luttenberger K, Donath C. [Predictors of intensity of use of adult day care centers in people with cognitive impairment]. Z Gerontol Geriatr 2021; 55:575-582. [PMID: 34586469 PMCID: PMC9587102 DOI: 10.1007/s00391-021-01972-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Abstract
Hintergrund Tagespflegen sind etablierte Versorgungsangebote für Personen mit kognitiven Beeinträchtigungen. Die Nutzungsintensität ist mit durchschnittlich 3 h/Woche jedoch gering. Bisherige Studien konnten Prädiktoren für eine Nutzung/Nichtnutzung aufzeigen. Es ist jedoch bisher unklar, inwieweit diese Faktoren auch mit der Nutzungsintensität zusammenhängen. Ziel der Arbeit Identifikation von Prädiktoren für die Intensität der Tagespflegenutzung bei Menschen mit kognitiven Beeinträchtigungen, basierend auf dem Modell der Versorgungsinanspruchnahme nach Andersen. Material und Methoden Grundlage sind Daten der Studie Demenz in der Tagespflege bei psychosozialer MAKS-Intervention (DeTaMAKS). Prädiktoren für die Nutzungsintensität der Tagespflege wurden mit logistischer Regression analysiert. Ergebnisse Eine signifikant höhere Intensität der Tagespflegenutzung lag vor bei: alleinlebenden Tagespflegegästen, höher gebildeten pflegenden Angehörigen, ab Pflegestufe 2, bei längerer bisheriger Nutzungsdauer der Tagespflege, bei vermehrten psychischen und Verhaltenssymptomen des Tagespflegegasts. Die Sensitivitätsanalyse zeigte bei zusammenlebenden Dyaden zusätzlich eine höhere Nutzungsintensität bei jüngeren pflegenden Angehörigen und kürzerer Entfernung zwischen Wohnort und Tagespflege, jedoch nicht in Bezug auf den Bildungsstand des pflegenden Angehörigen und die psychischen und Verhaltenssymptome des Tagespflegegasts. Diskussion Die Ergebnisse zeigen bestehenden Bedarf an Tagespflegeeinrichtungen, der sich durch Berufstätigkeit und das Leben ohne Partner erhöht. Neben einer guten Erreichbarkeit der Tagespflege könnten auch flexible Angebote die Intensität der Nutzung erhöhen. Zusatzmaterial online Zusätzliche Tabellen sind in der Online-Version dieses Artikels (10.1007/s00391-021-01972-x) enthalten.
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Affiliation(s)
- Catharina Wasić
- Zentrum für Medizinische Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - Katharina Luttenberger
- Zentrum für Medizinische Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - Carolin Donath
- Zentrum für Medizinische Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
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Lunt C, Dowrick C, Lloyd-Williams M. What is the impact of day care on older people with long-term conditions: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1201-1221. [PMID: 33332714 DOI: 10.1111/hsc.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.
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Affiliation(s)
- Catherine Lunt
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Christopher Dowrick
- Academic Palliative and Supportive Care Studies Group (APSCSG), Institute of Psychology Health and Society Block B Waterhouse Building, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), University of Liverpool / Honorary Consultant Liverpool CCG (Liverpool Health Partners), Liverpool, UK
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Webster L, Costafreda Gonzalez S, Stringer A, Lineham A, Budgett J, Kyle S, Barber J, Livingston G. Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep 2021; 43:5601416. [PMID: 31633188 PMCID: PMC7157185 DOI: 10.1093/sleep/zsz251] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Study Objectives Sleep disturbances are a feature in people living with dementia, including getting up during the night, difficulty falling asleep, and excessive daytime sleepiness and may precipitate a person with dementia moving into residential care. There are varying estimates of the frequency of sleep disturbances, and it is unknown whether they are a problem for the individual. We conducted the first systematic review and meta-analysis on the prevalence and associated factors of sleep disturbances in the care home population with dementia. Methods We searched Embase, MEDLINE, and PsycINFO (29/04/2019) for studies of the prevalence or associated factors of sleep disturbances in people with dementia living in care homes. We computed meta-analytical estimates of the prevalence of sleep disturbances and used meta-regression to investigate the effects of measurement methods, demographics, and study characteristics. Results We included 55 studies of 22,780 participants. The pooled prevalence on validated questionnaires of clinically significant sleep disturbances was 20% (95% confidence interval, CI 16% to 24%) and of any symptom of sleep disturbance was 38% (95% CI 33% to 44%). On actigraphy using a cutoff sleep efficiency of <85% prevalence was 70% (95% CI 55% to 85%). Staff distress, resident agitation, and prescription of psychotropic medications were associated with sleep disturbances. Studies with a higher percentage of males had a higher prevalence of sleep disturbance. Conclusions Clinically significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics. Actigraphy appears to offer no benefit over proxy reports in this population.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
- Corresponding author. Lucy Webster, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Amy Lineham
- University College London Medical School, London, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, UK
| | - Simon Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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6
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Webster L, Martin A, Livingston G. The minimum clinically important difference on the sleep disorders inventory for people with dementia. Int J Geriatr Psychiatry 2020; 35:1418-1423. [PMID: 32725642 DOI: 10.1002/gps.5384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/05/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Sleep disturbances in dementia causes distress to people with dementia and their family carers and are associated with care home admission. The Sleep Disorders Inventory (SDI) is a validated questionnaire of sleep disturbances in dementia often used to measure treatment effectiveness, but the minimum clinically important difference (MCID) is unknown. METHODS We triangulated three investigative methods to determine the MCID of the SDI. Using data on SDI from a randomised controlled trial (RCT) with 62 participants in an intervention for sleep disorders in dementia, we (1) calculated distribution-based values where MCID = 0.33 of a SD (SD) (2) an anchor based approach using quality of life (measured using DEMQOL-Proxy) as an anchor. We also employed a Delphi consensus process asking 12 clinicians, sleep researchers and family carers to rate which changes on vignettes were equivalent to a MCID. RESULTS We found that 0.33 SD in the SDI = 4.86. Reduction in SDI total score was not significantly correlated with improvement in DEMQOL-Proxy (Pearson's correlation = -0.01; P = 0.96) score. The Delphi consensus required two rounds to reach a consensus and concluded that changes equivalent to three points on the SDI equated to the MCID. CONCLUSIONS Taking into account both the distribution-based values and the Delphi process we used a whole number at the midpoint and judged the minimum clinically important difference MCID to be equal to four points. We note the clinicians and carers opinions from the Delphi process determined the MCID to be lower at three points.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
| | - Alice Martin
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
| | - Gill Livingston
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
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7
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Ibsen TL, Kirkevold Ø, Patil GG, Eriksen S. Dropout from farm-based day care for people with dementia in Norway: a follow-up study. BMC Geriatr 2020; 20:428. [PMID: 33109115 PMCID: PMC7590676 DOI: 10.1186/s12877-020-01826-y] [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: 05/06/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Farm-based day care services (FDCs) for people with dementia are intending to provide social relationships and meaningful activities in an agricultural landscape and offer respite for next of kin. As this requires a certain cognitive and physical functioning, it is of interest to investigate how this service contribute during the course of dementia. In this study we aim to explore the individual characteristics predicting dropout from FDC. Furthermore, we investigate whether the participants who drop out of the service continue to live at home with another day care service or if they move to a residential care facility. METHODS The study includes 92 people with dementia attending FDCs in Norway, assessed with standardized instruments at baseline between January 2017 and January 2018. They were followed for 1 year, and dropouts from FDC during this period were mapped. The association between individual characteristics and dropout was assessed using a Cox proportional hazards regression analysis. RESULTS Thirty-eight people stopped attending FDCs during the study. Twenty-six moved to residential care. Among the 12 who continued to live in their own homes, 9 people started in a regular day care service. Higher score on educational level and more severe dementia, as well as lower scores on social support, increased the probability of stopping FDC. CONCLUSION FDCs appeared as a service that is stable over time for most participants, as more than two-third could use the care facility until the need of residential care. The transfers within care services and levels of care seemed to be characterized by continuity. More research on the growing population of educated older adults with dementia are warranted, to facilitate for their course of care needs. Finally, extended knowledge is needed to improve the collaboration between private and public networks, such as day care services, to improve the experience of social support for people with dementia.
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Affiliation(s)
- T L Ibsen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ø Kirkevold
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway.,Norwegian University of Science and Technology (NTNU) Department of Health Sciences in Gjøvik, Gjøvik, Norway.,Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Gjøvik, Norway
| | - G G Patil
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - S Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings. Cochrane Database Syst Rev 2020; 8:CD010515. [PMID: 32786083 PMCID: PMC8094398 DOI: 10.1002/14651858.cd010515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.
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Affiliation(s)
- Ralph Möhler
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Abstract
OBJECTIVES Nearly 40% of care home residents who are living with dementia also have symptoms of disturbed sleep. However, the impact of these disturbances is relatively unknown and is needed to indicate whether interventions are warranted; therefore, we aimed to investigate the impact. DESIGN One-to-one semi-structured interviews. SETTINGS Four UK care homes. PARTICIPANTS We interviewed 18 nurses and care assistants about residents with sleep disturbances. MEASUREMENTS We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio recorded and transcribed and then analyzed thematically by two researchers independently. RESULTS Staff described that sleep disturbances in most, but not all, residents impacted negatively on the resident, other residents, staff, and relatives. Residents became more irritable or agitated if they had slept badly. They slept in the daytime after a bad night, which then increased their chances of being awake the following night. For some, being sleepy in the day led to falls, missing medication, drinks, and meals. Staff perceived hypnotics as having low efficacy, but increasing the risk of falls and drowsiness. Other residents were disturbed by noise, and staff described stress when several residents had sleep disturbance. Some of the strategies reported by staff to deal with sleep disturbances such as feeding or providing caffeinated tea at night might be counterproductive. CONCLUSIONS Sleep disturbances in care home residents living with dementia negatively affect their physical and psychological well-being. These disturbances also disturb other residents and increase stress in staff.
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Abstract
Importance Worldwide, 47 million people live with dementia and, by 2050, the number is expected to increase to 131 million. Observations Dementia is an acquired loss of cognition in multiple cognitive domains sufficiently severe to affect social or occupational function. In the United States, Alzheimer disease, one cause of dementia, affects 5.8 million people. Dementia is commonly associated with more than 1 neuropathology, usually Alzheimer disease with cerebrovascular pathology. Diagnosing dementia requires a history evaluating for cognitive decline and impairment in daily activities, with corroboration from a close friend or family member, in addition to a thorough mental status examination by a clinician to delineate impairments in memory, language, attention, visuospatial cognition such as spatial orientation, executive function, and mood. Brief cognitive impairment screening questionnaires can assist in initiating and organizing the cognitive assessment. However, if the assessment is inconclusive (eg, symptoms present, but normal examination findings), neuropsychological testing can help determine whether dementia is present. Physical examination may help identify the etiology of dementia. For example, focal neurologic abnormalities suggest stroke. Brain neuroimaging may demonstrate structural changes including, but not limited to, focal atrophy, infarcts, and tumor, that may not be identified on physical examination. Additional evaluation with cerebrospinal fluid assays or genetic testing may be considered in atypical dementia cases, such as age of onset younger than 65 years, rapid symptom onset, and/or impairment in multiple cognitive domains but not episodic memory. For treatment, patients may benefit from nonpharmacologic approaches, including cognitively engaging activities such as reading, physical exercise such as walking, and socialization such as family gatherings. Pharmacologic approaches can provide modest symptomatic relief. For Alzheimer disease, this includes an acetylcholinesterase inhibitor such as donepezil for mild to severe dementia, and memantine (used alone or as an add-on therapy) for moderate to severe dementia. Rivastigmine can be used to treat symptomatic Parkinson disease dementia. Conclusions and Relevance Alzheimer disease currently affects 5.8 million persons in the United States and is a common cause of dementia, which is usually accompanied by other neuropathology, often cerebrovascular disease such as brain infarcts. Causes of dementia can be diagnosed by medical history, cognitive and physical examination, laboratory testing, and brain imaging. Management should include both nonpharmacologic and pharmacologic approaches, although efficacy of available treatments remains limited.
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Affiliation(s)
- Zoe Arvanitakis
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
- Dept of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
- Dept of Family Medicine, Rush University Medical Center, Chicago, IL
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
- Dept of Neurological Sciences, Rush University Medical Center, Chicago, IL
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Eriksen S, Pedersen I, Taranrød LB, Ellingsen-Dalskau LH, Finnanger Garshol B, Ibsen TL, Kirkevold Ø, Strandli E, Patil GG. Farm-based day care services - a prospective study protocol on health benefits for people with dementia and next of kin. J Multidiscip Healthc 2019; 12:643-653. [PMID: 31616153 PMCID: PMC6698602 DOI: 10.2147/jmdh.s212671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction The increasing number of people with dementia will place a considerable challenge on the health care system and will necessitate innovation and new solutions. Day care services aim to provide meaningful activities and coping experiences for the target group. The aim of the present study is to explore the experience and potential health benefits for people with dementia attending farm-based day care services in Norway and their next of kin. Methods and design The present study is a prospective study organized into several qualitative and quantitative sub-studies. Study period will last from 2016-2020. We use a multi-method approach and both an empirical and a constructivist view on knowledge to explore this multi-facetted phenomenon. Discussion Several challenges are expected, for instance, the ability to include participants with dementia and keep them within the study for the whole study period. The functioning level of participants regarding language and understanding could challenge their ability to answer. Despite having several limitations, we believe that this study with its different approaches and methods will add important knowledge to the field. Knowledge from our study could be essential for creating day care services of good quality for people with dementia and such services could reduce the burden of care for their next of kin.
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Affiliation(s)
- Siren Eriksen
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust , Tønsberg, Norway.,Faculty of Health Studies, Vid Specialized University, Oslo, Norway
| | - Ingeborg Pedersen
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Liv Bjerknes Taranrød
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust , Tønsberg, Norway
| | - Lina Harvold Ellingsen-Dalskau
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Bjørnar Finnanger Garshol
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Tanja Louise Ibsen
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust , Tønsberg, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust , Tønsberg, Norway.,Centre of Old Age Psychiatry Research, Innlandet Hospital Trust , Gjøvik, Norway.,Norwegian University of Science and Technology (NTNU) Department of Health Sciences in Gjøvik , Norway
| | - Elin Strandli
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust , Tønsberg, Norway
| | - Grete Grindal Patil
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
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12
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Vossius C, Selbæk G, Benth JŠ, Wimo A, Engedal K, Kirkevold Ø, Rokstad AMM. Cost analysis of day care centres in Norway. PLoS One 2019; 14:e0219568. [PMID: 31393890 PMCID: PMC6687148 DOI: 10.1371/journal.pone.0219568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022] Open
Abstract
Background Day care services aim to offer meaningful activities and a safe environment for the attendees and a respite for family caregivers while being cost effective. This study compares the use of formal and informal care in users and non-users of day care centres designed for persons with dementia. Method Users of day care designed for dementia (DC group) and non-users (NDC group) were followed over a period of 24 months or until nursing home admission (NHA) respectively death. Demographic and clinical characteristics were collected at baseline and after 12 and 24 months. The use of care was recorded by Resource Utilization in Dementia (RUD). Results A total of 257 persons with dementia participated in the study, 181 in the DC group and 76 in the NDC group. Users of day care centres cause higher costs due to the expenses for day care, while neither the use of home nursing, secondary care, informal care nor the time until NHA did show any differences between users and non-users. The overall costs were higher in the DC group at baseline and after 12 months, but this difference was no longer present at the end of the two-year study period. Conclusion Our results indicate no potential cost-saving effect of day care designed for people with dementia, as the use of day care did neither result in a reduced use of care nor in a delay of NHA. Future research should balance the non-monetary benefits of day care against its costs for a full cost-effectiveness analysis, most favourable in a RCT-design.
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Affiliation(s)
- C. Vossius
- Centre for Age-Related Medicine, Stavanger University Hospital, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- * E-mail:
| | - G. Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - J. Šaltytė Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway
| | - A. Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - K. Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Ø. Kirkevold
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian University of Science and Technology (NTNU) Department of Health Sciences in Gjøvik, Gjøvik, Norway
| | - A. M. M. Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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