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Monnet F, Diaz A, Gove D, Dupont C, Pivodic L, Van den Block L. The perspectives of people with dementia and their supporters on advance care planning: A qualitative study with the European Working Group of People with Dementia. Palliat Med 2024; 38:251-263. [PMID: 38293945 PMCID: PMC10938474 DOI: 10.1177/02692163231219915] [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] [Indexed: 02/01/2024]
Abstract
BACKGROUND Advance care planning has been defined in an international consensus paper, supported by the European Association for Palliative Care. There are concerns that this definition may not apply to dementia. Moreover, it is not informed by input from people with dementia. AIM To gather the perspective of the European Working Group of People with Dementia and their supporters on how advance care planning is defined and develop recommendations for changes to the definition. DESIGN An in-depth qualitative study was conducted, analysing online focus groups and interviews using thematic analysis. SETTING/PARTICIPANTS We included 12 people with dementia and 9 supporters. RESULTS Participants suggested several changes to the current advance care planning definition: mentioning people with decreasing decisional capacity; better reflecting the role of family and/or trust-based relationships; reducing focus on end-of-life/medical decisions; strengthening focus on social aspects of care. Elements of the current definition that participants suggested keeping and highlighting include the framing of advance care planning as a continuous process, that is also optional; mention of communication next to documentation of decisions; and the importance of proxy decision makers. Based on this input, we developed three overarching and 16 specific recommendations for a modified definition of advance care planning that is inclusive of people with dementia. CONCLUSIONS The perspectives of the European Working Group of People with Dementia and their supporters highlighted the need for a person-centred and dementia-inclusive advance care planning definition. We provide tangible recommendations for future adaptations of the definition that reflect these perspectives.
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Affiliation(s)
- Fanny Monnet
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
| | | | - Charlèss Dupont
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Haraldsen IH, Hatlestad-Hall C, Marra C, Renvall H, Maestú F, Acosta-Hernández J, Alfonsin S, Andersson V, Anand A, Ayllón V, Babic A, Belhadi A, Birck C, Bruña R, Caraglia N, Carrarini C, Christensen E, Cicchetti A, Daugbjerg S, Di Bidino R, Diaz-Ponce A, Drews A, Giuffrè GM, Georges J, Gil-Gregorio P, Gove D, Govers TM, Hallock H, Hietanen M, Holmen L, Hotta J, Kaski S, Khadka R, Kinnunen AS, Koivisto AM, Kulashekhar S, Larsen D, Liljeström M, Lind PG, Marcos Dolado A, Marshall S, Merz S, Miraglia F, Montonen J, Mäntynen V, Øksengård AR, Olazarán J, Paajanen T, Peña JM, Peña L, Peniche DL, Perez AS, Radwan M, Ramírez-Toraño F, Rodríguez-Pedrero A, Saarinen T, Salas-Carrillo M, Salmelin R, Sousa S, Suyuthi A, Toft M, Toharia P, Tveitstøl T, Tveter M, Upreti R, Vermeulen RJ, Vecchio F, Yazidi A, Rossini PM. Intelligent digital tools for screening of brain connectivity and dementia risk estimation in people affected by mild cognitive impairment: the AI-Mind clinical study protocol. Front Neurorobot 2024; 17:1289406. [PMID: 38250599 PMCID: PMC10796757 DOI: 10.3389/fnbot.2023.1289406] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
More than 10 million Europeans show signs of mild cognitive impairment (MCI), a transitional stage between normal brain aging and dementia stage memory disorder. The path MCI takes can be divergent; while some maintain stability or even revert to cognitive norms, alarmingly, up to half of the cases progress to dementia within 5 years. Current diagnostic practice lacks the necessary screening tools to identify those at risk of progression. The European patient experience often involves a long journey from the initial signs of MCI to the eventual diagnosis of dementia. The trajectory is far from ideal. Here, we introduce the AI-Mind project, a pioneering initiative with an innovative approach to early risk assessment through the implementation of advanced artificial intelligence (AI) on multimodal data. The cutting-edge AI-based tools developed in the project aim not only to accelerate the diagnostic process but also to deliver highly accurate predictions regarding an individual's risk of developing dementia when prevention and intervention may still be possible. AI-Mind is a European Research and Innovation Action (RIA H2020-SC1-BHC-06-2020, No. 964220) financed between 2021 and 2026. First, the AI-Mind Connector identifies dysfunctional brain networks based on high-density magneto- and electroencephalography (M/EEG) recordings. Second, the AI-Mind Predictor predicts dementia risk using data from the Connector, enriched with computerized cognitive tests, genetic and protein biomarkers, as well as sociodemographic and clinical variables. AI-Mind is integrated within a network of major European initiatives, including The Virtual Brain, The Virtual Epileptic Patient, and EBRAINS AISBL service for sensitive data, HealthDataCloud, where big patient data are generated for advancing digital and virtual twin technology development. AI-Mind's innovation lies not only in its early prediction of dementia risk, but it also enables a virtual laboratory scenario for hypothesis-driven personalized intervention research. This article introduces the background of the AI-Mind project and its clinical study protocol, setting the stage for future scientific contributions.
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Affiliation(s)
| | | | - Camillo Marra
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Hanna Renvall
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Fernando Maestú
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
| | | | - Soraya Alfonsin
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | | | - Abhilash Anand
- Performance and Assurance Solutions, Digital Solutions, DNV, Oslo, Norway
| | | | - Aleksandar Babic
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Asma Belhadi
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | | | - Ricardo Bruña
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Department of Radiology, Universidad Complutense de Madrid, Madrid, Spain
| | - Naike Caraglia
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Carrarini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | | | - Americo Cicchetti
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | - Signe Daugbjerg
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Di Bidino
- The Graduate School of Health Economics and Management (ALTEMS), Catholic University of the Sacred Heart, Rome, Italy
| | | | - Ainar Drews
- IT Department, University of Oslo, Oslo, Norway
| | - Guido Maria Giuffrè
- Memory Clinic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Pedro Gil-Gregorio
- Department of Geriatric Medicine, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Department of Geriatrics, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid, Spain
| | | | - Tim M. Govers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Harry Hallock
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Marja Hietanen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Lone Holmen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Jaakko Hotta
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Samuel Kaski
- Department of Computer Science, Helsinki Institute of Information Technology, Aalto University, Helsinki, Finland
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Rabindra Khadka
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Antti S. Kinnunen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Anne M. Koivisto
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Shrikanth Kulashekhar
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Denis Larsen
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Mia Liljeström
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Pedro G. Lind
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Alberto Marcos Dolado
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Serena Marshall
- Healthcare Programme, Group Research and Development, DNV, Oslo, Norway
| | - Susanne Merz
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
| | - Francesca Miraglia
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Juha Montonen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Ville Mäntynen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | | | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teemu Paajanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | | | - Ana S. Perez
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mohamed Radwan
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Federico Ramírez-Toraño
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | - Andrea Rodríguez-Pedrero
- Centre for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Universidad Complutense de Madrid, Pozuelo de Alarcón, Spain
| | - Timo Saarinen
- BioMag Laboratory, HUS Medical Imaging Centre, Helsinki University Hospital, Helsinki University and Aalto University School of Science, Helsinki, Finland
| | - Mario Salas-Carrillo
- Institute of Sanitary Investigation (IdISSC), San Carlos University Hospital, Madrid, Spain
- Memory Unit, Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Riitta Salmelin
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland
| | - Sonia Sousa
- School of Digital Technologies, Tallinn University, Tallinn, Estonia
| | - Abdillah Suyuthi
- Performance and Assurance Solutions, Digital Solutions, DNV, Oslo, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pablo Toharia
- Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Mats Tveter
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Ramesh Upreti
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Robin J. Vermeulen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fabrizio Vecchio
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Como, Italy
| | - Anis Yazidi
- Department of Computer Science, OsloMet—Oslo Metropolitan University, Oslo, Norway
- NordSTAR—Nordic Center for Sustainable and Trustworthy AI Research, Oslo, Norway
| | - Paolo Maria Rossini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
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Muurling M, Pasmooij AMG, Koychev I, Roik D, Froelich L, Schwertner E, Religa D, Abdelnour C, Boada M, Almici M, Galluzzi S, Cardoso S, de Mendonça A, Owens AP, Kuruppu S, Gjestsen MT, Lazarou I, Gkioka M, Tsolaki M, Diaz A, Gove D, Visser PJ, Aarsland D, Lucivero F, de Boer C. Correction: Ethical challenges of using remote monitoring technologies for clinical research: A case study of the role of local research ethics committees in the RADAR-AD study. PLoS One 2023; 18:e0294797. [PMID: 37972073 PMCID: PMC10653398 DOI: 10.1371/journal.pone.0294797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0285807.].
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Rommerskirch-Manietta M, Manietta C, Hoffmann AL, Rohra H, Gove D, Alpers B, Hung L, Geary CR, Abbott KM, Ren LH, Oberfeld S, Diaz A, Roes M. Participatory development of a framework to actively involve people living with dementia and those from their social network, and healthcare professionals in conducting a systematic review: the DECIDE-SR protocol. Res Involv Engagem 2023; 9:52. [PMID: 37434210 PMCID: PMC10337195 DOI: 10.1186/s40900-023-00461-2] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Systematic reviews summarize and evaluate relevant studies to contribute to evidence-based practice. Internationally, researchers have reached a consensus that the active involvement of the public leads to better research. Despite this agreement, there are many reviews of research concerning healthcare interventions intended to promote the care of people living with dementia and those from their social network (e.g., close contacts, both family and non-family members) primarily involve only healthcare professionals and other experts. Due to the lack of a dementia-sensitive framework to actively involve people living with dementia and those from their social network, and healthcare professionals as co-researchers in systematic reviews, it is important to develop a framework to inform practice. METHODS For this framework development process, we will recruit four people living with dementia and a total of four people from their social network, and three healthcare professionals working in acute or long-term care settings. We will conduct regular meetings with these groups of the public and healthcare professionals to include them in all stages of the systematic review. We will also identify and develop methods necessary to ensure meaningful involvement. The results will be documented and analyzed for the development of a framework. For the planning and preparation for these meetings, as well as the conduct of the meetings themselves, we will be guided by the principles of the INVOLVE approach. In addition, the ACTIVE framework will be used to guide the degree of involvement and the stage in the review process. DISCUSSION We assume that our transparent approach to the development of a framework to support the active involvement of people living with dementia and those from their social network, and healthcare professionals in systematic reviews will serve as an impetus for and provide guidance to other researchers with the goal of increasing researchers' focus on this topic and facilitating systematic reviews that apply participatory approaches. TRIAL REGISTRATION Trial registration is unnecessary as no intervention study will be conducted.
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anna Louisa Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Helga Rohra
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Patient Advisory Board, Bonn, Germany
| | | | - Birgit Alpers
- Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | | | - Katherine M. Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, USA
- Scripps Gerontology Center, Oxford, USA
| | - Lily Haopu Ren
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Stefanie Oberfeld
- Department of Geriatric Psychiatry, St. Rochus-Hospital, Telgte, Germany
| | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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5
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Muurling M, Pasmooij AMG, Koychev I, Roik D, Froelich L, Schwertner E, Religa D, Abdelnour C, Boada M, Almici M, Galluzzi S, Cardoso S, de Mendonça A, Owens AP, Kuruppu S, Gjestsen MT, Lazarou I, Gkioka M, Tsolaki M, Diaz A, Gove D, Visser PJ, Aarsland D, Lucivero F, de Boer C. Ethical challenges of using remote monitoring technologies for clinical research: A case study of the role of local research ethics committees in the RADAR-AD study. PLoS One 2023; 18:e0285807. [PMID: 37418385 PMCID: PMC10328231 DOI: 10.1371/journal.pone.0285807] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Clinical research with remote monitoring technologies (RMTs) has multiple advantages over standard paper-pencil tests, but also raises several ethical concerns. While several studies have addressed the issue of governance of big data in clinical research from the legal or ethical perspectives, the viewpoint of local research ethics committee (REC) members is underrepresented in the current literature. The aim of this study is therefore to find which specific ethical challenges are raised by RECs in the context of a large European study on remote monitoring in all syndromic stages of Alzheimer's disease, and what gaps remain. METHODS Documents describing the REC review process at 10 sites in 9 European countries from the project Remote Assessment of Disease and Relapse-Alzheimer's Disease (RADAR-AD) were collected and translated. Main themes emerging in the documents were identified using a qualitative analysis approach. RESULTS Four main themes emerged after analysis: data management, participant's wellbeing, methodological issues, and the issue of defining the regulatory category of RMTs. Review processes differed across sites: process duration varied from 71 to 423 days, some RECs did not raise any issues, whereas others raised up to 35 concerns, and the approval of a data protection officer was needed in half of the sites. DISCUSSION The differences in the ethics review process of the same study protocol across different local settings suggest that a multi-site study would benefit from a harmonization in research ethics governance processes. More specifically, some best practices could be included in ethical reviews across institutional and national contexts, such as the opinion of an institutional data protection officer, patient advisory board reviews of the protocol and plans for how ethical reflection is embedded within the study.
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Affiliation(s)
- Marijn Muurling
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | | | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dora Roik
- Department of Geriatric Psychiatry, Central Institute for Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central Institute for Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Emilia Schwertner
- Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Krakow, Poland
| | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Mercè Boada
- Ace Alzheimer Center Barcelona–Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Monica Almici
- Laboratory Alzheimer’s Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Samantha Galluzzi
- Laboratory Alzheimer’s Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sandra Cardoso
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | - Andrew P. Owens
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sajini Kuruppu
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | | | - Ioulietta Lazarou
- Information Technologies Institute, Center for Research and Technology Hellas (CERTH-ITI), Thessaloniki, Greece
| | - Mara Gkioka
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI–AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Tsolaki
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI–AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
| | | | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Federica Lucivero
- Ethox and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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6
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Brem AK, Kuruppu S, de Boer C, Muurling M, Diaz-Ponce A, Gove D, Curcic J, Pilotto A, Ng WF, Cummins N, Malzbender K, Nies VJM, Erdemli G, Graeber J, Narayan VA, Rochester L, Maetzler W, Aarsland D. Digital endpoints in clinical trials of Alzheimer's disease and other neurodegenerative diseases: challenges and opportunities. Front Neurol 2023; 14:1210974. [PMID: 37435159 PMCID: PMC10332162 DOI: 10.3389/fneur.2023.1210974] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023] Open
Abstract
Alzheimer's disease (AD) and other neurodegenerative diseases such as Parkinson's disease (PD) and Huntington's disease (HD) are associated with progressive cognitive, motor, affective and consequently functional decline considerably affecting Activities of Daily Living (ADL) and quality of life. Standard assessments, such as questionnaires and interviews, cognitive testing, and mobility assessments, lack sensitivity, especially in early stages of neurodegenerative diseases and in the disease progression, and have therefore a limited utility as outcome measurements in clinical trials. Major advances in the last decade in digital technologies have opened a window of opportunity to introduce digital endpoints into clinical trials that can reform the assessment and tracking of neurodegenerative symptoms. The Innovative Health Initiative (IMI)-funded projects RADAR-AD (Remote assessment of disease and relapse-Alzheimer's disease), IDEA-FAST (Identifying digital endpoints to assess fatigue, sleep and ADL in neurodegenerative disorders and immune-mediated inflammatory diseases) and Mobilise-D (Connecting digital mobility assessment to clinical outcomes for regulatory and clinical endorsement) aim to identify digital endpoints relevant for neurodegenerative diseases that provide reliable, objective, and sensitive evaluation of disability and health-related quality of life. In this article, we will draw from the findings and experiences of the different IMI projects in discussing (1) the value of remote technologies to assess neurodegenerative diseases; (2) feasibility, acceptability and usability of digital assessments; (3) challenges related to the use of digital tools; (4) public involvement and the implementation of patient advisory boards; (5) regulatory learnings; and (6) the significance of inter-project exchange and data- and algorithm-sharing.
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Affiliation(s)
- Anna-Katharine Brem
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Sajini Kuruppu
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Casper de Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Marijn Muurling
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | | | | | - Jelena Curcic
- Novartis Institutes for Biomedical Research (NIBR), Basel, Switzerland
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia Hospital, Brescia, Italy
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre and Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nicholas Cummins
- Department of Biostats and Health Informatics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | | | - Gul Erdemli
- Novartis Pharmaceuticals Corporations, Cambridge, MA, United States
| | - Johanna Graeber
- Institute of General Practice, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | | | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Dag Aarsland
- Department of Old Age Psychiatry, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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van Corven CTM, Bielderman A, Diaz Ponce A, Gove D, Georges J, Graff MJL, Gerritsen DL. Empowering interventions for people living with dementia: A European survey. J Adv Nurs 2022; 78:4104-4112. [PMID: 35867338 PMCID: PMC9796734 DOI: 10.1111/jan.15385] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 01/07/2023]
Abstract
AIMS We aim to identify existing empowerment interventions for people living with dementia and to explore which used interventions and projects are considered empowering and why. DESIGN This was an online survey. METHODS We conducted an online survey between May 2018 and July 2018 amongst professionals interested in dementia care in Europe. Interventions were clustered within the ecological model for health promotion. Reasons from respondents as to why they considered interventions to be empowering were analysed and structured according to a recently developed conceptual framework of empowerment for people living with dementia. RESULTS Seventy-three respondents from 23 countries together mentioned 98 interventions or projects, of which 90 were unique. Interventions focused on the (inter)personal (n = 54), organizational (n = 15), communal (n = 6) and societal (n = 15) levels. A broad range of interventions were considered empowering, but no interventions were specifically developed for, nor aimed at, empowerment. Reasons as to why respondents considered these interventions as empowering fitted the framework's domains. CONCLUSION This European survey provides insights into interventions considered empowering for people living with dementia. An important step that needs to be taken is to develop and test interventions that specifically aim to promote empowerment for people living with dementia. IMPACT Empowerment may encourage people with dementia to live the life they choose, and focus on what is possible, instead of what is no longer possible. Many interventions are considered as empowering for people living with dementia, however no interventions could be identified that were specifically developed for or aimed at empowerment. This study shows that for promoting empowerment, it is necessary to develop and test interventions that specifically aim for empowerment, do this in collaboration with relevant stakeholders, and in this way support people living with dementia to live according to their competencies, talents and wishes.
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Affiliation(s)
- Charlotte T. M. van Corven
- Department of Primary and Community CareRadboud University Medical Centre, Radboud Institute for Health Sciences, Radboud Alzheimer CentreNijmegenThe Netherlands
| | - Annemiek Bielderman
- Department of Primary and Community CareRadboud University Medical Centre, Radboud Institute for Health Sciences, Radboud Alzheimer CentreNijmegenThe Netherlands
| | | | | | | | - Maud J. L. Graff
- Scientific Institute for Quality of Healthcare and Department of RehabilitationRadboud University Medical Centre, Radboud Institute for Health Sciences, Radboud Alzheimer CentreNijmegenThe Netherlands
| | - Debby L. Gerritsen
- Department of Primary and Community CareRadboud University Medical Centre, Radboud Institute for Health Sciences, Radboud Alzheimer CentreNijmegenThe Netherlands
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Georges J, Diaz-Ponce A, Lamirel D, Moradi-Bachiller S, Gove D. Keeping track of and recognizing the value of Public Involvement work in dementia research. Front Neurol 2022; 13:1031831. [PMID: 36438974 PMCID: PMC9691954 DOI: 10.3389/fneur.2022.1031831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 03/05/2024] Open
Abstract
The Public Involvement (PI) of people with dementia is slowly but progressively moving from a "nice to have" to a "must have" element of good-quality dementia research. Research funders and ethics committees increasingly ask for evidence of the planning of such involvement. The actual conduct and outcome of PI are, however, unfortunately typically under or inadequately reported. In this article, we provide an overview of what PI is and why it is important to dementia research and Alzheimer Europe's approach to PI. We draw on our recent experience of compiling a set of examples of PI in different European projects in publicly available sources. This highlighted the difficulty of finding information about PI activities and the almost total lack of details of such activities in formal reports, official records, and/or public project websites. In this article, we emphasize gaps and call for more stringent conditions for the inclusion and reporting of PI work in the context of the approval and funding of dementia research projects. We call for the establishment of obligatory reporting on the nature, specific challenges, and impact of PI in dementia research in formal reports (e.g., to funders), in public project websites, and in peer-reviewed articles. Such reporting should cover several key factors such as who was involved, how they were involved, and what impact PI had on the research process.
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Roes M, Gove D, Diaz A. Motivation for people living with dementia to engage in research advisory boards. Innov Aging 2021. [PMCID: PMC8681908 DOI: 10.1093/geroni/igab046.577] [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: 12/04/2022] Open
Abstract
The importance of Public Involvement (PI) is increasingly being recognized in the field of dementia research. In 2012, Alzheimer Europe set up the European Working Group of People with Dementia (EWGPWD) which provides advice and input for all activities of the organization including several large European-funded research projects. The German Center for Neurodegenerative Diseases (DZNE) created a research advisory patient board in 2020 with the intention of supporting the board in strategic research decisions. Both groups are composed of people with dementia and act independently. With the aim of finding out whether PI in research is mutually rewarding and beneficial, members of both groups were asked about their motivation to be involved in PI research activities and the value this had for them. This was collected either through narrative interviews or during meetings. People with dementia described several reasons for being involved in PI activities in dementia research.
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Affiliation(s)
- Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Witten, Nordrhein-Westfalen, Germany
| | - Dianne Gove
- Alzheimer Europe, Luxembourg, Diekirch, Luxembourg
| | - Ana Diaz
- Alzheimer Europe, Luxembourg, Diekirch, Luxembourg
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10
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Gove D, Nielsen TR, Smits C, Plejert C, Rauf MA, Parveen S, Jaakson S, Golan‐Shemesh D, Lahav D, Kaur R, Herz MK, Monsees J, Thyrian JR, Georges J. The challenges of achieving timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups in Europe. Int J Geriatr Psychiatry 2021; 36:1823-1828. [PMID: 34378237 PMCID: PMC9291493 DOI: 10.1002/gps.5614] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a just society, everyone should have equal access to healthcare in terms of prevention, assessment, diagnosis, treatment and care. Europe is a multicultural society made up of people who identify with a wide range of ethnic groups. Many older people from minority ethnic groups also have a direct migration background. Several studies have shown that there is a lack of equity in relation to dementia diagnoses and care because equal opportunities do not necessarily translate into equal outcomes. An expert ethics working group led by Alzheimer Europe has produced an extensive report on this issue, a policy brief and a guide for health and social care workers. In this brief summary, the authors/members of the expert working group present some of the key challenges and recommendations for healthcare clinicians striving to provide timely diagnosis and good quality care and treatment to people with dementia from all ethnic groups.
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Affiliation(s)
| | - Thomas Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreCopenhagen University HospitalKobenhavnDenmark
| | - Carolien Smits
- Pharos Dutch Centre of Expertise on Health DisparitiesUtrechtthe Netherlands
| | - Charlotta Plejert
- Department of Biomedical and Clinical SciencesDivision of Sensory Organs and CommunicationLinköping UniversityLinköpingSweden
| | | | - Sahdia Parveen
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Siiri Jaakson
- Multicultural Memory Centre ‐ the Finnish Society for Memory WorkVantaaFinland
| | | | - Debi Lahav
- Emda Alzheimer's AssociationKefar SabaIsrael
| | | | | | - Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
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11
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Mank A, van Maurik IS, Bakker ED, van de Glind EMM, Jönsson L, Kramberger MG, Novak P, Diaz A, Gove D, Scheltens P, van der Flier WM, Visser LNC. Identifying relevant outcomes in the progression of Alzheimer's disease; what do patients and care partners want to know about prognosis? Alzheimers Dement (N Y) 2021; 7:e12189. [PMID: 34458555 PMCID: PMC8377775 DOI: 10.1002/trc2.12189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prognostic studies in the context of Alzheimer's disease (AD) mainly predicted time to dementia. However, it is questionable whether onset of dementia is the most relevant outcome along the AD disease trajectory from the perspective of patients and their care partners. Therefore, we aimed to identify the most relevant outcomes from the viewpoint of patients and care partners. METHODS We used a two-step, mixed-methods approach. As a first step we conducted four focus groups in the Netherlands to elicit a comprehensive list of outcomes considered important by patients (n = 12) and care partners (n = 14) in the prognosis of AD. The focus groups resulted in a list of 59 items, divided into five categories. Next, in an online European survey, we asked participants (n = 232; 99 patients, 133 care partners) to rate the importance of all 59 items (5-point Likert scale). As participants were likely to rate a large number of outcomes as "important" (4) or "very important" (5), we subsequently asked them to select the three items they considered most important. RESULTS The top-10 lists of items most frequently mentioned as "most important" by patients and care partners were merged into one core outcome list, comprising 13 items. Both patients and care partners selected outcomes from the category "cognition" most often, followed by items in the categories "functioning and dependency" and "physical health." No items from the category "behavior and neuropsychiatry" and "social environment" ended up in our core list of relevant outcomes. CONCLUSION We identified a core list of outcomes relevant to patients and care partner, and found that prognostic information related to cognitive decline, dependency, and physical health are considered most relevant by both patients and their care partners.
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Affiliation(s)
- Arenda Mank
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Ingrid S. van Maurik
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
- Department of Epidemiology and Data ScienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Els D. Bakker
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | | | | | - Milica G. Kramberger
- Center for Cognitive ImpairmentsUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Petr Novak
- Institute of NeuroimmunologySlovak Academy of SciencesBratislavaSlovakia
| | - Ana Diaz
- Alzheimer Europe (AE)Luxembourg CityLuxembourg
| | - Dianne Gove
- Alzheimer Europe (AE)Luxembourg CityLuxembourg
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
| | - Leonie N. C. Visser
- Alzheimer Center AmsterdamDepartment of NeurologyVU University Medical CenterAmsterdam UMCAmsterdamthe Netherlands
- Department of Medical PsychologyAmsterdam Public Health Research InstituteAmsterdam UMCAmsterdamthe Netherlands
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12
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Angehrn Z, Sostar J, Nordon C, Turner A, Gove D, Karcher H, Keenan A, Mittelstadt B, de Reydet-de Vulpillieres F. Ethical and Social Implications of Using Predictive Modeling for Alzheimer's Disease Prevention: A Systematic Literature Review. J Alzheimers Dis 2021; 76:923-940. [PMID: 32597799 DOI: 10.3233/jad-191159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/15/2022]
Abstract
BACKGROUND The therapeutic paradigm in Alzheimer's disease (AD) is shifting from symptoms management toward prevention goals. Secondary prevention requires the identification of individuals without clinical symptoms, yet "at-risk" of developing AD dementia in the future, and thus, the use of predictive modeling. OBJECTIVE The objective of this study was to review the ethical concerns and social implications generated by this new approach. METHODS We conducted a systematic literature review in Medline, Embase, PsycInfo, and Scopus, and complemented it with a gray literature search between March and July 2018. Then we analyzed data qualitatively using a thematic analysis technique. RESULTS We identified thirty-one ethical issues and social concerns corresponding to eight ethical principles: (i) respect for autonomy, (ii) beneficence, (iii) non-maleficence, (iv) equality, justice, and diversity, (v) identity and stigma, (vi) privacy, (vii) accountability, transparency, and professionalism, and (viii) uncertainty avoidance. Much of the literature sees the discovery of disease-modifying treatment as a necessary and sufficient condition to justify AD risk assessment, overlooking future challenges in providing equitable access to it, establishing long-term treatment outcomes and social consequences of this approach, e.g., medicalization. The ethical/social issues associated specifically with predictive models, such as the adequate predictive power and reliability, infrastructural requirements, data privacy, potential for personalized medicine in AD, and limiting access to future AD treatment based on risk stratification, were covered scarcely. CONCLUSION The ethical discussion needs to advance to reflect recent scientific developments and guide clinical practice now and in the future, so that necessary safeguards are implemented for large-scale AD secondary prevention.
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Stavropoulos TG, Lazarou I, Diaz A, Gove D, Georges J, Manyakov NV, Pich EM, Hinds C, Tsolaki M, Nikolopoulos S, Kompatsiaris I. Wearable Devices for Assessing Function in Alzheimer's Disease: A European Public Involvement Activity About the Features and Preferences of Patients and Caregivers. Front Aging Neurosci 2021; 13:643135. [PMID: 33912025 PMCID: PMC8072390 DOI: 10.3389/fnagi.2021.643135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/17/2020] [Accepted: 03/10/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Alzheimer's Disease (AD) impairs the ability to carry out daily activities, reduces independence and quality of life and increases caregiver burden. Our understanding of functional decline has traditionally relied on reports by family and caregivers, which are subjective and vulnerable to recall bias. The Internet of Things (IoT) and wearable sensor technologies promise to provide objective, affordable, and reliable means for monitoring and understanding function. However, human factors for its acceptance are relatively unexplored. Objective: The Public Involvement (PI) activity presented in this paper aims to capture the preferences, priorities and concerns of people with AD and their caregivers for using monitoring wearables. Their feedback will drive device selection for clinical research, starting with the study of the RADAR-AD project. Method: The PI activity involved the Patient Advisory Board (PAB) of the RADAR-AD project, comprised of people with dementia across Europe and their caregivers (11 and 10, respectively). A set of four devices that optimally represent various combinations of aspects and features from the variety of currently available wearables (e.g., weight, size, comfort, battery life, screen types, water-resistance, and metrics) was presented and experienced hands-on. Afterwards, sets of cards were used to rate and rank devices and features and freely discuss preferences. Results: Overall, the PAB was willing to accept and incorporate devices into their daily lives. For the presented devices, the aspects most important to them included comfort, convenience and affordability. For devices in general, the features they prioritized were appearance/style, battery life and water resistance, followed by price, having an emergency button and a screen with metrics. The metrics valuable to them included activity levels and heart rate, followed by respiration rate, sleep quality and distance. Some concerns were the potential complexity, forgetting to charge the device, the potential stigma and data privacy. Conclusions: The PI activity explored the preferences, priorities and concerns of the PAB, a group of people with dementia and caregivers across Europe, regarding devices for monitoring function and decline, after a hands-on experience and explanation. They highlighted some expected aspects, metrics and features (e.g., comfort and convenience), but also some less expected (e.g., screen with metrics).
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Affiliation(s)
- Thanos G Stavropoulos
- Center for Research and Technology Hellas (CERTH-ITI), Information Technologies Institute, Thessaloniki, Greece
| | - Ioulietta Lazarou
- Center for Research and Technology Hellas (CERTH-ITI), Information Technologies Institute, Thessaloniki, Greece.,Medical School, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Ana Diaz
- Alzheimer Europe (AE), Luxembourg City, Luxembourg
| | - Dianne Gove
- Alzheimer Europe (AE), Luxembourg City, Luxembourg
| | - Jean Georges
- Alzheimer Europe (AE), Luxembourg City, Luxembourg
| | - Nikolay V Manyakov
- Clinical Insights and Experience, Janssen Research and Development, Beerse, Belgium
| | | | - Chris Hinds
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Magda Tsolaki
- Medical School, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.,Greek Association of Alzheimer's Disease and Related Disorders (GAADRD-Alzheimer Hellas), Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Center for Research and Technology Hellas (CERTH-ITI), Information Technologies Institute, Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Center for Research and Technology Hellas (CERTH-ITI), Information Technologies Institute, Thessaloniki, Greece
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14
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Diaz A, Gove D, Nelson M, Smith M, Tochel C, Bintener C, Ly A, Bexelius C, Gustavsson A, Georges J, Gallacher J, Sudlow C. Conducting public involvement in dementia research: The contribution of the European Working Group of People with Dementia to the ROADMAP project. Health Expect 2021; 24:757-765. [PMID: 33822448 PMCID: PMC8235878 DOI: 10.1111/hex.13246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/01/2021] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022] Open
Abstract
Background Dementia outcomes include memory loss, language impairment, reduced quality of life and personality changes. Research suggests that outcomes selected for dementia clinical trials might not be the most important to people affected. Objective One of the goals of the ‘Real world Outcomes across the Alzheimer's Disease spectrum for better care: Multi‐modal data Access Platform’ (ROADMAP) project was to identify important outcomes from the perspective of people with dementia and their caregivers. We review how ROADMAP's Public Involvement shaped the programme, impacted the research process and gave voice to people affected by dementia. Design The European Working Group of People with Dementia (EWGPWD) were invited to participate. In‐person consultations were held with people with dementia and caregivers, with advance information provided on ROADMAP activities. Constructive criticism of survey content, layout and accessibility was sought, as were views and perspectives on terminology and key concepts around disease progression. Results The working group provided significant improvements to survey accessibility and acceptability. They promoted better understanding of concepts around disease progression and how researchers might approach measuring and interpreting findings. They effectively expressed difficult concepts through real‐world examples. Conclusions The role of the EWGPWD in ROADMAP was crucial, and its impact was highly influential. Involvement from the design stage helped shape the ethos of the programme and ultimately its meaningfulness. Public contribution People with dementia and their carers were involved through structured consultations and invited to provide feedback on project materials, methods and insight into terminology and relevant concepts.
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Affiliation(s)
- Ana Diaz
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Mia Nelson
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Michael Smith
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Amanda Ly
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Cathie Sudlow
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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15
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Faulkner SD, Sayuri Ii S, Pakarinen C, Somers F, Jose Vicente Edo M, Prieto Remon L, Diaz Ponce A, Gove D, Ferrer E, Nafria B, Bertelsen N, Boudes M, Brooke N, Moutet A, Fahy N. Understanding multi-stakeholder needs, preferences and expectations to define effective practices and processes of patient engagement in medicine development: A mixed-methods study. Health Expect 2021; 24:601-616. [PMID: 33599067 PMCID: PMC8077078 DOI: 10.1111/hex.13207] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 09/01/2020] [Revised: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 01/23/2023] Open
Abstract
Background The holistic evolution of patient engagement in medicines development requires a more detailed understanding of the needs of all involved stakeholders, and one that better accounts for the specific needs of some potentially vulnerable patient populations and key stages in medicines development. Objective The purpose of this convergent mixed‐methods study was to better understand the needs of different stakeholders concerning patient engagement at three key stages in medicines development: research priority setting, clinical trial design and early dialogues with Health Technology Assessment bodies and regulators. Design This study brought together findings from three sources: i) an online questionnaire, ii) face‐to‐face consultations with two potentially vulnerable patient populations, a workshop with Health Technology Assessment bodies, and iii) three‐step modified Delphi methodology. Results Overall stakeholders still need additional varied support mechanisms to undertake, sustain or measure value of patient engagement. Health Technology Assessment bodies need better rationale for patient engagement in early dialogue and tools to support its implementation. Improved awareness and understanding of the need and value that involving patients, who are often considered as potentially vulnerable, can bring is needed, as is better accommodation of their specific needs. Similarly, weighted Delphi categories were as follows: aims and objectives, and sustainability. Several additional themes were common across the three key stages in medicines development. Conclusion This broad‐reaching study provides the blocks needed to build a framework for patient engagement in medicines development. Patient or Public Contribution Patients were involved in review and interpretation of data.
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Affiliation(s)
- Stuart D Faulkner
- Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Suzanne Sayuri Ii
- Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
| | | | | | - Maria Jose Vicente Edo
- Aragon Health Sciences Insitute, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Lucia Prieto Remon
- Aragon Health Sciences Insitute, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | | | | | | | - Begonya Nafria
- Patient Engagement in Research, Institut de Recerca Sant Joan de Déu- Hospital Sant Joan de Déu, Barcelona, Spain
| | | | | | | | | | - Nick Fahy
- Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
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Wolverson E, Dunn R, Moniz-Cook E, Gove D, Diaz-Ponce A. The language of behaviour changes in dementia: A mixed methods survey exploring the perspectives of people with dementia. J Adv Nurs 2021; 77:1992-2001. [PMID: 33591611 DOI: 10.1111/jan.14787] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/05/2020] [Revised: 12/11/2020] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to explore the opinions of people with dementia, about the language used to describe changes in behaviour associated with dementia. DESIGN This study adopted a human rights approach in a mixed methods convergent parallel synthesis design. METHODS Online and paper-based questionnaire data were collected between November 2019 and March 2020. A combination of convenience and purposive sampling was used to invite people with dementia to participate. RESULTS In total, 54 people completed the survey. There was no clear consensus on a preferred term, but 28.3% preferred the term 'unmet needs' for describing changes in behaviour associated with dementia. Qualitative data revealed important nuances and challenges for researchers and practitioners in relation to terminology for this paradigm. Participants felt that the language we use to talk about changes in behaviour could influence how people with dementia are viewed and treated and how people feel about themselves. CONCLUSION The majority of participants were familiar with a range of terminology. There was no universal agreement on terminology, but there was an overall preference for terms that reflect the unmet needs likely to underlie perceived changes in behaviour. IMPACT People with dementia raised concerns about the language used to describe changes in behaviour that can occur in dementia. There is scope for improvements in the language used for this paradigm in both research and practice. Following a diagnosis of dementia, clinicians need to take the time to explore an individual's preferences and understandings. They can then share their own understanding about the potential for changed behaviour and if relevant, how any negative impact of this may be minimized.
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Affiliation(s)
- Emma Wolverson
- Faculty of Health Sciences, The University of Hull, Hull, UK.,Humber Teaching NHS Foundation Trust, Hull, UK
| | - Rosie Dunn
- Faculty of Health Sciences, The University of Hull, Hull, UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, The University of Hull, Hull, UK
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Roberts C, Rochford-Brennan H, Goodrick J, Gove D, Diaz-Ponce A, Georges J. Our reflections of Patient and Public Involvement in research as members of the European Working Group of People with Dementia. Dementia (London) 2020; 19:10-17. [PMID: 31875708 DOI: 10.1177/1471301219876402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Jayne Goodrick
- European Working Group of People with Dementia, Luxembourg
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18
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Clarke C, Woods B, Moniz-Cook E, Mountain G, Øksnebjerg L, Chattat R, Diaz A, Gove D, Vernooij-Dassen M, Wolverson E. Measuring the well-being of people with dementia: a conceptual scoping review. Health Qual Life Outcomes 2020; 18:249. [PMID: 32709238 PMCID: PMC7382062 DOI: 10.1186/s12955-020-01440-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 05/14/2019] [Accepted: 06/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Enabling people with dementia to 'live well' is a policy and research priority in many countries. However, instruments for measuring outcomes of psychosocial interventions designed to promote well-being in dementia are often derived from a symptom-focused, loss/deficit approach, or from broad quality of life concepts. A pan-European dementia working group called for research on the development of an alternative asset/strengths-based conceptual framework of well-being in dementia. This paper takes forward this recommendation by developing such a framework and using this to map relevant self-report outcome measures. METHODS Three scoping reviews of published studies were conducted iteratively. First, we examined the literature on lived experiences of well-being and quality of life in people with dementia and then the wider dementia literature for application of well-being constructs. The synthesised findings generated conceptual domains of well-being in people with dementia. Corresponding self-report instruments used in dementia research were scoped, categorised within the conceptual framework and their potential value in measuring outcomes for people with dementia was examined. FINDINGS Six conceptual domains for the measurement of well-being and 35 self-report instruments that have been used with people with dementia were identified. Six instruments were developed specifically for people with dementia, five were derived from the gerontological literature and 24 from the well-being literature. Fifteen instruments and one sub-scale have been examined for psychometric properties amongst people with dementia. To date, 20 have been used as outcome measures, with seven measuring change over time. A number of identified instruments utilise traditional retrospective Likert-scaling response formats, limiting their potential for use with some groups of people with dementia. CONCLUSION An assets/strengths-based framework is presented, outlining structural domains for selecting self-report measures of well-being in people with dementia. It provides a foundation for enhancing research into processes and outcomes of psychosocial interventions, including instrument development, more precise matching of intervention aims with outcome measurement, and newer technology-based 'in-the-moment' measurement.
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Affiliation(s)
- Chris Clarke
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Bob Woods
- DSDC Wales, Bangor University, Ardudwy, Holyhead Road, Bangor, Gwynedd LL57 2PZ UK
| | - Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
| | - Gail Mountain
- School of Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP UK
| | - Laila Øksnebjerg
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Rabih Chattat
- Department of Psychology Università di Bologna - Via Zamboni, 33 - 40126 Bologna, Italy
| | - Ana Diaz
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Dianne Gove
- Alzheimer Europe, L-1417 14, rue Dicks, Luxembourg
| | - Myrra Vernooij-Dassen
- Radboud University Medical Centre, Scientific Center for Quality of Healthcare, IQ Healthcare 114, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, HU6 7RX UK
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Gregory S, Bunnik EM, Callado AB, Carrie I, De Boer C, Duffus J, Fauria K, Forster S, Gove D, Knezevic I, Laquidain A, Pennetier D, Saunders S, Sparks S, Rice J, Ritchie CW, Milne R. Involving research participants in a pan-European research initiative: the EPAD participant panel experience. Res Involv Engagem 2020; 6:62. [PMID: 33088590 PMCID: PMC7566117 DOI: 10.1186/s40900-020-00236-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/01/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Including participants in patient and public involvement activities is increasingly acknowledged as a key pillar of successful research activity. Such activities can influence recruitment and retention, as well as researcher experience and contribute to decision making in research studies. However, there are few established methodologies of how to set up and manage participant involvement activities. Further, there is little discussion of how to do so when dealing with collaborative projects that run across countries and operate in multiple linguistic and regulatory contexts. METHODS In this paper we describe the set-up, running and experiences of the EPAD participant panel. The EPAD study was a pan-European cohort study with the aim to understand risks for developing Alzheimer's disease and build a readiness cohort for Phase 2 clinical trials. Due to the longitudinal nature of this study, combined with the enrolment of healthy volunteers and those with mild cognitive impairments, the EPAD team highlighted participant involvement as crucial to the success of this project. The EPAD project employed a nested model, with local panels meeting in England, France, Scotland, Spain and The Netherlands, and feeding into a central study panel. The local panels were governed by terms of reference which were adaptable to local needs. RESULTS The impact of the panels has been widespread, and varies from feedback on documentation, to supporting with design of media materials and representation of the project at national and international meetings. CONCLUSIONS The EPAD panels have contributed to the success of the project and the model established is easily transferable to other disease areas investigating healthy or at-risk populations.
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Affiliation(s)
- S. Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - E. M. Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A. B. Callado
- BarcelonaBeta Brain Research Center, Pasqual Maragall Fundation, Barcelona, Spain
| | - I. Carrie
- Centre de Recherche Clinique du Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - C. De Boer
- VUmc Alzheimercentrum, Amsterdam, The Netherlands
| | - J. Duffus
- Participant panel member, Barcelona, Spain
| | - K. Fauria
- BarcelonaBeta Brain Research Center, Pasqual Maragall Fundation, Barcelona, Spain
| | - S. Forster
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D. Gove
- Alzheimer Europe, Luxembourg, Luxembourg
| | - I. Knezevic
- BarcelonaBeta Brain Research Center, Pasqual Maragall Fundation, Barcelona, Spain
| | | | - D. Pennetier
- Centre de Recherche Clinique du Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - S. Saunders
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S. Sparks
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - J. Rice
- Participant panel member, Barcelona, Spain
| | - C. W. Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - R. Milne
- Institute of Public Health, University of Cambridge, Cambridge, UK
- Society and Ethics Research, Wellcome Genome Campus, Hinxton, UK
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Owens AP, Hinds C, Manyakov NV, Stavropoulos TG, Lavelle G, Gove D, Diaz-Ponce A, Aarsland D. Selecting Remote Measurement Technologies to Optimize Assessment of Function in Early Alzheimer's Disease: A Case Study. Front Psychiatry 2020; 11:582207. [PMID: 33250792 PMCID: PMC7674649 DOI: 10.3389/fpsyt.2020.582207] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022] Open
Abstract
Despite the importance of function in early Alzheimer's disease (AD), current measures are outdated and insensitive. Moreover, COVID-19 has heighted the need for remote assessment in older people, who are at higher risk of being infection and are particularly advised to use social distancing measures, yet the importance of diagnosis and treatment of dementia remains unchanged. The emergence of remote measurement technologies (RMTs) allows for more precise and objective measures of function. However, RMT selection is a critical challenge. Therefore, this case study outlines the processes through which we identified relevant functional domains, engaged with stakeholder groups to understand participants' perspectives and worked with technical experts to select relevant RMTs to examine function. After an extensive literature review to select functional domains relevant to AD biomarkers, quality of life, rate of disease progression and loss of independence, functional domains were ranked and grouped by the empirical evidence for each. For all functional domains, we amalgamated feedback from a patient advisory board. The results were prioritized into: highly relevant, relevant, neutral, and less relevant. This prioritized list of functional domains was then passed onto a group of experts in the use of RMTs in clinical and epidemiological studies to complete the selection process, which consisted of: (i) identifying relevant functional domains and RMTs; (ii) synthesizing proposals into final RMT selection, and (iii) verifying the quality of these decisions. Highly relevant functional domains were, "difficulties at work," "spatial navigation and memory," and "planning skills and memory required for task completion." All functional domains were successfully allocated commercially available RMTs that make remote measurement of function feasible. This case study provides a set of prioritized functional domains sensitive to the early stages of AD and a set of RMTs capable of targeting them. RMTs have huge potential to transform the way we assess function in AD-monitoring for change and stability continuously within the home environment, rather than during infrequent clinic visits. Our decomposition of RMT and functional domain selection into identify, synthesize, and verify activities, provides a pragmatic structure with potential to be adapted for use in future RMT selection processes.
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Affiliation(s)
- Andrew P Owens
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Chris Hinds
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Nikolay V Manyakov
- Clinical Insights & Experience, Janssen Research & Development, Beerse, Belgium
| | - Thanos G Stavropoulos
- Centre for Research & Technology Hellas, Information Technologies Institute, Thessaloniki, Greece
| | - Grace Lavelle
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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21
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McKeown A, Turner A, Angehrn Z, Gove D, Ly A, Nordon C, Nelson M, Tochel C, Mittelstadt B, Keenan A, Smith M, Singh I. Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape. J Alzheimers Dis 2020; 77:339-353. [PMID: 32716354 PMCID: PMC7592677 DOI: 10.3233/jad-191300] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought. OBJECTIVE Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. METHODS Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience. RESULTS Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk. CONCLUSION These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Andrew Turner
- The National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | | | - Amanda Ly
- MRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Mia Nelson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Alex Keenan
- Janssen Pharmaceutica NV, Titusville, NJ, USA
| | - Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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22
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Rodríguez‐Gómez O, Rodrigo A, Iradier F, Santos‐Santos MA, Hundemer H, Ciudin A, Sannemann L, Zwan M, Glaysher B, Wimo A, Bonn J, Johansson G, Rodriguez I, Alegret M, Gove D, Pinó S, Trigueros P, Kivipelto M, Mathews B, Ciudad A, Ferreira D, Bintener C, Gurruchaga M, Westman E, Belger M, Valero S, Maguire P, Krivec D, Kramberger M, Simó R, Garro IP, Visser PJ, Dumas A, Georges J, Jessen F, Winblad B, Shering C, Stewart N, Campo L, Boada M. The MOPEAD project: Advancing patient engagement for the detection of “hidden” undiagnosed cases of Alzheimer's disease in the community. Alzheimers Dement 2019; 15:828-839. [DOI: 10.1016/j.jalz.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/30/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Octavio Rodríguez‐Gómez
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | | | - Miguel A. Santos‐Santos
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Hans Hundemer
- Eli Lilly and Company (Lilly Deutschland GmbH)Bad HomburgGermany
| | - Andreea Ciudin
- Vall d’Hebron Research Institute (VHIR) and CIBERDEM (ISCIII)BarcelonaSpain
| | - Lena Sannemann
- Department of PsychiatryUniversity of CologneCologneGermany
| | - Marissa Zwan
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | | | - Anders Wimo
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Jaka Bonn
- Center for Cognitive ImpairmentsDepartment of NeurologyUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Gunilla Johansson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
| | - Isabel Rodriguez
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Montse Alegret
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | - Susana Pinó
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | | | - Miia Kivipelto
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Institute of Clinical Medicine/NeurologyUniversity of Eastern FinlandKuopioFinland
| | | | | | - Daniel Ferreira
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | | | - Miren Gurruchaga
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
| | - Eric Westman
- Division of Clinical GeriatricsCentre for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
- Department of NeuroimagingCentre for Neuroimaging SciencesInstitute of PsychiatryPsychologyand NeuroscienceKing's College LondonLondonUK
| | | | - Sergi Valero
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
| | | | | | - Milica Kramberger
- Center for Cognitive ImpairmentsDepartment of NeurologyUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Rafael Simó
- Vall d’Hebron Research Institute (VHIR) and CIBERDEM (ISCIII)BarcelonaSpain
| | | | - Pieter Jelle Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | | | | | - Frank Jessen
- Department of PsychiatryUniversity of CologneCologneGermany
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Karolinska Univ HospitalTheme AgingStockholmSweden
| | | | - Neil Stewart
- Modus Research and Innovation LimitedDundeeScotland
| | | | - Mercè Boada
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades ‐ Universitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIBarcelonaSpain
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Angehrn Z, Nordon C, Turner A, Gove D, Karcher H, Keenan A, Neumann M, Sostar J, de Reydet de Vulpillieres F. Ethical and social implications of using predictive modeling for Alzheimer's disease prevention: a systematic literature review protocol. BMJ Open 2019; 9:e026468. [PMID: 30833325 PMCID: PMC6443073 DOI: 10.1136/bmjopen-2018-026468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The therapeutic paradigm in Alzheimer's disease (AD) has shifted towards secondary prevention, defined as an intervention aiming to prevent or delay disease onset in pre-symptomatic individuals at risk of developing dementia due to AD. The key feature of AD prevention is the need to treat years or even decades before the onset of cognitive, behavioural or functional decline. Prediction of AD risk and evaluation of long-term treatment outcomes in this setting requires predictive modelling and is associated with ethical concerns and social implications. The objective of this review is to identify and elucidate them, as presented in the literature. METHODS AND ANALYSIS A systematic literature review was conducted in Medline, Embase, PsycInfo and Scopus, and was complemented with a grey literature search. All searches were conducted between March and July 2018. Two reviewers independently assessed each study for inclusion and disagreements were adjudicated by a third reviewer. Data are now being extracted using an extraction sheet developed within the group of reviewers, based on an initial sample of three manuscripts, but allowing for inclusion of newly identified data items (ethical arguments). Data will be analysed qualitatively using a thematic analysis technique. Potential biases in selection and interpretation of extracted data are mitigated by the fact that reviewers come from a range of different scientific backgrounds and represent different types of stakeholders in this ethical discussion (academia, industry, patient advocacy groups). ETHICS AND DISSEMINATION The study does not require ethical approval. The findings of the review will be disseminated in a peer-reviewed journal and presented at conferences. They will also be reported through the Innovative Medicine Initiative project: Real World Outcomes Across the AD Spectrum for Better Care: Multi-modal Data Access Platform (IMI: ROADMAP). TRIAL REGISTRATION NUMBER CRD42018092205.
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Affiliation(s)
| | | | - Andrew Turner
- Oxford Internet Institute, University of Oxford, Oxford, UK
| | | | | | | | | | - Jelena Sostar
- Analytica Laser, a Certara Company, Loerrach, Germany
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Woods B, Arosio F, Diaz A, Gove D, Holmerová I, Kinnaird L, Mátlová M, Okkonen E, Possenti M, Roberts J, Salmi A, van den Buuse S, Werkman W, Georges J. Timely diagnosis of dementia? Family carers' experiences in 5 European countries. Int J Geriatr Psychiatry 2019; 34:114-121. [PMID: 30246266 PMCID: PMC6586062 DOI: 10.1002/gps.4997] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure? METHODS/DESIGN Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female. RESULTS Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term. CONCLUSIONS Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed.
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Affiliation(s)
- Bob Woods
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | | | - Ana Diaz
- Alzheimer EuropeLuxembourgLuxembourg
| | | | | | | | | | - Eila Okkonen
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
| | | | - Jennifer Roberts
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | - Anna Salmi
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
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Wagg A, Gove D, Leichsenring K, Ostaszkiewicz J. Development of quality outcome indicators to improve the quality of urinary and faecal continence care. Int Urogynecol J 2018; 30:23-32. [PMID: 30327849 PMCID: PMC6514083 DOI: 10.1007/s00192-018-3768-2] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis Despite the range of treatment options available, relatively few people with incontinence find a total cure. The importance of daily management with toileting and containment cannot be underestimated. To our knowledge, there are no outcome measures to benchmark good care. The aim of this study was to create a set of key performance indicators (KPIs) to measure outcomes for toileting and containment. Methods An expert panel (EP) defined a set of KPIs using evidence from a scoping review, stakeholder engagement, and expert consensus. Peer reviewed articles, high-quality grey literature and international and national standards were reviewed to identify existing measures for management. These findings were augmented by an exercise involving patients, caregivers, nurses, clinicians, payers, policy makers and care providers to prioritise the findings and identify additional areas of interest. Results The final set of 14 KPIs includes quality indicators of process and outcome for those managed with a toileting and containment strategy and is relevant for both care-independent and -dependent persons. Rates of assessment, days waiting for specialist assessment, rates of return to work and those rating their quality of life as good or acceptable are captured. An indicator of well-being for caregivers and the economic costs of poor care are also defined. Conclusions The set of KPIs to measure outcomes from toileting and containment strategies describes the components of each to encourage integration into existing quality frameworks. Each KPI has been refined and detailed to encourage this. If implemented, resulting benchmarking data will facilitate care quality improvement and inform value-based care procurement and provision of toileting and containment strategies. Electronic supplementary material The online version of this article (10.1007/s00192-018-3768-2) contains supplementary material, which is available to authorized users
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Affiliation(s)
- Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Division of Geriatric Medicine, University of Alberta, 1-198, Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2P4, Canada.
| | - Dianne Gove
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Kai Leichsenring
- European Centre for Social Welfare Policy and Research Vienna, Vienna, Austria
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
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Milne R, Bunnik E, Tromp K, Bemelmans S, Badger S, Gove D, Maman M, Schermer M, Truyen L, Brayne C, Richard E. Ethical Issues in the Development of Readiness Cohorts in Alzheimer's Disease Research. J Prev Alzheimers Dis 2018; 4:125-131. [PMID: 29186282 DOI: 10.14283/jpad.2017.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is growing interest in the development of novel approaches to secondary prevention trials in Alzheimer's disease to facilitate screening and recruitment of research participants and to reduce the time and costs associated with clinical trials. Several international research collaborations are setting up research infrastructures that link existing research cohorts, studies or patient registries to establish 'trial-ready' or 'readiness' cohorts. From these cohorts, individuals are recruited into clinical trial platforms. In setting up such research infrastructures, researchers must make ethically challenging design decisions in at least three areas: re-contacting participants in existing research studies, obtaining informed consent for participation in a readiness cohort, and disclosure of Alzheimer's disease-related biomarkers. These ethical considerations have been examined by a dedicated workgroup within the European Prevention of Alzheimer's Dementia (EPAD) project, a trans-European longitudinal cohort and adaptive proof-of-concept clinical trial platform. This paper offers recommendations for the ethical management of re-contact, informed consent and risk disclosure which may be of value to other research collaborations in the process of developing readiness cohorts for prevention trials in Alzheimer's disease and other disease areas.
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Affiliation(s)
- R Milne
- Richard Milne, PhD, Institute of Public Health, University of Cambridge, 2 Wort's Causeway Cambridge, UK, CB1 8RN, , 0044 (0)1223 761912
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Thorogood A, Mäki‐Petäjä‐Leinonen A, Brodaty H, Dalpé G, Gastmans C, Gauthier S, Gove D, Harding R, Knoppers BM, Rossor M, Bobrow M. Consent recommendations for research and international data sharing involving persons with dementia. Alzheimers Dement 2018; 14:1334-1343. [DOI: 10.1016/j.jalz.2018.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Anna Mäki‐Petäjä‐Leinonen
- Faculty of Social Sciences and Business StudiesLaw SchoolUniversity of Eastern FinlandJoensuuFinland
| | - Henry Brodaty
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Gratien Dalpé
- Centre of Genomics and PolicyMcGill UniversityMontrealCanada
| | - Chris Gastmans
- Interfaculty Centre for Biomedical Ethics and LawKU LeuvenLeuvenBelgium
| | - Serge Gauthier
- McGill Centre for Studies in AgingMcGill UniversityMontrealCanada
| | | | - Rosie Harding
- Birmingham Law SchoolUniversity of BirminghamBirminghamUnited Kingdom
| | | | - Martin Rossor
- UCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Martin Bobrow
- Department of Medical GeneticsUniversity of CambridgeCambridgeUnited Kingdom
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Øksnebjerg L, Diaz-Ponce A, Gove D, Moniz-Cook E, Mountain G, Chattat R, Woods B. Towards capturing meaningful outcomes for people with dementia in psychosocial intervention research: A pan-European consultation. Health Expect 2018; 21:1056-1065. [PMID: 29920881 PMCID: PMC6250864 DOI: 10.1111/hex.12799] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Accepted: 04/29/2018] [Indexed: 01/10/2023] Open
Abstract
Background People with dementia are often marginalized and excluded from influence, also in relation to dementia research. There is, however, a growing requirement for inclusion through Patient and Public Involvement (PPI), but there is still limited knowledge on how researchers can fully benefit from the involvement of people with dementia in the development and testing of psychosocial interventions. This paper describes the results of a pan‐European consultation with people with dementia, synthesizing their views on outcomes of psychosocial interventions. Objective To involve people with dementia in establishing what are meaningful outcomes when participating in psychosocial interventions. Setting and participants Consultations took place at four divergent sites across Europe, involving twenty‐five people with dementia from nine European countries. Methods The methods used for the consultation were developed through an iterative process involving people with dementia. Data from the consultation were analysed from a thematic analysis approach. Results The results suggested that people with dementia wish to participate in interventions that enhance their well‐being, confidence, health, social participation and human rights. This highlights a need for improvements in psychosocial research to capture these outcomes. Discussion and conclusions Involving people with dementia in discussions of psychosocial interventions has enhanced our understanding about meaningful outcome measures in research and methods of data collection. This study suggests that new outcome measures in psychosocial research are needed where concepts of positive psychology and social health can guide innovation and outcome measurement.
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Affiliation(s)
- Laila Øksnebjerg
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Esme Moniz-Cook
- School of Health and Social Work, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Rabih Chattat
- Dipartimento di Psicologia, University of Bologna, Bologna, Italy
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
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Gove D, Diaz-Ponce A, Georges J, Moniz-Cook E, Mountain G, Chattat R, Øksnebjerg L. Alzheimer Europe's position on involving people with dementia in research through PPI (patient and public involvement). Aging Ment Health 2018; 22:723-729. [PMID: 28513210 DOI: 10.1080/13607863.2017.1317334] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [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: 10/19/2022]
Abstract
This paper reflects Alzheimer Europe's position on PPI (patient and public involvement) in the context of dementia research and highlights some of the challenges and potential risks and benefits associated with such meaningful involvement. The paper was drafted by Alzheimer Europe in collaboration with members of INTERDEM and the European Working Group of People with Dementia. It has been formally adopted by the Board of Alzheimer Europe and endorsed by the Board of INTERDEM and by the JPND working group 'Dementia Outcome Measures - Charting New Territory'. Alzheimer Europe is keen to promote the involvement of people with dementia in research, not only as participants but also in the context of PPI, by generating ideas for research, advising researchers, being involved in consultations and being directly involved in research activities. This position paper is in keeping with this objective. Topics covered include, amongst others, planning involvement, establishing roles and responsibilities, training and support, managing information and input from PPI, recognising the contribution of people with dementia involved in research in this way, promoting and protecting the rights and well-being of people with dementia, training and support, and promoting an inclusive approach and the necessary infrastructure for PPI in dementia research.
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Affiliation(s)
- Dianne Gove
- a Alzheimer Europe , Luxembourg , Luxembourg
| | | | | | - Esme Moniz-Cook
- b Faculty of Health & Social Care , University of Hull , Hull , United Kingdom
| | - Gail Mountain
- c School of Dementia Studies , University of Bradford , Bradford , United Kingdom
| | - Rabih Chattat
- d Dipartimento di Psicologia , University of Bologna , Bologna , Italy
| | - Laila Øksnebjerg
- e Danish Dementia Research Centre, Copenhagen University Hospital , University of Copenhagen , Copenhagen , Denmark
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- a Alzheimer Europe , Luxembourg , Luxembourg
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Milne R, Bunnik E, Diaz A, Richard E, Badger S, Gove D, Georges J, Fauria K, Molinuevo JL, Wells K, Ritchie C, Brayne C. Perspectives on Communicating Biomarker-Based Assessments of Alzheimer's Disease to Cognitively Healthy Individuals. J Alzheimers Dis 2018; 62:487-498. [PMID: 29480179 PMCID: PMC5836405 DOI: 10.3233/jad-170813] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
In clinical trials which target pathophysiological mechanisms associated with Alzheimer's disease, research participants who are recruited based on biomarker test results should be informed about their increased risk of developing Alzheimer's dementia. This paper presents the results of a qualitative focus group study of attitudes and concerns toward learning information about biomarker-based risk status among healthy research participants in the United Kingdom and Spain and people with dementia and their supporters/caregivers from countries represented in the European Working Group of People with Dementia of Alzheimer Europe. The study identified expectations related to learning risk status and preferences related to the content, quality, and follow-up of the disclosure process. The latter emphasize distinctions between risk and diagnoses, the importance of clear information about risk, and suggestions for risk reduction, as well as expectations for follow up and support. The implications of these preferences for practice are discussed. Providing details of research participants' experience and views may serve as a guide for the development of processes for the responsible disclosure of Alzheimer's disease biomarkers.
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Affiliation(s)
- Richard Milne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Eline Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shirlene Badger
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Karine Fauria
- BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Jose-Luis Molinuevo
- BarcelonaBeta Brain Research Centre, Fundació Pasqual Maragall, Barcelona, Spain
| | - Katie Wells
- Centre of Mental Health, Imperial College London, London, UK
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Gove D, Diaz-Ponce A, Georges J. Palliative care covers more than end-of-life issues: why is this not common practice in dementia care and what are the implications? Ann Palliat Med 2017; 6:390-392. [PMID: 28754050 DOI: 10.21037/apm.2017.06.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022]
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Tromp K, Bunnik E, Milne R, Badger S, Gove D, Maman M, Truyen L, Richard E, Schermer M, Smedinga M. [P3–077]: AN ADAPTED STAGED CONSENT MODEL FOR RECRUITMENT AND INFORMED CONSENT IN READINESS COHORTS: THE PERSPECTIVE OF THE EUROPEAN PREVENTION OF ALZHEIMER's DEMENTIA CONSORTIUM (EPAD). Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1287] [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: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | - Luc Truyen
- Janssen Research & Development, LLCTitusvilleNJUSA
| | - Edo Richard
- Radboud University Medical CenterNijmegenNetherlands
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Meiland F, Innes A, Mountain G, Robinson L, van der Roest H, García-Casal JA, Gove D, Thyrian JR, Evans S, Dröes RM, Kelly F, Kurz A, Casey D, Szcześniak D, Dening T, Craven MP, Span M, Felzmann H, Tsolaki M, Franco-Martin M. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics. JMIR Rehabil Assist Technol 2017; 4:e1. [PMID: 28582262 PMCID: PMC5454557 DOI: 10.2196/rehab.6376] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. OBJECTIVE The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. METHODS Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. RESULTS According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. CONCLUSIONS Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.
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Affiliation(s)
- Franka Meiland
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Anthea Innes
- Universities of Salford and Stirling UK, Manchester, Stirling, United Kingdom
| | - Gail Mountain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Louise Robinson
- Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - Henriëtte van der Roest
- Department of General Practice and Elderly Care Medicine, VU university medical centre, Amsterdam, Netherlands
| | - J Antonio García-Casal
- Iberian Research Psychosciences Institute, Psychosocial Rehabilitation Centre, Intras Foundation, Zamora, Spain
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock, Greifswald, Germany
| | - Shirley Evans
- Association for Dementia Studies, University of Worcester, Worcester, United Kingdom
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Fiona Kelly
- Centre for Person-centred Practice Research, Queen Margaret University, Edinburgh, United Kingdom
| | | | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michael P Craven
- NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
- Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Marijke Span
- Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Magda Tsolaki
- Memory and dementia outpatient clinic, 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manuel Franco-Martin
- Iberian Research Psychosciences Institute, Psychiatric Department in Zamora Hospital, Salamanca University, Zamora, Spain
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Dröes RM, Chattat R, Diaz A, Gove D, Graff M, Murphy K, Verbeek H, Vernooij-Dassen M, Clare L, Johannessen A, Roes M, Verhey F, Charras K. Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice. Aging Ment Health 2017; 21:4-17. [PMID: 27869503 DOI: 10.1080/13607863.2016.1254596] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [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: 10/20/2022]
Abstract
BACKGROUND Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. METHOD Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). RESULTS The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. CONCLUSION A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.
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Affiliation(s)
- R M Dröes
- a Department of Psychiatry, Alzheimer Centre , EMGO Institute for Health and Care Research, VU University Medical Centre , Amsterdam , The Netherlands
| | - R Chattat
- b Department of Psychology , University of Bologna , Bologna , Italy
| | - A Diaz
- c Alzheimer Europe , Luxembourg , Luxembourg
| | - D Gove
- c Alzheimer Europe , Luxembourg , Luxembourg
| | - M Graff
- d Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud Alzheimer Centre , Nijmegen , The Netherlands
| | - K Murphy
- e School of Nursing and Midwifery, Aras Loyola, National University of Irelands , Galway , Ireland
| | - H Verbeek
- f Research School CAPHRI, Department of Health Services Research , Maastricht University , Maastricht , The Netherlands
| | - M Vernooij-Dassen
- d Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud Alzheimer Centre , Nijmegen , The Netherlands
| | - L Clare
- g Centre for Research in Ageing and Cognitive Health (REACH) , School of Psychology, University of Exeter, and PenCLAHRC, University of Exeter Medical School , Exeter , United Kingdom
| | - A Johannessen
- h Norwegian National Advisory Unit on Ageing and Health , VID Specialized University , Oslo , Norway
| | - M Roes
- i German Center for Neurodegenerative Diseases, Department of Nursing Science, Faculty of Health , University of Witten/Herdecke , Witten , Germany
| | - F Verhey
- j Department of Psychiatry and Neuropsychology , Maastricht University , Maastricht , The Netherlands
| | - K Charras
- k Fondation Médéric Alzheimer , Psychosocial Interventions Department , Paris , France
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Di Lorito C, Birt L, Poland F, Csipke E, Gove D, Diaz-Ponce A, Orrell M. A synthesis of the evidence on peer research with potentially vulnerable adults: how this relates to dementia. Int J Geriatr Psychiatry 2017; 32:58-67. [PMID: 27633160 DOI: 10.1002/gps.4577] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited literature around peer research in dementia. This study aims to identify the benefits, the risks and the practical challenges and to develop a model of good practice in peer research with people with dementia. METHODS We searched on PsycInfo, PubMed and Google Scholar for empirical investigations or discussion papers on peer research. Given the limited literature in the field of dementia, we included studies with groups who share similar demographics (older people), experience of stigma (mental health service users) and exclusion from research (people with learning disabilities). We applied no restrictions on language and publication date. ANALYSIS We identified three themes: the potential benefits, the potential risks and the practical challenges of peer research. We developed a model of good practice. The European Working Group of People with Dementia reviewed our paper and added to our findings. RESULTS We included seven papers. Potential benefits of peer research included enriched data and empowering people with dementia. Potential risks included power differentials between researchers and issues of representativeness. The practical issues for good practice included the training of peer researchers, defining involvement and roles, working with cognitive impairment and considering resource implications. The European Working Group of People with Dementia emphasised the importance of equality issues. CONCLUSION Involving people with dementia in peer research can generate several benefits, including empowerment and opportunities for inclusion for the peer researchers and the research participants living with dementia, challenging academics' traditional views on research processes and gathering enhanced research data. There remains a need for further research on the impact of peer research in dementia studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Claudio Di Lorito
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - 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
| | - Emese Csipke
- Division of Psychiatry, University College London, London, UK
| | | | | | - Martin Orrell
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
OBJECTIVES General practitioners (GPs) are crucial to improving timely diagnosis, but little is reported about how they perceive dementia, and whether their perceptions display any elements of stigma. The aim of this study was to explore how GPs' perceptions of dementia map onto current conceptualizations of stigma and whether GPs feel that stigma affects timely diagnosis. METHODS Twenty-three GPs from England were interviewed by telephone. Data were analyzed by means of content analysis. This involved open coding followed by the application of a coding framework derived from the literature to explore how and to what extent their perceptions relate to stigma as well as the unique nature of their perceptions. RESULTS Three themes emerged from the analysis: (1) 'making sense of dementia', (2) 'relating perceptions of dementia to oneself' and (3) 'considering the consequences of dementia'. GPs' perceptions of dementia mapped onto current conceptualizations of stigma. Perceptions about dementia that were linked to their own existential anxiety and to a perceived similarity between people with dementia and themselves were particularly salient. GPs perceived dementia as a stigma which was gradually being overcome but that stigma still hindered timely diagnosis. They provided examples of structural discrimination within the health service, including lack of time for patients and shortcomings in training that were to the detriment of people with dementia. CONCLUSION Measures to involve GPs in tackling stigma should include training and opportunities to explore how they perceive dementia, as well as support to address structural discrimination.
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Affiliation(s)
- D Gove
- a Alzheimer Europe , Luxembourg
| | - M Downs
- b School of Dementia Studies, Faculty of Health Studies , University of Bradford , Bradford , United Kingdom
| | - M Vernooij-Dassen
- c Scientific Institute for Quality of Healthcare (IQ Healthcare) , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
| | - N Small
- d Faculty of Health Studies , University of Bradford , Bradford , United Kingdom
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Gove D, Scerri A, Georges J, van Houten P, Huige N, Hayder-Beichel D, Leichsenring K, Morris VC. Continence care for people with dementia living at home in Europe: a review of literature with a focus on problems and challenges. J Clin Nurs 2016; 26:356-365. [PMID: 27626773 DOI: 10.1111/jocn.13582] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To report the findings of a review of literature relating to the continence care of community-dwelling people with dementia in Europe. BACKGROUND More than two-thirds of people with dementia live at home, and many experience continence problems. Incontinence is a significant contributor towards institutionalisation. Care and support is often inadequate or inappropriate, and guidelines are lacking. This represents a failure to respect the human rights and dignity of this group. DESIGN A structured review of the literature relating to the continence care of community-dwelling people with dementia in Europe with a focus on problems and challenges. METHODS Search terms reflecting dementia, continence, care/management and guidelines for community-dwelling people with dementia were applied to four databases. Hand-searching was also carried out. A total of 208 articles were searched for content relating to problems and challenges linked to continence care for this group. RESULTS Six relevant articles were fully reviewed. The main difficulties and challenges included the following: (1) perceptions, (2) availability/provision of support and care, (3) financial cost, (4) mobility and the environment, (5) relationships and social inclusion and (6) emotional issues. CONCLUSION Dementia and incontinence have profound effects on quality of life. The dearth of good quality data within this area and the findings of the review confirm the need for expert, consensus-based guidelines and appropriate research to ensure that the rights and dignity of people with dementia are respected. RELEVANCE TO CLINICAL PRACTICE The findings of the review will hopefully raise awareness amongst healthcare professionals in community practice of unmet needs of people with dementia and continence problems, and their caregivers, especially those related to social, financial, emotional and relational issues. The review does not provide solutions or guidance but is helpful in highlighting some of the key areas where special attention is needed.
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Affiliation(s)
- Dianne Gove
- Alzheimer Europe, Luxembourg City, Luxembourg
| | - Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | | | | | - Nicole Huige
- SCA Global Hygiene Category - Incontinence Care, Mölndal, Sweden
| | | | - Kai Leichsenring
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Vikky Christina Morris
- Royal College of Physicians, British Geriatric Society, Musgrove Park Hospital, Taunton, Somerset, UK
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Abstract
The way we perceive and portray dementia has implications for how we act towards people with dementia and how we address the issue of dementia within society. As a multi-disciplinary working group, established within the framework of the European Dementia Ethics Network of Alzheimer Europe, we aimed to describe the different ways that people with dementia are perceived and portrayed within society and to consider the moral implications of this. In the current paper, we address perceptions of dementia as reflected in explanatory models of its cause and nature, descriptions of characteristics of people with dementia, the use of language, media portrayals and the views of people living with dementia. Academics and professionals could use this exploration to reflect on their behaviour and their use of language regarding people with dementia.
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Affiliation(s)
- Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen; Radboudumc Alzheimer Centre; Joachim en Anna, centre for specialized geriatric care, Nijmegen, the Netherlands
| | - Jan Oyebode
- School of Dementia Studies, University of Bradford, Bradford, BD7 1DP, UK
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Abstract
A qualitative exploration of the stigma of dementia reported that general practitioners described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this article, we explore whether general practitioners perceive people with dementia as lacking reciprocity and, if so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. Our approach is to follow the thread of reciprocity in the data from our initial study. In this follow-up study, general practitioners’ perceptions of societal views of people with dementia included a perception of a lack of reciprocity specifically linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden on, society. General practitioners reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia, and lack of opportunities for people with dementia to reciprocate. General practitioners occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasize the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.
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Smets T, Deliens L, Payne S, Gambassi G, Finne-Soveri U, Szczerbinska K, Onwuteaka-Philipsen B, Vernooij-Dassen M, Van den Noortgate N, Aarendonk D, Parent A, Gove D, van den Block L. P091: Comparing the effectiveness of an intervention to improve palliative care for older people in long term care facilities in Europe (PACE), an EU funded project. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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van der Steen JT, Radbruch L, Hertogh CMPM, de Boer ME, Hughes JC, Larkin P, Francke AL, Jünger S, Gove D, Firth P, Koopmans RTCM, Volicer L. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med 2014; 28:197-209. [PMID: 23828874 DOI: 10.1177/0269216313493685] [Citation(s) in RCA: 552] [Impact Index Per Article: 55.2] [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: 11/16/2022]
Abstract
BACKGROUND Dementia is a life-limiting disease without curative treatments. Patients and families may need palliative care specific to dementia. AIM To define optimal palliative care in dementia. METHODS Five-round Delphi study. Based on literature, a core group of 12 experts from 6 countries drafted a set of core domains with salient recommendations for each domain. We invited 89 experts from 27 countries to evaluate these in a two-round online survey with feedback. Consensus was determined according to predefined criteria. The fourth round involved decisions by the core team, and the fifth involved input from the European Association for Palliative Care. RESULTS A total of 64 (72%) experts from 23 countries evaluated a set of 11 domains and 57 recommendations. There was immediate and full consensus on the following eight domains, including the recommendations: person-centred care, communication and shared decision-making; optimal treatment of symptoms and providing comfort (these two identified as central to care and research); setting care goals and advance planning; continuity of care; psychosocial and spiritual support; family care and involvement; education of the health care team; and societal and ethical issues. After revision, full consensus was additionally reached for prognostication and timely recognition of dying. Recommendations on nutrition and dehydration (avoiding overly aggressive, burdensome or futile treatment) and on dementia stages in relation to care goals (applicability of palliative care) achieved moderate consensus. CONCLUSION We have provided the first definition of palliative care in dementia based on evidence and consensus, a framework to provide guidance for clinical practice, policy and research.
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Affiliation(s)
- Jenny T van der Steen
- 1Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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Gove D, Sparr S, Dos Santos Bernardo AMC, Cosgrave MP, Jansen S, Martensson B, Pointon B, Tudose C, Holmerova I. Recommendations on end-of-life care for people with dementia. J Nutr Health Aging 2010; 14:136-9. [PMID: 20126962 DOI: 10.1007/s12603-009-0229-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To establish, in collaboration with national Alzheimer Societies in Europe, practical and consensual recommendations for the end-of-life care of people with dementia. The aim of these recommendations is to provide a basis for understanding and action with regard to end-of-life care not only for family caregivers but also for professionals, policy makers and anyone with an interest in palliative care. DESIGN A literature review was carried out by Alzheimer Europe in collaboration with a working group comprised of people from different backgrounds such as family caregivers, physicians, palliative care nurses and members of Alzheimer associations, who also prepared the draft recommendations during 4 sessions. These recommendations were then discussed with external experts and sent to Alzheimer Europe's member associations to be broadly discussed within their countries until a consensus was reached. SETTING Alzheimer Europe is an umbrella association of European Alzheimer societies with 34 member associations in 30 different countries. SUBJECTS Not applicable. METHODS Literature review, workshops, dissemination by e-mail and during conferences, consensus finding. RESULTS At the end of 2008, Alzheimer Europe prepared written recommendations on good end-of-life care for people with dementia. We are aware that this topic is challenging and that there is therefore a need for further discussion. CONCLUSION In this article we aim to present these recommendations and to invite professionals to consider these important issues and to contribute towards a broader discussion.
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Affiliation(s)
- D Gove
- Alzheimer Europe, 145 route de Thionville, Luxembourg, Luxembourg
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Katona C, Chiu E, Adelman S, Baloyannis S, Camus V, Firmino H, Gove D, Graham N, Ghebrehiwet T, Icelli I, Ihl R, kalasic AM, Leszek J, Kim SYH, Lima CADM, Peisah C, Tataru N, Warner J. Declaração de consenso da seção de psiquiatria geriátrica da Associação Mundial de Psiquiatria sobre ética e capacidade em pessoas idosas com doença mental. ARCH CLIN PSYCHIAT 2010. [DOI: 10.1590/s0101-60832010000400003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Katona C, Chiu E, Adelman S, Baloyannis S, Camus V, Firmino H, Gove D, Graham N, Ghebrehiwet T, Icelli I, Ihl R, Kalasic A, Leszek L, Kim S, Lima CDM, Peisah C, Tataru N, Warner J. World psychiatric association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disorders. Int J Geriatr Psychiatry 2009; 24:1319-24. [PMID: 19472302 DOI: 10.1002/gps.2279] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The World Psychiatric Association (WPA) Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older people with mental disorders, which was completed in Prague, September 2008, prior to the World Congress in Psychiatry. This Consensus meets one of the goals of the WPA Action Plan 2008-2011, "to promote the highest ethical standards in psychiatric practice and advocate the rights of persons with mental disorders in all regions of the world". This Consensus Statement offers to mental health clinicians caring for older people with mental disorders, caregivers, other health professionals and the general public the setting out of and discourse in ethical principles which can often be complex and challenging, supported by practical guidance in meeting such ethical needs and standards, and to encouraged good clinical practice.
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Affiliation(s)
- C Katona
- Department of Mental Health Science, University College of London, UK
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Abstract
This article focuses on the main legal provisions in Europe relating to the protection and rights of people with dementia. The information referred to was obtained in the framework of two EC funded projects, which involved the collection, translation and comparison of relevant legislation, and then the writing of legal recommendations to improve the legal rights and protection of people with dementia. The first project started in 1997 and was completed in 1999. The second project started in 1999 and was completed in November 2000. The article provides an overview of the main features of some of the laws in Europe on a few key issues, i.e. guardianship, coercive measures and bioethical issues. Some of the main differences between the systems in different countries are highlighted. An attempt is made to show how the adequacy and appropriateness of legal provisions differ vastly from one country to the next and also to identify the emergence of a few trends, which seem to reflect a movement towards a greater awareness of the nature of mental incapacity and hence a better provision for the rights and protection of people with dementia.
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Affiliation(s)
- D Gove
- Alzheimer Europe, Luxembourg.
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Abstract
This paper presents an operational model of patient flow through a hospital. The operations involved in the patient flow are explained and the development and use of the model are discussed. The model uses the data derived from the NHS minimum contract data set which is collected by all hospitals, and this results in the model being generalizable to any hospital. Typically the model can be used to determine the appropriate bed numbers for a given arrival pattern, or the effects of particular management strategies or changes in patient care patterns on the hospital. The model is implemented on a PC running the Microsoft Windows operating environment, and solved used a simulation approach.
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Affiliation(s)
- D Gove
- Institute of Modelling for Healthcare, Faculty of Mathematical Studies, University of Southhampton, UK
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Fassett RG, Horgan B, Gove D, Mathew TH. Scanning electron microscopy of glomerular and non glomerular red blood cells. Clin Nephrol 1983; 20:11-6. [PMID: 6883816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Phase contrast microscopic examination of the urine has been recently shown to be of value in predicting whether hematuria is due to glomerulonephritis or lesions of the lower urinary tract. Glomerular red cells show variations in size and shape and have distorted surfaces. Non glomerular red cells are uniform in size and shape and have smooth surfaces. Scanning electron microscopy was performed on urine sediment containing either glomerular or non glomerular red cells to better define their surface characteristics. Glomerular red cells exhibited a variety of forms, most cells having lumpy projections from the surface, some showing fragmentation of the membrane and others showing gross distortion. In contrast non glomerular red cells show smooth surfaces and usually maintain the normal biconcave disc shape of peripheral red blood cells. Scanning electron microscopy can better define surface structural abnormalities of urinary glomerular and non glomerular red blood cells.
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