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Coşkun E, Çuhadar D. The effect of cognitive stimulation therapy on daily life activities, depression and life satisfaction of older adults living with dementia in nursing home: Randomized controlled trial. DEMENTIA 2024:14713012241270852. [PMID: 39150072 DOI: 10.1177/14713012241270852] [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: 08/17/2024]
Abstract
OBJECTIVES In this research, it was aimed to evaluate the effects of Cognitive Stimulation Therapy on activities of daily living, depression, and life satisfaction in older adults with dementia in nursing homes. METHODS It is a randomized controlled experimental study. The study consisted of a total of 60 older adults, 30 in the intervention group and 30 in the control group, in two different nursing homes. RESULTS In the post-CST comparison, BADLI posttest measurements, IADLS posttest, follow-up test measurements (p < .001, Fr = 45.982, Fr = 42.54) and SWLS posttest (p < .001, Fr = 38.47) of the individuals in the intervention group measurements were significantly higher. The mean depression level of the CSDD posttest and follow-up test intervention group was significantly lower (p < .001, F = 0.402). CONCLUSION It was found that Cognitive Stimulation Therapy is effective in increasing the levels of daily life activity and life satisfaction and reducing the level of depression in older adults with dementia. It is recommended to be used by psychiatric nurses.
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Affiliation(s)
- Ejdane Coşkun
- Nursing Department (Psychiatric Nursing), Faculty of Health Sciences, Osmaniye Korkut Ata University, Türkiye
| | - Döndü Çuhadar
- Department of Psychiatric Nursing, Faculty of Health Science, Gaziantep University, Türkiye
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2
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Lee J, Kim J, Woo B, Pesola A, Tikkanen O. The longitudinal relationship between levels of leisure-time physical activity and positive and negative affect among older foreign-born adults with mild cognitive impairment. Psychogeriatrics 2024; 24:778-788. [PMID: 38627982 DOI: 10.1111/psyg.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The purpose of this study was to investigate the longitudinal impact of different levels of leisure-time physical activity (LTPA) participation on positive and negative affect among older foreign-born adults with mild cognitive impairment (MCI). METHODS This study used 2012 to 2020 data from the Health and Retirement Study data (n = 1206) that was analyzed using repeated measured multivariate analysis of covariance. RESULTS The high-level participation LTPA group reported higher positive affect and lower negative affect than the mid and low-level participation groups. The mid-level LTPA group also reported higher positive and lower negative affect than the low-level LTPA group. CONCLUSIONS This study provides evidence that high levels of LTPA participation contribute to an increase in positive affect and a reduction of negative affect among older foreign-born adults with MCI. The findings of this study will help fill the gap in research on the longitudinal relationship between levels of LTPA participation and positive and negative affect among older foreign-born adults.
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Affiliation(s)
- Jungjoo Lee
- School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Junhyoung Kim
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Bomi Woo
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Arto Pesola
- Active Life Lab South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Olli Tikkanen
- Fibion Inc. Jyväskylä, Finland and Physical Activity Researcher Podcast, Jyväskylä, Finland
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3
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Wong B, Wu P, Ismail Z, Watt J, Goodarzi Z. Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy. BMC Geriatr 2024; 24:559. [PMID: 38926638 PMCID: PMC11210082 DOI: 10.1186/s12877-024-05143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE 40-60% of persons living with dementia (PLWD) experience agitation and/or aggression symptoms. There is a need to understand the best method to detect agitation and/or aggression in PLWD. We aimed to identify agitation and/or aggression tools that are validated against a reference standard within the context of PLWD. METHODS Our study was registered on PROSPERO (CRD42020156708). We searched MEDLINE, Embase, and PsycINFO up to April 22, 2024. There were no language or date restrictions. Studies were included if they used any tools or questionnaires for detecting either agitation or aggression compared to a reference standard among PLWD, or any studies that compared two or more agitation and/or aggression tools in the population. All screening and data extraction were done in duplicates. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data extraction was completed in duplicates by two independent authors. We extracted demographic information, prevalence of agitation and/or aggression, and diagnostic accuracy measures. We also reported studies comparing the correlation between two or more agitation and/or aggression tools. RESULTS 6961 articles were screened across databases. Six articles reporting diagnostic accuracy measures compared to a reference standard and 30 articles reporting correlation measurements between tools were included. The agitation domain of the Spanish NPI demonstrated the highest sensitivity (100%) against the agitation subsection of the Spanish CAMDEX. Single-study evidence was found for the diagnostic accuracy of commonly used agitation scales (BEHAVE-AD, NPI and CMAI). CONCLUSIONS The agitation domain of the Spanish NPI, the NBRS, and the PAS demonstrated high sensitivities, and may be reasonable for clinical implementation. However, a limitation to this finding is that despite an extensive search, few studies with diagnostic accuracy measurements were identified. Ultimately, more research is needed to understand the diagnostic accuracy of agitation and/or aggression detection tools among PLWD.
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Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pauline Wu
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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4
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Andres EB, Chaudhry I, Balasubramanian I, Poco L, Malhotra C. Caregiver-reported use of physical restraints among community-dwelling older adults with severe dementia in Singapore. J Am Geriatr Soc 2024; 72:1817-1823. [PMID: 38424687 DOI: 10.1111/jgs.18797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Older adults with severe dementia are at increased risk of being physically restrained in nursing homes and acute care settings, but little is known about restraint use among those cared for at home. This study explores caregiver-reported use of restraints among community-dwelling older adults with severe dementia. METHODS Using cross-sectional data from 215 family caregivers, we describe restraint use among older adults with severe dementia living at home. We then use multivariable logistic regression to identify factors associated with restraint use. RESULTS Nearly half (47%) of caregivers reported on older adults who had been subject to restraints. Most caregivers reporting restraint use suggested safety reasons, such as prevention of falls (68%), wandering (30%), and removal of catheters or feeding tubes (29%); and 44% indicated doctors or other health care providers were involved in the decision to restrain. Feeding tubes (OR = 4.16, 95% CI: 1.27-13.59) and physically aggressive agitation behaviors (OR = 1.93, 95% CI: 1.09-3.40) were associated with higher odds of restraint use among older adults with severe dementia. Caregivers who received strong emotional support from friends (OR = 0.45, 95% CI: 0.21-0.95) were less likely to report restraint use while serving as a caregiver to others (OR = 2.77, 95% CI: 1.36-5.63) increased the odds of restraint use. CONCLUSIONS The pervasiveness of restraint use is concerning and suggests a lack of evidence-based guidance and support for both caregivers and healthcare providers to prevent restraint use among older adults with severe dementia cared for at home.
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Affiliation(s)
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | | | - Louisa Poco
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
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5
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Duan Q, Liu X, Zhang A. Effects of simulated presence therapy on agitated behavior, cognition, and use of protective constraint among patients with senile dementia. Int J Neurosci 2024:1-11. [PMID: 38646703 DOI: 10.1080/00207454.2024.2346154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
The research was conducted to investigate the improvement of agitated behaviors, cognitive functions, and negative emotions among patients with senile dementia and the burden of caregivers after simulated presence therapy (SPT) intervention. 85 Patients with senile dementia were included as the research subjects and divided into control group (40 cases performed with routine nursing) and observation group (45 cases undergoing routine nursing combined with SPT) via a random number table method. Cohen-Mansfield agitation inventory (CAMI) and protective constraint were used to assess the improvement of agitated behaviors among patients. Besides, apathy evaluation scale-informant (AES-I), functional independence measure (FIM), self-rating depression scale (SDS), self-rating anxiety scale (SAS), clock drawing test, and caregiver burden inventory (CBI) were adopted to evaluate the differences in apathy, daily living and sociability, depression, anxiety, cognitive functions, and caregiver burden between the two groups. It was demonstrated that CAMI score, the duration of protective constraint use, AES-I score, SDS score, SAS score, and CBI score among patients in observation group all apparently decreased compared with those in control group after the intervention. In contrast, FIM and clock drawing test scores both notably increased (p < 0.05). The above findings suggested that SPT could obviously reduce the incidence of agitated behaviors, improve the level of apathy, daily living and sociability, depression, anxiety, and cognitive functions, and relieve caregiver burden among patients with senile dementia during SPT intervention for patients with senile dementia.
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Affiliation(s)
- Qingyi Duan
- Department of Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xing Liu
- Department of Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ailing Zhang
- Department of Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
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6
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Liu J, Lin T, Liu G, Dong X, Min R. Risk factors for agitation in home-cared older adults with dementia: evidence from 640 elders in East China. Front Neurosci 2023; 17:1189590. [PMID: 37476836 PMCID: PMC10354277 DOI: 10.3389/fnins.2023.1189590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Agitation is common among older adults with dementia, negatively affecting their quality of life and their caregivers'. Since home care remains the dominant approach for older adults, this study investigates the risk factors for agitation in older adults with dementia in China. Methods We perform a cross-sectional study of home-cared older adults with dementia in Ningbo, China, using 2020 data. We use a self-made questionnaire to investigate the risks of agitated behavior and its related factors. We perform descriptive, univariate, and regression analyses. Findings We address 640 older Chinese adults; 42.8% of the sample exhibits one or more agitated behaviors. We find that basic health issues, such as activities of daily living (ADL), family support issues, such as Zarit Burden Interview (ZBI) scale and Family APGAR Questionnaire (APGAR), and behavioral awareness issues, such as fall and scald, significantly influence the occurrence of agitation behaviors (p < 0.05). Older adults with severe ADL disorder (b = 6.835, β = 0.196, p < 0.001), ZBI score of 67.00-88.0 (b = 10.212, β = 0.248, p = 0.005), severe APGAR disorder (b = 3.699, β = 0.100, p = 0.012) and a history of fall (b = 9.311, β = 0.199, P = <0.001) or scald (b = 9.288, β = 0.125, p = 0.002) are more likely to exhibit agitated behaviors. Interpretation Agitated behavior in home-cared older adults with dementia are diverse and related to mental state, family support, and behavioral awareness issues. Caregivers, often family members, should be attentive to the needs of dementia patients and take active and effective measures to improve their quality of life. They should be aware of the causes and triggers of agitated behavior and take steps to reduce its occurrence.
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Affiliation(s)
- Jiaxin Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taoyu Lin
- The People’s Hospital of Suzhou New District, Suzhou, China
| | - Guanjun Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxin Dong
- Institute of Health Services, Ningbo College of Health Sciences, Ningbo, China
| | - Rui Min
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Maziero MP, Rocha NP, Teixeira AL. Antipsychotics in Alzheimer's Disease: Current Status and Therapeutic Alternatives. Curr Alzheimer Res 2023; 20:682-691. [PMID: 38409713 DOI: 10.2174/0115672050287534240215052417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Psychosis and hyperactive behaviors, such as agitation and wandering, affect a significant proportion of patients with Alzheimer's disease (AD). These symptoms are often treated with antipsychotics, usually in an off-label approach. This mini-review provides an updated perspective on the pharmacological approach for the neuropsychiatric symptoms (NPS) in AD. The results of new studies have provided a better understanding of AD-related NPS management, but high-quality evidence still needs to be obtained. Herein, we argue for a more cautious approach to the use of antipsychotics in AD and highlight the importance of exploring alternative treatments for NPS. By doing so, we can ensure that patients with AD receive optimal care that is both effective and safe.
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Affiliation(s)
- Maria Paula Maziero
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas 77030, USA
| | - Natalia P Rocha
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas 77030, USA
| | - Antonio L Teixeira
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas 77030, USA
- The Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, TX, USA
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8
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Chekani F, Pike J, Jones E, Husbands J, Khandker RK. Impact of Dementia-Related Behavioral Symptoms on Healthcare Resource Use and Caregiver Burden: Real-World Data from Europe and the United States. J Alzheimers Dis 2021; 81:1567-1578. [PMID: 34057080 PMCID: PMC8293640 DOI: 10.3233/jad-201483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dementia is commonly accompanied by neurobehavioral symptoms; however, the relationship between such symptoms and health-related outcomes is unclear. OBJECTIVE To investigate the impact of specific neurobehavioral symptoms in dementia on healthcare resource use (HCRU), patient quality of life (QoL), and caregiver burden. METHODS Data were taken from the 2015/16 Adelphi Real World Dementia Disease Specific Programme™, a point-in-time survey of physicians and their consulting dementia patients. Multiple regression analyses were used to examine associations between patient symptom groups and health-related outcomes. RESULTS Each patient symptom group of interest (patients with agitation/aggression and related symptoms [AARS] with psychosis, patients with AARS without psychosis, and patients with other behavioral symptoms) had a positive association with HCRU variables (i.e., HCRU was greater), a negative association with proxy measures of patient QoL (i.e., QoL was decreased), and a positive association with caregiver burden (i.e., burden was greater) compared with patients with no behavioral symptoms (control group). The magnitude of effect was generally greatest in patients with AARS with psychosis. Regression analysis covariates that were found to be most often significantly related to the outcomes were dementia severity and the patients' living situation (i.e., whether they were in nursing homes or living in the community). CONCLUSION Combinations of behavioral symptoms, particularly involving AARS plus psychosis, may have a detrimental impact on health-related outcomes such as HCRU, patient QoL, and caregiver burden in dementia. Our results have implications for intervention development in patients who report clusters of symptoms and caregivers, and for identifying at-risk individuals.
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Affiliation(s)
- Farid Chekani
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Rezaul K Khandker
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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9
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Carrarini C, Russo M, Dono F, Barbone F, Rispoli MG, Ferri L, Di Pietro M, Digiovanni A, Ajdinaj P, Speranza R, Granzotto A, Frazzini V, Thomas A, Pilotto A, Padovani A, Onofrj M, Sensi SL, Bonanni L. Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions. Front Neurol 2021; 12:644317. [PMID: 33935943 PMCID: PMC8085397 DOI: 10.3389/fneur.2021.644317] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 01/11/2023] Open
Abstract
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marianna G Rispoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Rino Speranza
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Alberto Granzotto
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States
| | - Valerio Frazzini
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié Salpêtrière Hospital, Paris, France.,AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Neurophysiology Department, Paris, France
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S. Isidoro Hospital, Trescore Balneario, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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10
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Abstract
Caregivers search for mobile device apps that offer meaningful and enjoyable activities to simultaneously enhance the preserved cognitive and functional abilities of those in their care. The purpose of this review article was to describe the current state of tablet apps with which elders with Alzheimer's disease and related forms of dementia may engage as users. Using the keywords "app," "Alzheimer's," and "dementia," a sample of 83 apps was selected from the iTunes Store, Google, and discussion boards of Apple Support Communities. A descriptive content analysis was conducted using a coding scheme on the characteristics of tablet app activity and the requirements for functional abilities of the users. This review found that the activities of the selected apps included games, simple watching and viewing, music and sounds, memory training, learning and information, and social interaction starters. A high-level cognitive and physical ability such as eye-hand coordination is often required to play the majority of the game apps. A few apps are designed specifically for the population. Individuals' variability in cognitive and functional abilities necessitates a person-centered approach in designing and selecting games and activities for apps in order to increase engagement and promote positive experiences in older adults.
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Affiliation(s)
- Sunghee H. Tak
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
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11
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Mulkey MA, Munro CL. Calming the Agitated Patient: Providing Strategies to Support Clinicians. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2021; 30:9-13. [PMID: 34092999 PMCID: PMC8171292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.
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Affiliation(s)
- Malissa A Mulkey
- UNC-REX Hospital, Raleigh, NC; and Post-Doctoral Research Fellow, Indiana University-Purdue University, Indianapolis, IN
| | - Cindy L Munro
- School of Nursing, Miami University, Coral Gables, FL
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12
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Kennedy M, Koehl J, Shenvi CL, Greenberg A, Zurek O, LaMantia M, Lo AX. The agitated older adult in the emergency department: a narrative review of common causes and management strategies. J Am Coll Emerg Physicians Open 2020; 1:812-823. [PMID: 33145525 PMCID: PMC7593470 DOI: 10.1002/emp2.12110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life-threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non-pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time-sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non-opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric-specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non-pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Jennifer Koehl
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of PharmacyMassachusetts General HospitalBostonMassachusettsUSA
| | - Christina L. Shenvi
- Department of Emergency MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Allyson Greenberg
- Department of PharmacyNorthwestern Memorial HospitalChicagoIllinoisUSA
- Department of Emergency MedicineNorthwestern Memorial HospitalChicagoIllinoisUSA
| | - Olivia Zurek
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael LaMantia
- Division of Geriatric MedicineUniversity of VermontBurlingtonVermontUSA
| | - Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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13
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Aigbogun MS, Cloutier M, Gauthier-Loiselle M, Guerin A, Ladouceur M, Baker RA, Grundman M, Duffy RA, Hartry A, Gwin K, Fillit H. Real-World Treatment Patterns and Characteristics Among Patients with Agitation and Dementia in the United States: Findings from a Large, Observational, Retrospective Chart Review. J Alzheimers Dis 2020; 77:1181-1194. [PMID: 32925028 PMCID: PMC7683079 DOI: 10.3233/jad-200127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few studies have examined patient characteristics and treatment patterns among patients with dementia and agitation in the United States (US). OBJECTIVE To examine real-world treatment patterns and characteristics of patients with agitation related to dementia who were treated with antipsychotics in US residential care and community-based settings. METHODS This retrospective chart review collected US physician-level data from patients 55 to 90 years old initiated on an antipsychotic medication for the treatment of agitation related to dementia from January 2018 to May 2018. Clinical characteristics and treatment patterns were assessed overall and stratified by residential care and community-based settings. RESULTS A total of 313 participating physicians, 59.5% of whom were primary care physicians, abstracted 801 patient charts (residential care: n = 312; community-based: n = 489). Of patients with agitation who were initiated on an antipsychotic, most patients (74.5%) were initiated within 3 months of the onset of their studied agitation episode, and 62.8% experienced multiple agitation episodes before initiation. While non-pharmacological therapies are recommended first-line approach for agitation in dementia, use of non-pharmacological therapy before initiation of antipsychotics was reported for only 37.8% of patients in residential care and 21.3% in community-based settings. CONCLUSION Most patients were initiated on an antipsychotic treatment after multiple episodes of agitation and largely without initial non-pharmacological therapy, suggesting that current treatment guideline recommendations for first-line non-pharmacological intervention may not be adequately followed in clinical practice. Understanding the clinical burden and treatment patterns among dementia patients with agitation is imperative for effective disease management.
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Affiliation(s)
| | | | | | | | | | - Ross A Baker
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Michael Grundman
- Global R&D Partners, LLC, San Diego, CA, USA.,University of California, San Diego, San Diego, CA, USA
| | - Ruth A Duffy
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Ann Hartry
- Lundbeck Pharmaceuticals, Deerfield, IL, USA
| | - Keva Gwin
- Lundbeck Pharmaceuticals, Deerfield, IL, USA
| | - Howard Fillit
- Alzheimer's Drug Discovery Foundation, New York, NY, USA.,Mount Sinai School of Medicine, New York, NY, USA
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