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Bell G, El Baou C, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Fearn C, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Predictors of primary care psychological therapy outcomes for depression and anxiety in people living with dementia: evidence from national healthcare records in England. Br J Psychiatry 2024:1-8. [PMID: 38328941 DOI: 10.1192/bjp.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. AIMS To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. METHOD National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. RESULTS People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. CONCLUSIONS Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and iCope Psychological Therapies Service, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
| | - Caroline Fearn
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Rapaport P, Amador S, Adeleke M, Banerjee S, Barber J, Charlesworth G, Clarke C, Connell C, Espie C, Gonzalez L, Horsley R, Hunter R, Kyle SD, Manela M, Morris S, Pikett L, Raczek M, Thornton E, Walker Z, Webster L, Livingston G. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open 2024; 14:e075273. [PMID: 38307536 PMCID: PMC10836385 DOI: 10.1136/bmjopen-2023-075273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives' sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care. METHODS AND ANALYSIS We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1-2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation. ETHICS AND DISSEMINATION London-Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention. TRIAL REGISTRATION NUMBER ISRCTN13072268.
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Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Mariam Adeleke
- Department of Statistical Science, University College London, London, UK
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Georgina Charlesworth
- Division of Psychology and Language Sciences, University College London, London, UK
- North East London NHS Foundation Trust, Rainham, UK
| | | | | | - Colin Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lina Gonzalez
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Sarah Morris
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Liam Pikett
- Division of Psychiatry, University College London, London, UK
| | - Malgorzata Raczek
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Emma Thornton
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
| | - Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
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Bhatt J, Kohl G, Scior K, Charlesworth G, Muller M, Dröes RM. Comparing the stigma experiences and comfort with disclosure in Dutch and English populations of people living with dementia. Dementia (London) 2023; 22:1567-1585. [PMID: 37480343 PMCID: PMC10521157 DOI: 10.1177/14713012231188503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVES People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. METHODS Community-dwelling adults living with dementia in the Netherlands (n = 40) and England (n = 40) completed either the English versions or the Dutch translations of the Comfort with Disclosure scale and three stigma measures (Stigma Impact, Stigma Stress, and Secrecy Scale). We established the psychometric properties of the stigma measures and conducted correlation and regression analyses. RESULTS Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. CONCLUSIONS The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation.
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Affiliation(s)
- Jem Bhatt
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Gianna Kohl
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- UCL Unit for Stigma Research, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Research and Development, North East London Foundation Trust, London, UK
| | - Majon Muller
- Department of Internal Medicine, Geriatric Medicine Section, Amsterdam Cardiovascular Sciences Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centers, location VUmc/Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Birt L, Charlesworth G, Moniz-Cook E, Leung P, Higgs P, Orrell M, Poland F. "The Dynamic Nature of Being a Person": An Ethnographic Study of People Living With Dementia in Their Communities. Gerontologist 2023; 63:1320-1329. [PMID: 36879407 PMCID: PMC10474587 DOI: 10.1093/geront/gnad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A dementia diagnosis can affect social interactions. This study aims to understand how people living with dementia act as social beings within everyday interactions in their local communities. RESEARCH DESIGN AND METHODS Focused ethnography informed by Spradley's approach to data collection and analysis. Observations in community spaces. RESULTS Twenty-nine observations were undertaken in everyday social settings with 11 people with dementia who were part of a longitudinal interview study. Data consisted of 40 hr of observation, and researcher field notes. The overarching theme "the dynamic nature of being a person" encapsulates participants' exhibited experiences in negotiating to attain and sustain an acknowledged place in their communities. Two subthemes characterized contexts and actions: (1) "Being me-not dementia": Participants constructed narratives to assert their ontological presence in social settings. They and others used strategies to mediate cognitive changes evidencing dementia. (2) "Resisting or acquiescing to 'being absent in place'": Participants were often able to resist being absent to the gaze from others, but some social structures and behaviors led to a person being "in place," yet not having their presence confirmed. DISCUSSION AND IMPLICATIONS People living with dementia can actively draw on personal attributes, familiar rituals, objects, and social roles to continue to present themselves as social beings. Identifying how postdiagnosis people may self-manage cognitive changes to retain their presence as a person can help health and social care practitioners and families collaborate with the person living with dementia enabling them to have a continued social presence.
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Affiliation(s)
- Linda Birt
- School Health Sciences, University of East Anglia, Norwich, UK
| | - Georgina Charlesworth
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School Health Sciences, University of East Anglia, Norwich, UK
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Ali A, Aguirre E, Carter J, Hoare S, Brackley K, Goulden N, Hoare Z, Clarke CS, Charlesworth G, Acton D, Spector A. Group cognitive stimulation therapy versus usual care for people with intellectual disabilities and dementia (CST-IDD) in the UK: protocol for a mixed-methods feasibility randomised controlled trial. BMJ Open 2023; 13:e072391. [PMID: 37116994 PMCID: PMC10151918 DOI: 10.1136/bmjopen-2023-072391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION The prevalence of dementia is almost five times higher in people with intellectual disabilities compared with the general population. However, evidence-based treatments for this population are lacking, as most randomised controlled trials for dementia interventions have not included people with intellectual disabilities. Cognitive stimulation therapy (CST) has a robust evidence base in the general dementia population, consistently showing benefits to cognition, quality of life and being cost-effective. We are conducting a mixed-methods feasibility trial of group CST for people with intellectual disabilities and dementia, to determine if a future definitive randomised controlled trial is feasible. METHODS AND ANALYSIS Fifty individuals with intellectual disabilities and dementia will be randomised to either the intervention arm (14 sessions of group CST plus treatment as usual) or the control arm (treatment as usual). Randomisation will occur after informed consent has been obtained and baseline assessments completed. Each arm will have 25 participants, with the intervention arm divided into five or more CST groups with three to five participants in each. The outcomes will be feasibility of recruitment, acceptability and adherence of the intervention, suitability of study outcome measures and feasibility of collecting resource use data. Quantitative and qualitative approaches, including semistructured interviews with group participants, carers and group facilitators, will be employed to assess these outcomes. ETHICS AND DISSEMINATION This study has been approved by Essex REC (Ref: 21/EE/027) and the HRA ethical approval process through the Integrated Research Application System (IRAS ID: 306 756). We plan to publish the results in peer-reviewed journals and conferences as well as provide feedback to funders, sponsors and study participants. TRIAL REGISTRATION NUMBER ISRCTN88614460.
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Affiliation(s)
- Afia Ali
- Unit of Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
| | - Elisa Aguirre
- Psychology Department, Universidad Europea de Madrid, Madrid, Spain
| | - Joanna Carter
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Sarah Hoare
- Research and Development, North East London NHS Foundation Trust, Rainham, UK
| | - Kate Brackley
- Birmingham Research Park, British Institute of Learning Disabilities, Edgbaston, UK
| | - Nia Goulden
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, UCL Medical School, London, UK
| | | | - Danny Acton
- Wirral Community Learning Disabilty Team, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Desai R, John A, Saunders R, Marchant NL, Buckman JEJ, Charlesworth G, Zuber V, Stott J. Examining the Lancet Commission risk factors for dementia using Mendelian randomisation. BMJ Ment Health 2023; 26:e300555. [PMID: 36789917 PMCID: PMC10035779 DOI: 10.1136/bmjment-2022-300555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/30/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Dementia incidence is increasing across the globe and currently there are no disease-modifying pharmaceutical treatments. The Lancet Commission on dementia identified 12 modifiable risk factors which explain 40% of dementia incidence. However, whether these associations are causal in nature is unclear. OBJECTIVE To examine the modifiable risk factors for dementia as identified in the Lancet Commission review using Mendelian randomisation (MR) to establish if, based on genetic evidence, these associations with different dementia subtypes are causal in nature. METHODS Publicly available genome-wide association study data were used for 10 risk factors and Alzheimer's disease (AD), frontotemporal dementia and dementia with Lewy bodies. Two-sample MR using the inverse varianceweighted method was conducted to test for causal relationships. Weighted median MR and MR-Egger were used to test for pleiotropic effects. RESULTS Genetic proxied risk for higher levels of smoking (OR: 0.80 (95% CI: 0.69; 0.92), p=0.002), obesity (OR: 0.87 (95% CI: 0.82; 0.92), p<0.001) and blood pressure (OR: 0.90 (95% CI: 0.82; 0.99), p=0.035) appeared to be protective against the risk of AD. Post hoc analyses indicated these associations had pleiotropic effects with the risk of coronary artery disease. Genetic proxied risk of educational attainment was found to be inconsistently associated with the risk of AD. CONCLUSIONS AND IMPLICATIONS Post hoc analysis indicated that the apparent protective effects of smoking, obesity and blood pressure were a result of survivor bias. The findings from this study did not support those presented by the Lancet Commission. Evidence from causal inference studies should be considered alongside evidence from epidemiological studies and incorporated into reviews of the literature.
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Affiliation(s)
- Roopal Desai
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Amber John
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Verena Zuber
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC Centre for Environment and Health at Imperial College, Imperial College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Bell G, Singham T, Saunders R, Buckman JEJ, Charlesworth G, Richards M, John A, Stott J. Positive psychological constructs and cognitive function: A systematic review and meta-analysis. Ageing Res Rev 2022; 82:101745. [PMID: 36210034 DOI: 10.1016/j.arr.2022.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/04/2022] [Indexed: 01/31/2023]
Abstract
AIM To synthesise evidence regarding the association between positive psychological constructs (PPCs) and cognitive function in adults aged 50 +. METHODS Literature searches: Medline, PsycINFO, and Scopus (inception to February 2022). Studies were included if they reported on the association between at least one PPC and one objective measure of cognitive function in people aged 50 + without cognitive impairment at baseline. Where at least two studies reported on the same PPC and cognitive outcome, estimates were pooled through meta-analysis. FINDINGS In total, 37 studies were included. There was evidence of cross-sectional associations for 'meaning in life' (verbal fluency: b = 0.09, 95 %CI [0.07, 0.11], p < .001; memory: b = 0.10, 95 %CI [0.08, 0.12], p < .001), 'purpose in life' (verbal fluency: b = 0.07, 95 %CI [0.05, 0.08], p < .001; memory: r = 0.13, 95 %CI [0.08, 0.18], p < .001), and positive affect (cognitive state: r = 0.25, 95 %CI [0.14, 0.36], p < .001; memory: r = 0.05, 95 %CI [0.02, 0.08], p < .001) with various domains of cognitive function. However, no significant results were found for life satisfaction (p = .13) or longitudinal studies investigating positive affect and memory (p = .48). Other PPCs were included in narrative syntheses only. IMPLICATIONS Purpose and meaning in life may be sensible primary targets for interventions to promote healthy cognitive aging. More longitudinal and causal inference research is needed to better understand this association and its implications for clinical practice.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Timothy Singham
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; iCope - Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Kohl G, Bhatt J, Scior K, Charlesworth G. Development and Co‐Design of a Digital Intervention for People Affected by Dementia who are Fearful of Disclosing the Diagnosis to Their Social Networks. Alzheimers Dement 2022. [DOI: 10.1002/alz.067833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Gianna Kohl
- University College London London United Kingdom
| | - Jem Bhatt
- University College London London United Kingdom
| | | | - Georgina Charlesworth
- University College London London United Kingdom
- North East London Foundation Trust London United Kingdom
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Bhatt J, Scior K, Stoner CR, Moniz-Cook E, Charlesworth G. Stigma among UK family carers of people living with dementia. BJPsych Open 2022; 8:e179. [PMID: 36205002 PMCID: PMC9634559 DOI: 10.1192/bjo.2022.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Models of caregiving seldom include the role of stigma when understanding the experiences of carers of people living with dementia. AIMS To investigate the validity of the Family Stigma Instrument (FAMSI), and use it to explore the extent to which experiences of stigma are endorsed in family carers of people living with dementia. METHOD The FAMSI was tested with 70 carers of people living with dementia. They also completed a measure of self-esteem. RESULTS The FAMSI demonstrated some good preliminary psychometric properties. Carers endorsed stigma by association more so than affiliate stigma constructs, suggesting that carers were aware that others viewed or treated them in a stigmatising fashion but did not endorse internalised consequences of this as much (e.g. behavioural or affective affiliate stigma). CONCLUSIONS The FAMSI offers new avenues for understanding the contribution of stigma to caregiver burden in dementia. It also captures the positive aspects of caregiving, which may mitigate internalised stigma in family carers, and has good potential for evaluating stigma-neutralising interventions in dementia care.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Charlotte R Stoner
- Centre for Chronic Illness and Ageing, School of Human Sciences, University of Greenwich, UK
| | | | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Research and Development Department, North East London Foundation Trust, UK
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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11
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Kohl G, Ulate MM, Bhatt J, Lynch J, Scior K, Charlesworth G. Individuals’ Decision to Disclose a Diagnosis of Dementia and the Development of an Online Empowerment Intervention. Innov Aging 2021. [PMCID: PMC8680809 DOI: 10.1093/geroni/igab046.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Learning to live with a diagnosis of dementia is a complex process. Many people affected by dementia choose not to disclose the diagnosis to others and avoid social activities due to fear of others’ adverse reactions. This in turn can limit their social participation and negatively affect their psychosocial health. A systematic review explored factors influencing the decision to disclose or conceal a dementia diagnosis to one’s social network, including individuals’ attitudes and experiences regarding this decision. The sixteen studies included reveal the complexity of this decision. Findings highlight the role of stigma and individuals’ wishes to remain ‘normal’, but also the need of explaining what has changed. Results were further discussed with people with dementia and informal caregivers as part of patient and public involvement. End users expressed their attitudes, needs, and wishes towards the design of an online empowerment intervention supporting disclosure decision-making in people affected by dementia.
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Affiliation(s)
- Gianna Kohl
- University College London, University College London, England, United Kingdom
| | | | - Jem Bhatt
- University College London, London, England, United Kingdom
| | - Jennifer Lynch
- University of Hertfordshire, Hatfield, England, United Kingdom
| | - Katrina Scior
- University College London, London, England, United Kingdom
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12
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Kohl G, Ulate MM, Bhatt J, Scior K, Charlesworth G. Factors associated with disclosing a diagnosis of dementia to one’s social network: A systematic review. Alzheimers Dement 2021. [DOI: 10.1002/alz.056146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianna Kohl
- University College London London United Kingdom
| | - Mauricio Molinari Ulate
- Biomedical Research Institute of Salamanca, University of Salamanca Salamanca Spain
- Iberian Institute of Research in Psycho‐Sciences, INTRAS Foundation Zamora Spain
| | - Jem Bhatt
- University College London London United Kingdom
| | | | - Georgina Charlesworth
- University College London London United Kingdom
- North East London Foundation Trust Essex United Kingdom
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13
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Desai R, Whitfield T, Said G, John A, Saunders R, Marchant NL, Stott J, Charlesworth G. Affective symptoms and risk of progression to mild cognitive impairment or dementia in subjective cognitive decline: A systematic review and meta-analysis. Ageing Res Rev 2021; 71:101419. [PMID: 34390850 DOI: 10.1016/j.arr.2021.101419] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023]
Abstract
AIMS To systematically review the literature on outcomes for individuals with subjective cognitive decline (SCD) with concurrent affective symptoms. To conduct a meta-analysis to establish whether either higher depressive symptoms or higher levels of anxiety increased the risk of progression SCD to mild cognitive impairment (MCI) or dementia. METHODS Five databases were searched from inception to February 2021 for longitudinal studies of older adults with SCD, reporting depressive and anxiety symptoms at baseline and risk of MCI or dementia at follow-up. Data were extracted and pooled using a random-effects meta-analysis. RESULTS Twelve studies were identified. Pooled effect sizes indicated higher depressive symptoms did not increase risk of clinical progression to either MCI (RR = 0.98; 95 % CI: 0.75-1.26) or dementia (RR = 0.69; 95 % CI: 0.27-1.79). However, presence of anxiety or SCD-related worry did significantly increase risk of progression from subjective to objective cognitive impairment by 40 % (RR = 1.40; 95 % CI:1.20 - 1.63). CONCLUSIONS Affective symptoms in the form of anxiety, but not depressive symptoms, increase the risk of progression to objective cognitive impairment in individuals with SCD. Further research should focus on establishing whether psychological interventions aimed at reducing anxiety and worry also reduce the risk of clinical progression.
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14
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Baker S, Brede J, Cooper R, Charlesworth G, Stott J. Barriers and facilitators to providing CBT for people living with dementia: Perceptions of psychological therapists. Clin Psychol Psychother 2021; 29:950-961. [PMID: 34626445 DOI: 10.1002/cpp.2674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022]
Abstract
Many people living with dementia or mild cognitive impairment (MCI) experience anxiety and depression. Cognitive behavioural therapy (CBT) is a recommended treatment for adults, commonly provided through primary care psychological therapies services. This study explored the facilitators and barriers to providing CBT interventions for people living with dementia or MCI, as perceived by therapists working in such services. Structured interviews were conducted with 14 clinicians recruited through primary care psychological therapies services about their experiences of working with people living with dementia or MCI and their ideas about factors that enhance or hinder offering and delivering CBT to this population. Interview recordings were transcribed and analysed using thematic analysis. Credibility checks were incorporated throughout. Three themes were identified: 'attitudes towards dementia', 'competing demands', and 'pressure without support'. Perceived facilitators and barriers occurred across individual, service, and system levels. Facilitators were positive engagement and outcomes for people living with dementia or MCI, positive attitudes of clinicians, and flexibility within some services. In contrast, perceived barriers were stigma towards dementia and mental health in older adults, high pressure on staff to perform with a lack of support to do so, exclusion based on diagnosis, and inflexibility within some services. Clinicians were confident that people living with dementia or MCI could benefit from CBT, with some adaptations to delivery. There are implications for staff support and training, and for commissioning practices relating to the tension between minimal resources, equitable access, and person-centred care.
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Affiliation(s)
- Samatha Baker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Janina Brede
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rebecca Cooper
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development, North East London NHS Foundation Trust (NELFT), Ilford, UK
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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15
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Douglas S, Stott J, Spector A, Brede J, Hanratty É, Charlesworth G, Noone D, Payne J, Patel M, Aguirre E. Mindfulness-based cognitive therapy for depression in people with dementia: A qualitative study on participant, carer and facilitator experiences. Dementia (London) 2021; 21:457-476. [PMID: 34558340 PMCID: PMC8811330 DOI: 10.1177/14713012211046150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed. Objective This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators. Methods This qualitative study was nested within a randomised controlled feasibility study. Semi-structured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data. Findings Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups. Conclusion Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population.
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Affiliation(s)
- Sarah Douglas
- Division of Psychiatry, 4919University College London, UK
| | - Josh Stott
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Aimee Spector
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Janina Brede
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Éanna Hanratty
- Waltham Forest Child and Family Consultation Service, 5098North East London NHS Foundation Trust, UK
| | - Georgina Charlesworth
- Department of Clinical, Education and Health Psychology, 4919University College London; Goodmayes Hospital, 5098North East London NHS Foundation Trust, UK
| | - Deirdre Noone
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Jacob Payne
- Department of Clinical, Education and Health Psychology, 4919University College London, UK
| | - Mina Patel
- 5098North East London NHS Foundation Trust, UK
| | - Elisa Aguirre
- Department of Clinical, Education and Health Psychology, 4919University College London; Goodmayes Hospital, 5098North East London NHS Foundation Trust, UK
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16
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Bhatt J, Stoner CR, Scior K, Charlesworth G. Adaptation and preliminary psychometric properties of three self-stigma outcome measures for people living with dementia. BMC Geriatr 2021; 21:34. [PMID: 33422016 PMCID: PMC7796608 DOI: 10.1186/s12877-020-01983-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background A diagnosis of dementia presents individuals with both social and psychological challenges but research on self-stigma in dementia has been largely confined to qualitative approaches due to a lack of robust outcome measures that assess change. The Stigma Impact Scale (SIS) is the most commonly used measure of self-stigma in dementia but its suitability as a tool to assess change in a UK population is unclear. Thus, the aim of this study was to identify, adapt and evaluate the acceptability and preliminary psychometric properties of self-stigma measures for people with dementia for use as measures of change. Method A 4-step sequential design of identifying, selecting, adapting and testing psychometric measures as follows: 1) identification of stigma outcome measures through reviewing anti-stigma intervention literature, 2) selection of candidate measures through quality assessment (Terwee criteria) and expert consultation, 3) adaptation for UK dementia population (Stewart and colleagues Modification Framework) 4) testing of adapted measures in people living with dementia (N=40) to establish acceptability and preliminary reproducibility (test retest), criterion (concurrent with SIS) and construct (negative convergence with Rosenberg self-esteem scale) validity. Results Seven measures were identified from the review, but most were poor quality (Terwee range: 0–4). Three measures were selected for modification: Stigma Stress Scale; Secrecy subscale of the Stigma Coping Orientation Scale; Disclosure Related Distress Scale. Internal consistency and test-retest reliability were acceptable (.866≤α≤ .938; ICC .721–.774), except for the Stigma Stress Scale (α= .643) for which the component subscales (perceived harm, ability to cope) had stronger psychometric properties. Concurrent validity with the SIS was not established (r<.7) although there were significant correlations between total SIS and perceived harm (r=.587) and between internalized shame and secrecy (r=.488). Relationships with self-esteem were in the hypothesized direction for all scales and subscales indicating convergent validity. Conclusion Stigma scales from mental health are not readily adapted for use with people with dementia. However there is preliminary evidence for the acceptability, reliability and validity of measures of perceived harm, secrecy and stigma impact. Further conceptual and psychometric development is required.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development, North East London Foundation Trust, Essex, UK
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17
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Fossey J, Charlesworth G, Fowler JA, Frangou E, Pimm TJ, Dent J, Ryder J, Robinson A, Kahn R, Aarsland D, Pickett J, Ballard C. Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial. J Am Med Dir Assoc 2020; 22:1403-1409.e1. [PMID: 33288467 DOI: 10.1016/j.jamda.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare online cognitive-behavioral therapy (CBT) with and without telephone support respectively to online psychoeducation in a randomized controlled trial (RCT) in caregivers of people with dementia with mild anxiety or depression. DESIGN Three-arm parallel-group RCT comparing online CBT with and without telephone support respectively to online psychoeducation. SETTING AND PARTICIPANTS Online study with caregivers of people with dementia. MEASURES The primary outcome measure was mental health measured by General Health Questionnaire-12 (GHQ-12) at 26 weeks. Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS); the Relative Stress Scale (RSS) and the Short Sense of Competency Questionnaire. The primary analysis focused on people completing GHQ-12 at both baseline and 26 weeks, evaluated using analysis of covariance. RESULTS 638 people were randomized to the 3 treatment arms, of whom 208 were included in the analysis population. There were significant improvements in GHQ-12 in all treatment arms compared to baseline (P < .001 for all interventions), but neither CBT with nor without telephone support conferred any significant advantage compared to psychoeducation. For the secondary outcomes, there were no significant differences between CBT with telephone support and psychoeducation, but CBT without telephone support was less effective than psychoeducation with respect to HADS depression subscale [mean difference 1.86, 95% confidence interval (CI) 0.61, 3.11; P = .004] and caregiver stress (RSS mean difference 3.11, 95% CI 0.13, 6.09; P = .04). Good safety was achieved in all 3 treatment arms, with no deaths or serious adverse events. CONCLUSIONS AND IMPLICATIONS Online CBT with telephone support and psychoeducation both achieved significant benefits over 26 weeks compared with baseline in mental health and mood, but there were no advantages for CBT compared with the psychoeducation intervention. CBT without telephone support was less effective with respect to mood outcomes than psychoeducation and should not be recommended based on current evidence.
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Affiliation(s)
- Jane Fossey
- Fulbrook Centre, Oxford Health NHS Foundation Trust, Oxford, United Kingdom; University of Exeter Medical School, Exeter, United Kingdom
| | - Georgina Charlesworth
- Research and Development, North East London NHS Foundation Trust, Ilford, United Kingdom; Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jo-Ann Fowler
- Fulbrook Centre, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Elena Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, United Kingdom
| | - Theo John Pimm
- Whiteleaf Centre, Oxford Health NHS Foundation Trust, Aylesbury, United Kingdom
| | - June Dent
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Oxford VR, Oxford Centre for Innovation, Oxford, United Kingdom
| | - Joanne Ryder
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Amanda Robinson
- TalkingSpace Plus, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Robert Kahn
- Alzheimer's Society Research Network Volunteer, Warrington, United Kingdom
| | - Dag Aarsland
- Wolfson Centre for Age Related Diseases, Kings College London, United Kingdom
| | | | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom.
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18
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Mansour H, Whitty E, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan‐Trimmer S, Nyman S, Lang IA, Walters K, Petersen I, Wenborn J, Minihane A, Ritchie K, Huntley JD, Walker Z, Cooper C. Effectiveness of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review. Alzheimers Dement 2020. [DOI: 10.1002/alz.042843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Emma Whitty
- University College London London United Kingdom
| | | | | | | | - Serena Ramjee
- Queen Mary University of London London United Kingdom
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing UNSW Sydney NSW Australia
| | | | | | - Samuel Nyman
- Bournemouth University Bournemouth United Kingdom
| | - Iain A Lang
- PenCLAHRC Medical School College of Medicine and Health University of Exeter Exeter United Kingdom
| | | | | | | | | | - Karen Ritchie
- INSERM Montpellier University Neuropsychiatry: Epidemiological and Clinical Research Montpellier France
| | - Jonathan D Huntley
- Institute of Psychiatry Psychology and Neuroscience King's College London London United Kingdom
| | - Zuzana Walker
- Mental Health Unit, St. Margaret’s Hospital Epping Essex United Kingdom
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19
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Stott J, Cadman T, Scior K, Brede J, Charlesworth G. Role of anxiety, depression and neurocognition for cognitive behavioural therapy pre-therapy skills in people living with dementia, older and younger adults ✰. J Affect Disord 2020; 276:1022-1029. [PMID: 32759022 DOI: 10.1016/j.jad.2020.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/01/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety and depression are common in people living with dementia (PLWD) and Cognitive behavioural therapy (CBT) seems to be one of the few efficacious interventions. However, PLWD's ability to engage with CBT has been questioned due to the presumed impact of neurocognitive impairment on core skills necessary to engage with CBT (pre-therapy skills). Here, we (i) compare CBT pre-therapy skills in PLWD to older and younger adults (OA, YA), (ii) examine potential confounders and mediators and (iii) explore associations of neurocognition, anxiety and depression with pre-therapy skills in PLWD. METHODS Pre-therapy skills were compared between PLWD (n = 102), OA (n = 77) and YA (n = 56). Structural equation modelling was used to assess mediators and confounders of differences in pre-therapy skills between groups. Spearman's rank correlations were used to examine the relationship of pre-therapy skills with neurocognition and mood in PLWD. RESULTS Group differences in pre-therapy skills were found, following the pattern YA>OA>PLWD. Neurocognition mediated the difference between OA and PLWD. In PLWD, language was associated with performance on all skills. There was little evidence that anxiety or depression contributed to variability in skill performance within PLWD. LIMITATIONS Cross-sectional design limited ability to ascertain cause and effect. Pre-therapy skill measures have not been used in the context of actual CBT; consequently, their relationship with CBT outcomes needs to be established. CONCLUSIONS PLWD may have a relative difficulty in CBT pre-therapy skills. Yet, there seems to be substantial variability of skill level, independent of mood. Therefore, mild dementia does not necessarily preclude CBT readiness.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Tim Cadman
- Population Health Science, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Janina Brede
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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20
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Whitty E, Mansour H, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan-Trimmer S, Nyman SR, Lang I, Walters K, Petersen I, Wenborn J, Minihane AM, Ritchie K, Huntley J, Walker Z, Cooper C. Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review. Ageing Res Rev 2020; 62:101113. [PMID: 32534025 DOI: 10.1016/j.arr.2020.101113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 01/06/2023]
Abstract
It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade A evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.
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21
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Desai R, John A, Stott J, Charlesworth G. Living alone and risk of dementia: A systematic review and meta-analysis. Ageing Res Rev 2020; 62:101122. [PMID: 32659336 DOI: 10.1016/j.arr.2020.101122] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/15/2020] [Accepted: 07/08/2020] [Indexed: 01/11/2023]
Abstract
AIMS To systematically review longitudinal studies on living alone and incident dementia, to pool the results in a meta-analysis and calculate the population risk. METHODS Embase, Medline and PsycInfo were searched from inception to August 2019 for longitudinal cohort studies of people living alone and risk of dementia. Relative risks (RR) were extracted and effect sizes pooled, with a sensitivity analysis for risk of bias (QUIPS quality rating tool). Population Attributable Fraction (PAF) was calculated, with prevalence of living alone calculated from UK Census data. RESULTS Twelve studies were identified for inclusion, nine of which had low risk of bias. The pooled effect size indicated an elevated risk of incident dementia when living alone (all studies RR = 1.30; 95 % CI: 1.15-1.46; low risk of bias studies (RR = 1.31; 95 % CI: 1.13-1.51). The PAF for living alone was 8.9 %. CONCLUSIONS Social isolation is a more important risk factor for dementia than previously identified, with living alone associated with greater population risk than physical inactivity, hypertension, diabetes and obesity.
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22
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Bhatt J, Ruffell TO, Scior K, Charlesworth G. "Who to Tell, How and When?": Development and Preliminary Feasibility of an Empowerment Intervention for People Living with Dementia Who are Fearful of Disclosing Their Diagnosis. Clin Interv Aging 2020; 15:1393-1407. [PMID: 32884249 PMCID: PMC7439500 DOI: 10.2147/cia.s257317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study describes the adaptation of Honest, Open, Proud (HOP), to develop an empowerment intervention supporting disclosure decision-making for dyads of people living with dementia and their chosen supporter. Methods Medical Research Council guidelines for developing complex interventions informed intervention development and feasibility testing. This included identifying the evidence base and theory (establishing HOP theory of change, a systematic review on decision-making in dementia, a stakeholder consultation), modelling the intervention materials with research experts (creation of version 1.0) and experts by experience (creation of version 2.0), and pilot testing the intervention recording participant observations and facilitator reflections. The final version of the intervention materials was developed with experts by experience of dementia where the accessibility of language and appropriate styles of facilitation were the focus. Results The concept of the intervention was strongly endorsed by respondents of the stakeholder consultation (209/226). Stakeholder preferences included face-to-face delivery, a manualized workbook approach and the inclusion of the primary carer during intervention delivery. Recruitment for intervention groups took place in non-NHS settings (2 small groups recruited) and NHS settings (no groups recruited). In non-NHS settings, 7 dyads agreed to take part in one of two intervention groups. Both intervention groups had over 70% attendance by participants (group 1: 72.2% group 2: 87.5%). Conclusion The concept of an intervention to support diagnostic disclosure was endorsed by stakeholders; however, recruitment was challenging; the “who to tell, how and when?” intervention has the potential to fill a gap in the post-diagnostic pathway.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamatha Ophelia Ruffell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development, North East London Foundation Trust, London, UK
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Birt L, Poland F, Charlesworth G, Leung P, Higgs P. Relational experiences of people seeking help and assessment for subjective cognitive concern and memory loss. Aging Ment Health 2020; 24:1356-1364. [PMID: 30917667 DOI: 10.1080/13607863.2019.1592111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To understand the experience of people who seek help for subjective cognitive concern and memory loss, including people not referred for further assessment. To understand the patients' perspective of the medical process of receiving a cognitive assessment. This work is situated within the context of policy priorities for dementia diagnosis.Methods: Participants with and without dementia were recruited through NHS trusts and community organisations in four regional areas in England. Data were collected using longitudinal qualitative interviews. Transcript data were thematically analysed.Results: Sample of 41 people (mean 75 years, 25 dementia diagnoses). Interpretative thematic analyses focused on the presence or absence of trust in relational experiences. There were three transition points where trust could be specifically developed or undermined: (1) deciding to seek help; (2) healthcare practitioners' response to help-seeking; (3) process and outcome of assessment. Triggers for help-seeking for subjective cognitive concern were being prompted by family and knowing a relative with dementia. When participants perceived healthcare practitioners' behaviour as dismissive, they had less trust in the outcome of the healthcare encounter. Misunderstandings and absence of trust in assessment processes led to participants stating they did not fully agree with the outcomes of the assessment.Conclusions: Healthcare practitioners have an important role in supporting people with subjective cognitive concern ensuring patients have trust in assessment outcomes. Where the validity of the assessment process is seen as ambiguous, people can be left dealing with uncertainty, rather than being clear about ways they can manage their condition, situation or status.
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Affiliation(s)
- Linda Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
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Gaber SN, Nygård L, Brorsson A, Kottorp A, Charlesworth G, Wallcook S, Malinowsky C. Social Participation in Relation to Technology Use and Social Deprivation: A Mixed Methods Study Among Older People with and without Dementia. Int J Environ Res Public Health 2020; 17:E4022. [PMID: 32516958 PMCID: PMC7312692 DOI: 10.3390/ijerph17114022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
Social participation is a modifiable determinant for health and wellbeing among older people; however, social participation is increasingly dependent on technology use. This study investigated social participation in relation to Everyday Technology use and social deprivation of the living environment, among older people with and without dementia in the United Kingdom. Sixty-four people with dementia and sixty-four people without dementia were interviewed using standardized questionnaires: The Participation in ACTivities and Places OUTside Home Questionnaire and Everyday Technology Use Questionnaire. A mixed methods approach integrated statistical analyses and content analysis of free-text responses, through data visualizations. Small, statistically significant associations were found between social participation and Everyday Technology use outside home, for participants with dementia (Rs = 0.247; p = 0.049) and without dementia (Rs = 0.343; p = 0.006). A small, statistically significant association was identified between social participation and social deprivation in the living environment, among only participants with dementia (Rs = 0.267, p = 0.033). The content analysis and graphical joint display revealed motivators, considerations that require extra attention, and strategies for managing social participation. The results underline how Everyday Technology use can be assistive to social participation but also the need to consider social deprivation of the living environment, especially among people with dementia.
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Affiliation(s)
- Sophie N. Gaber
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
- Faculty of Brain Sciences, University College London, London WC1E 6BT, UK
| | - Louise Nygård
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
| | - Anna Brorsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
| | - Anders Kottorp
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
- Faculty of Health and Society, Malmö University, 20506 Malmö, Sweden
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK;
- Research and Development Department, North East London NHS Foundation Trust, Maggie Lilley Suite, Goodmayes Hospital, Essex IG3 8XJ, UK
| | - Sarah Wallcook
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
- Faculty of Brain Sciences, University College London, London WC1E 6BT, UK
| | - Camilla Malinowsky
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (S.N.G.); (A.B.); (A.K.); (S.W.); (C.M.)
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Gaber SN, Nygård L, Kottorp A, Charlesworth G, Wallcook S, Malinowsky C. Perceived risks, concession travel pass access and everyday technology use for out-of-home participation: cross-sectional interviews among older people in the UK. BMC Geriatr 2020; 20:192. [PMID: 32503429 PMCID: PMC7275447 DOI: 10.1186/s12877-020-01565-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background The health-promoting qualities of participation as an opportunity for social and cognitive engagement are well known. Use of Everyday Technology such as Smartphones or ATMs, as enabling or disabling factors for out-of-home participation is however under-researched, particularly among older people with and without dementia. Out-of-home participation involves participation in places and activities outside of a person’s home, in public space. Situated within the context of an increasingly technological society, the study investigated factors such as perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK. Methods One hundred twenty-eight older people with and without dementia in urban and rural environments in the UK, were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) Questionnaire and the Everyday Technology Use Questionnaire (ETUQ). Associations between Everyday Technology use, perceived risk of falling, functional impairment, access to a concession travel pass and out-of-home participation were investigated using ordinal regression. Results A higher probability of Everyday Technology use (Odds Ratio [OR] = 1.492; 95% Confidence Interval [CI] = 1.041–1.127), perceived risk of falling outside home (OR = 2.499; 95% CI = 1.235–5.053) and, access to a concession travel pass (OR = 3.943; 95% CI = 1.970–7.893) were associated with a higher level of out-of-home participation. However, other types of risk (getting lost; feeling stressed or embarrassed) were not associated with out-of-home participation. Having a functional impairment was associated with a low probability of a higher level of out-of-home participation (OR = .470; 95% CI = .181–1.223). Across the sample, ‘outside home’ Everyday Technologies were used to a higher degree than ‘portable’ Everyday Technologies which can be used both in and outside home. Conclusions The study provides insights into perceived risks, access to a concession travel pass and use of Everyday Technologies, and their relationship with out-of-home participation, among older people in the UK. Increased knowledge about factors associated with out-of-home participation may help to guide targeted health and social care planning.
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Affiliation(s)
- Sophie Nadia Gaber
- Department of Neurobiology, Care Sciences & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Huddinge, Sweden. .,Faculty of Brain Sciences, University College London, London, UK.
| | - Louise Nygård
- Department of Neurobiology, Care Sciences & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Huddinge, Sweden
| | - Anders Kottorp
- Department of Neurobiology, Care Sciences & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Huddinge, Sweden.,Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK.,Research and Development, North East London NHS Foundation Trust, Ilford, UK
| | - Sarah Wallcook
- Department of Neurobiology, Care Sciences & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Huddinge, Sweden.,Faculty of Brain Sciences, University College London, London, UK
| | - Camilla Malinowsky
- Department of Neurobiology, Care Sciences & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Fack 23 200, SE-141 83, Huddinge, Sweden
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Abstract
Purpose
This paper aims to interrogate online comments from consumers with dementia and family carers on surveillance technology products used by or for people with dementia.
Design/methodology/approach
A naturalistic, observational study of qualitative posts (N = 120) by people with dementia (n = 7) and family carers (n = 38) to discussion threads on surveillance technology (ST), hosted by an online dementia support forum in the Netherlands. Kozinet’s (2002) typology was used to describe respondent characteristics, and comments on features of ST products were analysed within a pre-existing framework.
Findings
Forum users were mainly “tourists” interested in ST, with some “insiders” interested in sharing experiences of ST use. They expressed a lack of trust in information from marketers and providers to the experience of being provided with poor information. Consumer-to-consumer comments on products triangulated with previous face-to-face qualitative studies. Carers prioritised “peace of mind” through location monitoring. In contrast, people with dementia prioritised user-friendliness (simple, with capability and compatible with daily routines).
Practical implications
Using online discussions of ST products provides a rapid approach to understanding current consumer needs and preferences in the ever-changing world of technology.
Originality/value
No previous study is known to have explored the views of carers and people with dementia in online discussions about ST.
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Wallcook S, Malinowsky C, Nygård L, Charlesworth G, Lee J, Walsh R, Gaber S, Kottorp A. The perceived challenge of everyday technologies in Sweden, the United States and England: Exploring differential item functioning in the everyday technology use questionnaire. Scand J Occup Ther 2020; 27:554-566. [PMID: 32150507 DOI: 10.1080/11038128.2020.1723685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The changing technological environment is reflected in regular updates made to the everyday technology (ET) use questionnaire (ETUQ). Newly added ETs may not present comparable challenges across countries and diagnoses.Aims: To identify whether country context, or dementia diagnosis, impact ETs' challenge level.Material and methods: 315 older adults from three countries were included; Sweden (n = 73), United States (n = 114), England (n = 128), and had a confirmed diagnosis of mild dementia (n = 99) or no known cognitive impairment (n = 216). Differential Items Functioning (DIF) analysis was performed on 88 ETs included in the ETUQ by country and diagnosis. The impact of DIF was evaluated in a Differential Test Functioning (DTF) analysis.Results: Nine items (10.2%) in the ETUQ showed statistically significant DIF between countries; five of which were public space ETs and none of which were information and communication technologies (ICTs). Three ICT items, and no others, showed significant DIF by diagnosis. The items' DIF was shown to have no impact upon person measures of ability to use ET in the DTF.Conclusions and significance: The utility of the ETUQ in occupational therapy practice and research internationally is highlighted through the stability of the challenge hierarchy and lack of impact on person measures.
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Affiliation(s)
- Sarah Wallcook
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Faculty of Brain Sciences, University College London, London, UK
| | - Camilla Malinowsky
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Louise Nygård
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jenica Lee
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Walsh
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Sophie Gaber
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Faculty of Brain Sciences, University College London, London, UK
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
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Abstract
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia.Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvementResults: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate (n = 10) to high (n = 5) quality ratings. Participants were predominantly people living with dementia (n = 13), Parkinson's disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources).Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.
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Affiliation(s)
- Jem Bhatt
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Holly Walton
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK
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Ching EYN, Smyth L, De Souza T, Charlesworth G. The Adaptation and Feasibility of Narrative Enhancement and Cognitive Therapy (NECT) for Late-Onset Psychosis. Community Ment Health J 2020; 56:211-221. [PMID: 31664623 PMCID: PMC6971141 DOI: 10.1007/s10597-019-00495-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022]
Abstract
The aim of this study is to adapt and feasibility test the narrative component of Narrative Enhancement and Cognitive Therapy (NECT) for late-onset psychosis. This study followed the development and feasibility phases of the Medical Research Council framework. The original NECT intervention was adapted based on consultations with service users, experts, and clinicians. The evaluation of the feasibility test of the adapted intervention was guided by Orsmond and Cohn (Occup Particip Health 35(3):169-177, 2015)'s model for feasibility studies. The final adaptations consist of language, readability, and delivery. The adapted intervention was tested for feasibility and acceptability with one group of five patients recruited from a National Health Service (NHS) Trust in UK Results were mixed in participant outcomes and a likelihood of acceptability of the intervention. This indicates the need for a larger scale feasibility test to explore the identified benefits and challenges of implementing NECT in NHS or community settings for late-onset psychosis.
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Affiliation(s)
- Elaine Y N Ching
- Research Department of Clinical, Educational and Health Psychology, University College London, Room 436, 4th Floor, 1-19 Torrington Place, Gower Street, London, WC1E 7HB, UK. .,Barnet Psychology Hub, Barnet, Enfield and Haringey Mental Health NHS Trust, Springwell Centre, Wellhouse Lane, Barnet, EN5 3DJ, United Kingdom.
| | - Lucy Smyth
- Research Department of Clinical, Educational and Health Psychology, University College London, Room 436, 4th Floor, 1-19 Torrington Place, Gower Street, London, WC1E 7HB, UK
| | - Tanisha De Souza
- Research and Development, North East London NHS Foundation Trust, Goodmayes Hospital, 157 Barley Lane Ilford, London, IG3 8XJ, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, Room 436, 4th Floor, 1-19 Torrington Place, Gower Street, London, WC1E 7HB, UK.,Research and Development, North East London NHS Foundation Trust, Goodmayes Hospital, 157 Barley Lane Ilford, London, IG3 8XJ, UK
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McEvoy P, Morris L, Yates-Bolton N, Charlesworth G. Living with dementia: using mentalization-based understandings to support family carers. Psychoanalytic Psychotherapy 2020. [DOI: 10.1080/02668734.2019.1709536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Phil McEvoy
- Six Degrees Social Enterprise CIC, Salford, UK
| | | | - Natalie Yates-Bolton
- School of Nursing, Midwifery and Social Work, University of Salford, Salford, UK
| | - Georgina Charlesworth
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Birt L, Griffiths R, Charlesworth G, Higgs P, Orrell M, Leung P, Poland F. Maintaining Social Connections in Dementia: A Qualitative Synthesis. Qual Health Res 2020; 30:23-42. [PMID: 31550999 DOI: 10.1177/1049732319874782] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The clinical symptoms of dementia include difficulty with speech, poor short-term memory, and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat's theories on "self." People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis.
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Affiliation(s)
- Linda Birt
- University of East Anglia, Norwich, United Kingdom
| | | | - Georgina Charlesworth
- University College London, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Paul Higgs
- University College London, London, United Kingdom
| | - Martin Orrell
- University of Nottingham, Nottingham, United Kingdom
| | - Phuong Leung
- University College London, London, United Kingdom
| | - Fiona Poland
- University of East Anglia, Norwich, United Kingdom
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Shafayat A, Csipke E, Bradshaw L, Charlesworth G, Day F, Leung P, Moniz-Cook E, Montgomery AA, Morris S, Mountain G, Ogollah R, Sprange K, Yates L, Orrell M. Promoting Independence in Dementia (PRIDE): protocol for a feasibility randomised controlled trial. Trials 2019; 20:709. [PMID: 31829232 PMCID: PMC6907171 DOI: 10.1186/s13063-019-3838-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Memory services often see people with early stage dementia who are largely independent and able to participate in community activities but who run the risk of reducing activities and social networks. PRIDE is a self-management intervention designed to promote living well and enhance independence for people with mild dementia. This study aims to examine the feasibility of conducting a definitive randomised trial comparing the clinical and cost-effectiveness of the PRIDE intervention offered in addition to usual care or with usual care alone. METHODS/DESIGN PRIDE is a parallel, two-arm, multicentre, feasibility, randomised controlled trial (RCT). Eligible participants aged 18 or over who have mild dementia (defined as a score of 0.5 or 1 on the Clinical Dementia Rating Scale) who can participate in the intervention and provide informed consent will be randomised (1:1) to treatment with the PRIDE intervention delivered in addition to usual care, or usual care only. Participants will be followed-up at 3 and 6 month's post-randomisation. There will be an option for a supporter to join each participant. Each supporter will be provided with questionnaires at baseline and follow-ups at 3 to 6 months. Embedded qualitative research with both participants and supporters will explore their perspectives on the intervention investigating a range of themes including acceptability and barriers and facilitators to delivery and participation. The feasibility of conducting a full RCT associated with participant recruitment and follow-up of both conditions, intervention delivery including the recruitment, training, retention of PRIDE trained facilitators, clinical outcomes, intervention and resource use costs and the acceptability of the intervention and study related procedures will be examined. DISCUSSION This study will assess whether a definitive randomised trial comparing the clinical and cost-effectiveness of whether the PRIDE intervention offered in addition to usual care is feasible in comparison to usual care alone, and if so, will provide data to inform the design and conduct of a future trial. TRIAL REGISTRATION ISRCTN, ISRCTN11288961, registered on 23 October 2019, http://www.isrctn.com/ISRCTN12345678 Protocol V2.1 dated 19 June 2019.
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Affiliation(s)
- Aisha Shafayat
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Emese Csipke
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Lucy Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Georgina Charlesworth
- North East London NHS Foundation Trust, Goodmayes Hospital, 1st Floor, Maggie Lillie Suite, Ilford, IG3 8XJ UK
| | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Phuong Leung
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Esme Moniz-Cook
- Psychology Ageing & Dementia Care Research, Faculty of Health Sciences, Department of Psychological Health, Wellbeing and Social Work, University of Hull, Hull, HU6 7RX UK
| | - Alan A. Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Steve Morris
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Gail Mountain
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - Lauren Yates
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Martin Orrell
- Division of Psychiatry and Applied Psychology, University of Nottingham, Room D07, Institute of Mental Health Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
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Vermeer Y, Higgs P, Charlesworth G. What do we require from surveillance technology? A review of the needs of people with dementia and informal caregivers. J Rehabil Assist Technol Eng 2019; 6:2055668319869517. [PMID: 31832230 PMCID: PMC6891003 DOI: 10.1177/2055668319869517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Dementia has become a major global concern and surveillance technology might
provide support for informal caregivers and people with dementia. However,
the needs of caregivers and people with dementia for surveillance technology
have not been reviewed. Method A scoping literature review was used to identify the needs of caregivers
and/or people with dementia towards surveillance technology. Electronic
database searching was undertaken on LexisNexis, PubMed, Scopus, EMBASE,
MEDLINE, Cumulative Index to Nursing, Allied Health Literature, PsycINFO,
Web of Science, Assistive Technology database, and Google Scholar. Eligible
studies were synthesized by theme. Results Twenty-eight eligible studies were identified, with the majority reporting
the needs of caregivers rather than people with dementia. The predominant
themes for caregivers were location accuracy, and increasing the safety of
the person with dementia. People with dementia wanted simple useful
technology that fits within their capacity and existing routines. Conclusions The needs of people with dementia must be considered when designing
surveillance products. Studies have mostly focused on caregivers and
discount ST product requirements. Further work is required to establish
effective use of surveillance technology in dementia care. Therefore,
further research should cross analyze these results by examining both the
needs of caregivers, and people with dementia.
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Affiliation(s)
- Yvette Vermeer
- Division of Psychiatry, University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
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Gaber SN, Gaber SN, Nygard L, Brorsson A, Kottorp A, Wallcook S, Charlesworth G, Malinowsky C. EVERYDAY TECHNOLOGY: A USEFUL SERVANT BUT DANGEROUS MASTER FOR PARTICIPATION IN SOCIETY? Innov Aging 2019. [PMCID: PMC6845931 DOI: 10.1093/geroni/igz038.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With an increasingly technological society comes an assumed ability to use Everyday Technologies (ET) in order to participate in activities and places in public space, e.g. operating ticket machines to access public transport. This study addresses a mismatch between a growing dependency on ET and evidence that people with dementia experience increased challenges using ET. The aim is to explore how ET-use and perceived risk relate to participation in public space, among people with and without dementia. People with dementia and without dementia, aged 55+, were interviewed using questionnaires including the Participation in ACTivities and Places OUTside the Home questionnaire, across Sweden (n=69) and the UK (n=128). The Swedish and UK findings show small but significant associations between total participation in places within public space, and i) ET-use, and ii) perceived risk in public space. Furthermore, people with dementia participated in fewer places within public space than those without dementia.
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Affiliation(s)
- Sophie N Gaber
- Karolinska Institutet, Stockholm, Stockholm Lans, Sweden
| | - Sophie N Gaber
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
| | - Louise Nygard
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
| | - Anna Brorsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmo University.Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Malmo, Skane Lan, Sweden
| | - Sarah Wallcook
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
| | - Georgina Charlesworth
- Research Department for Clinical, Education, and Health Psychology., London, England, United Kingdom
| | - Camilla Malinowsky
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
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Stott J, Cadman T, Scior K, Brede J, Chadwick E, Charlesworth G. Cognitive mediation in people with dementia: Development, structural, and construct validity of the first dementia-specific measure. Int J Geriatr Psychiatry 2019; 34:1590-1598. [PMID: 31322763 DOI: 10.1002/gps.5169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/08/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Anxiety and depression are common and deleterious comorbidities in people living with dementia (PLWD). Cognitive behavioural therapy (CBT) is one of the few promising treatments; however, it is unclear whether PLWD have the necessary prerequisites to engage in this. Having an understanding of cognitive mediation, that a thought mediates the relationship between an antecedent event and its emotional consequence, is key for engaging with CBT and is also a critical component of emotion regulation. There are no measures of this construct validated for PLWD. This study aims to adapt and validate an existing measure for this population. A secondary aim is to assess its applicability in older adults (OA) without a recognised neurocognitive impairment. METHODS A measure of cognitive mediation was adapted via expert and service user consultation for use in PLWD. A total of 102 PLWD and 77 OA without neurocognitive impairments completed the adapted measure along with two measures of emotion recognition and reasoning. Factor structure was examined separately in both samples, and the measure reduced, with convergent validity assessed. RESULTS A final measure of 10 items (named the CM-Dem) was subject to factor analysis yielding a single factor solution. The measure showed good psychometric properties in PLWD, including good model fit, high internal consistency, inter-rater reliability, and moderate convergent validity with related constructs. In contrast, poor validity was found in OA, especially a lack of convergent validity. CONCLUSIONS The CM-Dem has clinical and research utility as a measure of cognitive mediation in PLWD, but less so in OA.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tim Cadman
- Population Health Science, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Janina Brede
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Eleanor Chadwick
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Poland F, Charlesworth G, Leung P, Birt L. Embedding patient and public involvement: Managing tacit and explicit expectations. Health Expect 2019; 22:1231-1239. [PMID: 31538704 PMCID: PMC6882252 DOI: 10.1111/hex.12952] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Evidencing well-planned and implemented patient and public involvement (PPI) in a research project is increasingly required in funding bids and dissemination activities. There is a tacit expectation that involving people with experience of the condition under study will improve the integrity and quality of the research. This expectation remains largely unproblematized and unchallenged. OBJECTIVE To critically evaluate the implementation of PPI activity, including co-research in a programme of research exploring ways to enhance the independence of people with dementia. DESIGN Using critical cases, we make visible and explicate theoretical and moral challenges of PPI. RESULTS Case 1 explores the challenges of undertaking multiple PPI roles in the same study making explicit different responsibilities of being a co-applicant, PPI advisory member and a co-researcher. Case 2 explores tensions which arose when working with carer co-researchers during data collection; here the co-researcher's wish to offer support and advice to research participants, a moral imperative, was in conflict with assumptions about the role of the objective interviewer. Case 3 defines and examines co-research data coding and interpretation activities undertaken with people with dementia, reporting the theoretical outputs of the activity and questioning whether this was co-researcher analysis or PPI validation. CONCLUSION Patient and public involvement activity can empower individual PPI volunteers and improve relevance and quality of research but it is a complex activity which is socially constructed in flexible ways with variable outcomes. It cannot be assumed to be simple or universal panacea for increasing the relevance and accessibility of research to the public.
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Affiliation(s)
- Fiona Poland
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Linda Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Yates L, Csipke E, Moniz-Cook E, Leung P, Walton H, Charlesworth G, Spector A, Hogervorst E, Mountain G, Orrell M. The development of the Promoting Independence in Dementia (PRIDE) intervention to enhance independence in dementia. Clin Interv Aging 2019; 14:1615-1630. [PMID: 31571842 PMCID: PMC6748161 DOI: 10.2147/cia.s214367] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/07/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Support after a diagnosis of dementia may facilitate better adjustment and ongoing management of symptoms. The aim of the Promoting Independence in Dementia (PRIDE) study was to develop a postdiagnostic social intervention to help people live as well and as independently as possible. The intervention facilitates engagement in evidence-based stimulating cognitive, physical and social activities. METHODS Theories to promote adjustment to a dementia diagnosis, including theories of social learning and self-efficacy, were reviewed alongside self-management and the selective optimization model, to form the basis of the intervention. Analyses of two longitudinal databases of older adults, and qualitative analyses of interviews of older people, people with dementia, and their carers about their experiences of dementia, informed the content and focus of the intervention. Consensus expert review involving stakeholders was conducted to synthesize key components. Participants were sourced from the British NHS, voluntary services, and patient and public involvement groups. A tailored manual-based intervention was developed with the aim for this to be delivered by an intervention provider. RESULTS Evidence-based stimulating cognitive, physical, and social activities that have been shown to benefit people were key components of the proposed PRIDE intervention. Thirty-two participants including people with dementia (n=4), carers (n=11), dementia advisers (n=14), and older people (n=3) provided feedback on the drafts of the intervention and manual. Seven topics for activities were included (eg, "making decisions" and "getting your message across"). The manual outlines delivery of the intervention over three sessions where personalized profiles and plans for up to three activities are developed, implemented, and reviewed. CONCLUSION A manualized intervention was constructed based on robust methodology and found to be acceptable to participants. Consultations with stakeholders played a key role in shaping the manualized PRIDE intervention and its delivery. Unlike most social interventions for dementia, the target audience for our intervention is the people with dementia themselves.
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Affiliation(s)
- Lauren Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Emese Csipke
- Division of Psychiatry, University College London, London, UK
| | - Esme Moniz-Cook
- Department of Psychological Health and Well-Being, Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
| | - Phuong Leung
- Division of Psychiatry, University College London, London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, London, UK
| | - Georgina Charlesworth
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Eef Hogervorst
- National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Waite J, Poland F, Charlesworth G. Facilitators and barriers to co-research by people with dementia and academic researchers: Findings from a qualitative study. Health Expect 2019; 22:761-771. [PMID: 31012214 PMCID: PMC6737841 DOI: 10.1111/hex.12891] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Public and patient involvement (PPI) is now established in dementia research. Barriers and facilitators to engagement from family carers and people in early stages of dementia have been explored. However, specific barriers and facilitators to co-research with people with dementia have not previously been investigated. OBJECTIVE To discover the facilitators of, and barriers to, involving people with dementia as co-researchers, from the perspectives of people with dementia, gatekeepers (family caregivers, ethics committee members, service providers) and researchers. DESIGN Thematic analysis of data from individual interviews about the co-research experience. RESULTS Four themes emerged from interviews with 19 participants (five people with dementia): "getting one's head round it" (assumptions about research and dementia; different forms of language); practicalities (eg transport; accessibility of communication); "this feeling of safety" (perceptions of danger, protectiveness and opportunities for building trust); and motivations ("making a difference" and "keeping doing"). CONCLUSIONS Findings both replicate and extend previous knowledge on PPI in dementia. Cognitive capacity of potential co-researchers with dementia is only a part of the picture, with attitudes and expectations of researchers, gatekeepers and people with dementia also forming barriers. Researcher education, adequate resourcing, and both creativity and flexibility are needed to support recruitment of co-researchers with dementia and to enable meaningful co-research.
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Affiliation(s)
- Jacob Waite
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Greenwich CMHT for Older Adults, Memorial Hospital, Oxleas NHS Foundation Trust, London, UK
| | - Fiona Poland
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Balint B, Charlesworth G, Stamelou M, Carr L, Mencacci NE, Wood NW, Bhatia KP. Mitochondrial complex I NUBPL mutations cause combined dystonia with bilateral striatal necrosis and cerebellar atrophy. Eur J Neurol 2019; 26:1240-1243. [PMID: 30897263 PMCID: PMC6767441 DOI: 10.1111/ene.13956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Background and purpose The recent advances in genetics have helped to unravel the cause of many dystonia syndromes. With the broadening spectrum of genetically defined dystonia syndromes, distinct clinico‐radiological phenotypes are a welcome handle to guide the diagnostic work‐up. Methods Exome sequencing was used to elucidate the genetic cause of a syndrome characterized by generalized dystonia, pyramidal and cerebellar involvement, with bilateral striatal necrosis (BSN) and cerebellar atrophy on magnetic resonance imaging. Homozygosity mapping and linkage analysis were used in a supportive role. Known genetic causes of BSN were excluded by use of exome data or Sanger sequencing. Results Compound heterozygous mutations were identified in the NUBPL gene in a small UK kindred. The gene lay in a region of positive linkage and segregated with disease in a family of six individuals. Conclusion NUBPL mutations cause early onset, autosomal recessive generalized dystonia with cerebellar ataxia, pyramidal signs, preserved cognition and a distinct magnetic resonance imaging appearance with BSN and cerebellar atrophy.
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Affiliation(s)
- B Balint
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - G Charlesworth
- Department of Neurology, Charing Cross Hospital, London, UK
| | - M Stamelou
- Second Department of Neurology, Attiko Hospital, University of Athens, Athens, Greece.,Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece
| | - L Carr
- Neuroscience Department, GOSH, London, UK
| | - N E Mencacci
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - N W Wood
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - K P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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40
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McDermott O, Charlesworth G, Hogervorst E, Stoner C, Moniz-Cook E, Spector A, Csipke E, Orrell M. Psychosocial interventions for people with dementia: a synthesis of systematic reviews. Aging Ment Health 2019; 23:393-403. [PMID: 29338323 DOI: 10.1080/13607863.2017.1423031] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works. METHODS A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted. RESULTS Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews. CONCLUSION There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.
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Affiliation(s)
- Orii McDermott
- a Division of Psychiatry and Applied Psychology , University of Nottingham , Nottingham , United Kingdom
| | - Georgina Charlesworth
- b Division of Psychology and Language Sciences , University College London , London , United Kingdom
| | - Eef Hogervorst
- c School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , United Kingdom
| | - Charlotte Stoner
- d Department of Neurodegenerative Disease , Institute of Neurology, University College London , London , United Kingdom
| | - Esme Moniz-Cook
- e Faculty of Health Sciences , University of Hull , Hull , United Kingdom
| | - Aimee Spector
- b Division of Psychology and Language Sciences , University College London , London , United Kingdom
| | - Emese Csipke
- f Division of Psychiatry , University College London , London , United Kingdom
| | - Martin Orrell
- a Division of Psychiatry and Applied Psychology , University of Nottingham , Nottingham , United Kingdom
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Abstract
Public and patient involvement in research is a well-established requirement for applications to many grant-awarding bodies. Numerous models of consultation, collaboration and leadership have been developed to support all stages of research, from ideas development through to project execution and dissemination of findings. However, the interface between researchers and lay members is not always a happy one; scientific ‘fact’ may not square with lived experience; clinical researchers may regard their accumulated knowledge from working with many people with dementia and their families as ‘more valid’ than the individual experience(s) of a small number of public and patient involvement representatives; public and patient involvement members can fall victim to tokenism and manipulation. In this opinion piece, I consider the nature of representation in public and patient involvement in dementia research, and whether identifying disconfirmatory cases provides greater value than current consensus building approaches. I conclude by encouraging researchers to listen, reflect and embrace the opportunity to engage with alternative perspectives.
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Csipke E, Yates L, Moniz Cook E, Leung P, Charlesworth G, Walton H, Birt L, Orrell M. Promoting independence in dementia: protocol for a feasibility trial of the PRIDE intervention for living well with dementia. ACTA ACUST UNITED AC 2018. [DOI: 10.18203/2349-3259.ijct20184399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p class="abstract"><strong>Background:</strong> Dementia can lead to social exclusion, loss of identity and independence, due to deterioration in cognition and activities of daily living. The aim of the study is to investigate the feasibility of the Promoting Independence in Dementia (PRIDE) intervention, designed to facilitate independence in people with mild dementia.</p><p class="abstract"><strong>Methods:</strong> This is a mixed-methods feasibility trial of the PRIDE, in preparation for a future randomised controlled trial. Up to 50 people with dementia will be recruited. Demetia advisors will deliver the three session intervention. Quantitative outcomes will be taken at baseline and up to three months post baseline. Fidelity checklists will assess fidelity to the intervention. Qualitative implementation data will be gathered in a series of post-intervention semi-structured interviews with staff and participants. This will include data to examine participant experiences of and engagement with the intervention, and other aspects of delivery such as recruitment of DAWs, fidelity and experiences of receiving and delivering the intervention. This study aims to establish and field test the PRIDE intervention; determine the recruitment rate of sites, providers and participants; assess fidelity in delivery of the intervention and engagement with people with dementia; assess the feasibility and acceptability of outcome measure data and assess the acceptability of the intervention by stakeholders.</p><p class="abstract"><strong>Conclusions: </strong>There has been increased need for non-pharmacological interventions for mild dementia. The results of this feasibility study will allow us to plan for a definitive RCT of a three session dementia advisor led intervention for mild dementia.</p>
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Goll JC, Charlesworth G, Scior K, Stott J. Correction: Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity. PLoS One 2018; 13:e0201510. [PMID: 30044856 PMCID: PMC6059490 DOI: 10.1371/journal.pone.0201510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0116664.].
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Stott J, Scior K, Mandy W, Charlesworth G. Dementia Screening Accuracy is Robust to Premorbid IQ Variation: Evidence from the Addenbrooke's Cognitive Examination-III and the Test of Premorbid Function. J Alzheimers Dis 2018; 57:1293-1302. [PMID: 28372334 DOI: 10.3233/jad-161218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scores on cognitive screening tools for dementia are associated with premorbid IQ. It has been suggested that screening scores should be adjusted accordingly. However, no study has examined whether premorbid IQ variation affects screening accuracy. OBJECTIVE To investigate whether the screening accuracy of a widely used cognitive screening tool for dementia, the Addenbrooke's cognitive examination-III (ACE-III), is improved by adjusting for premorbid IQ. METHODS 171 UK based adults (96 memory service attendees diagnosed with dementia and 75 healthy volunteers over the age of 65 without subjective memory impairments) completed the ACE-III and the Test of Premorbid Function (TOPF). The difference in screening performance between the ACE-III alone and the ACE-III adjusted for TOPF was assessed against a reference standard; the presence or absence of a diagnosis of dementia (Alzheimer's disease, vascular dementia, or others). RESULTS Logistic regression and receiver operating curve analyses indicated that the ACE-III has excellent screening accuracy (93% sensitivity, 94% specificity) in distinguishing those with and without a dementia diagnosis. Although ACE-III scores were associated with TOPF scores, TOPF scores may be affected by having dementia and screening accuracy was not improved by accounting for premorbid IQ, age, or years of education. CONCLUSION ACE-III screening accuracy is high and screening performance is robust to variation in premorbid IQ, age, and years of education. Adjustment of ACE-III cut-offs for premorbid IQ is not recommended in clinical practice. The analytic strategy used here may be useful to assess the impact of premorbid IQ on other screening tools.
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Stott J, Spector A, Orrell M, Scior K, Sweeney J, Charlesworth G. Limited validity of the Hospital Anxiety and Depression Scale (HADS) in dementia: evidence from a confirmatory factor analysis. Int J Geriatr Psychiatry 2017; 32:805-813. [PMID: 27352820 DOI: 10.1002/gps.4530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Hospital Anxiety and Depression Scale (HADS) is a well-validated, self-report measure of both anxiety and depression. It is frequently used with people with dementia. However, its structural validity has never been examined in this population. The current study used confirmatory factor analysis (CFA) to assess this. METHODS Baseline data from two intervention studies for people with mild to moderate dementia were combined (N = 268). CFA was used to test whether a one, two or three factor structure best fit the data. Indices of model misspecification were examined to test for poor quality items, and models re-specified accordingly. Finally, measurement invariance across gender and different levels of cognitive impairment was assessed. RESULTS A one-factor structure did not fit the data. Two and three factor structures fitted the data equally well. Model fit was improved by removal of two items. Measurement invariance was adequate across gender, but poor across groups with differing levels of cognitive impairment. CONCLUSION The HADS is acceptable and feasible but difficult to interpret in a dementia population. We suggest that it should be interpreted as measuring two separate factors of anxiety and depression and not one 'distress' factor. However, two items may need to be removed, affecting cut-off scores. Poor measurement invariance means the HADS may not be a good tool for measuring differences in anxiety and depression between those with mild and those with moderate cognitive impairment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joanne Sweeney
- Division of Psychology and Language Science, University College London, London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O’Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Robinson L, Livingston G. Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations. PLoS One 2017; 12:e0179521. [PMID: 28662127 PMCID: PMC5491018 DOI: 10.1371/journal.pone.0179521] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/31/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia. METHODS AND FINDINGS We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification. LIMITATIONS Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties. INTERPRETATION This is the first review to identify the 81 outcome measures the research community uses for disease-modifying trials in mild-to-moderate dementia. Our recommendations will facilitate designing, comparing and meta-analysing disease modification trials in mild-to-moderate dementia, increasing their value. TRIAL REGISTRATION PROSPERO no. CRD42015027346.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, United Kingdom
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Gail Mountain
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Jenny McCleery
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Katie Featherstone
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Roy Jones
- Research Institute for the Care of Older People (RICE), University of Bath, Bath, United Kingdom
| | - Sarah Lamb
- Warwick Clinical Trials Research Unit, University of Warwick, Warwick, United Kingdom
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, United Kingdom
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, United Kingdom
| | - Jo Thompson-Coon
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Linda Clare
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Peter Garrard
- Neuroscience Research Centre, St. George's, University of London, London, United Kingdom
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, United Kingdom
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
- North Thames CLAHRC, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O'Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burke O, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Murtagh F, Robinson L, Livingston G. Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations. Health Technol Assess 2017; 21:1-192. [PMID: 28625273 PMCID: PMC5494514 DOI: 10.3310/hta21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia. An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials, as well as making results comparable and meta-analysable in future trials. OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement (PPI). DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from (1) references from related systematic reviews in workstream 1; (2) searches of the Cochrane Dementia and Cognitive Improvement Group study register, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015, and clinical trial registries [International Standard Randomised Controlled Trial Number (ISRCTN) and clinicaltrials.gov] on 22 and 29 January 2016; and (3) hand-searches of reference lists of relevant systematic reviews from database searches. REVIEW METHODS The project consisted of four workstreams. (1) We obtained related core outcome sets and work from co-applicants. (2) We systematically reviewed published and ongoing disease modification trials to identify the outcomes used in different domains. We extracted outcomes used in each trial, recording how many used each outcome and with how many participants. We divided outcomes into the domains measured and searched for validation data. (3) We consulted with PPI participants about recommended outcomes. (4) We presented all the synthesised information at a conference attended by the wider body of National Institute for Health Research (NIHR) dementia researchers to reach consensus on a core set of outcomes. RESULTS We included 149 papers from the 22,918 papers screened, referring to 125 individual trials. Eighty-one outcomes were used across trials, including 72 scales [31 cognitive, 12 activities of daily living (ADLs), 10 global, 16 neuropsychiatric and three quality of life] and nine biological techniques. We consulted with 18 people for PPI. The conference decided that only cognition and biological markers are core measures of disease modification. Cognition should be measured by the Mini Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), and brain changes through structural magnetic resonance imaging (MRI) in a subset of participants. All other domains are important but not core. We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms: the Disability Assessment for Dementia for ADLs, the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally. LIMITATIONS Most of the trials included participants with Alzheimer's disease, so recommendations may not apply to other types of dementia. We did not conduct economic analyses. The PPI consultation was limited to members of the Alzheimer's Society Research Network. CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials, measured by the MMSE or ADAS-Cog, and structural MRI in a subset of participants. FUTURE WORK We envisage that the core set may be superseded in the future, particularly for other types of dementia. There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog. STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/studies/details/819?result=true (accessed 7 April 2016)]. The systematic review protocol is registered as PROSPERO CRD42015027346. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gail Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, UK
| | | | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Roy Jones
- Research Institute for the Care of Older People, University of Bath, Bath, UK
| | - Sallie Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Jo Thompson-Coon
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Orlaith Burke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Clare
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
- School of Psychology, University of Exeter, Exeter, UK
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Peter Garrard
- Neuroscience Research Centre, St George's, University of London, UK
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, UK
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Fliss Murtagh
- Cicely Saunders Institute, King's College London, London, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- North Thames Collaboration for Leadership in Applied Health Research and Care, London, UK
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Charlesworth G, Sinclair JB, Brooks A, Sullivan T, Ahmad S, Poland F. The impact of volunteering on the volunteer: findings from a peer support programme for family carers of people with dementia. Health Soc Care Community 2017; 25:548-558. [PMID: 26970311 DOI: 10.1111/hsc.12341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
With an ageing population, there are increasing numbers of experienced family carers (FCs) who could provide peer support to newer carers in a similar care situation. The aims of this paper are to: (i) use a cross-sectional study design to compare characteristics of volunteers and recipients of a peer support programme for FCs of people with dementia, in terms of demographic background, social networks and psychological well-being; and (ii) use a longitudinal study design to explore the overall impact of the programme on the volunteers in terms of psychological well-being. Data were collected from programmes run in Norfolk, Northamptonshire, Berkshire and four London boroughs between October 2009 and March 2013. The volunteer role entailed empathic listening and encouragement over a 10-month period. Both carer support volunteers (N = 87) and recipient FCs (N = 109) provided baseline demographic information. Data on social networks, personal growth, self-efficacy, service use and well-being (SF-12; EuroQol Visual Analogue Scale; Hospital Anxiety and Depression Scale; Control, Autonomy, Self-Realisation, Pleasure-19) were collected prior to the start of the intervention (N = 43) and at either 3- to 5 month or 10 month follow-up (N = 21). Volunteers were more likely than recipients of support to be female and to have cared for a parent/grandparent rather than spouse. Volunteers were also more psychologically well than support recipients in terms of personal growth, depression and perceived well-being. The longitudinal analysis identified small but significant declines in personal growth and autonomy and a positive correlation between the volunteers' duration of involvement and perceived well-being. These findings suggest that carers who volunteer for emotional support roles are resilient and are at little psychological risk from volunteering.
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Affiliation(s)
- Georgina Charlesworth
- Research and Development Department, North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - James B Sinclair
- Research and Development Department, North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Alice Brooks
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Theresa Sullivan
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Shaheen Ahmad
- Dementia Advisory Service, Age Concern Havering, Romford, UK
| | - Fiona Poland
- School of Allied Health Professions, University of East Anglia, Norwich, UK
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Orrell M, Hoe J, Charlesworth G, Russell I, Challis D, Moniz-Cook E, Knapp M, Woods B, Hoare Z, Aguirre E, Toot S, Streater A, Crellin N, Whitaker C, d’Amico F, Rehill A. Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital.Objectives(1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial.Methods(1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing.Results(1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia.LimitationsGiven constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation.Future researchTo improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed.ConclusionThere is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world.Trial registrationsCurrent Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin Orrell
- Department of Mental Health Sciences, University College London, London, UK
| | - Juanita Hoe
- Department of Mental Health Sciences, University College London, London, UK
| | | | - Ian Russell
- Clinical Trials Unit, Swansea University, Swansea, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Esme Moniz-Cook
- Centre of Dementia Research and Practice, University of Hull, Hull, UK
| | - Martin Knapp
- Health and Social Care Department, London School of Economics and Political Science, London, UK
| | - Bob Woods
- North Wales Organisation for Randomised Trials in Health (NWORTH) Clinical Trials Unit, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH) Clinical Trials Unit, Bangor University, Bangor, UK
| | - Elisa Aguirre
- Department of Mental Health Sciences, University College London, London, UK
| | - Sandeep Toot
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Amy Streater
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Nadia Crellin
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Chris Whitaker
- North Wales Organisation for Randomised Trials in Health (NWORTH) Clinical Trials Unit, Bangor University, Bangor, UK
| | - Francesco d’Amico
- Health and Social Care Department, London School of Economics and Political Science, London, UK
| | - Amritpal Rehill
- Health and Social Care Department, London School of Economics and Political Science, London, UK
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Abstract
Within western cultures, portrayals of dementia as 'a living death' are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or 'liminal' state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of 'person with dementia'. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post-liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
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Affiliation(s)
- Linda Birt
- School of Health Sciences, University of East Anglia, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, UK
| | - Emese Csipke
- Division of Psychiatry, University College London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
- Research and Development Department, North East London NHS Foundation Trust, UK
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