Are large simple trials for dementia prevention possible?

William N Whiteley et al. | Are large simple trials for dementia prevention possible? | Age and Ageing | published 12th December 2019

  • Large simple trials have transformed care for heart attack and stroke. Lessons from these trials may be applicable to dementia prevention.
  • The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge. The reliable identification of higher risk populations is difficult but will be important.
  • Patients and families prioritise loss of function. Loss of functional abilities or clinical dementia are infrequent, but might be measured with lower variability than cognitive scores.

Abstract

New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention.Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials.

The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.

Full article: Are large simple trials for dementia prevention possible?

A good CHAT boosts quality and saves money in dementia care

A nurse-led service aimed at providing more care for care home residents with dementia outside hospital has produced big savings and improved patient care – winning national endorsement from NHS England | Primary Care Commissioning

As well as providing expert care to the residents, the Enfield Care Home Assessment Team (CHAT)  supports and trains care home staff – giving them the confidence to respond to the residents’ needs and easier access to healthcare services when needed.

Having started as a pilot in four care homes in 2011, CHAT now supports 41 homes across Enfield and the neighbouring London borough of Haringey.  Its membership  draws together mental and physical health expertise – including community matrons, geriatricians, a consultant psychiatrist, mental health nurses, occupational therapists, a phlebotomist and pharmacists. The sense of integrated care is underlined by close partnerships with primary care, frailty networks and a tissue viability service.

Full story at Primary Care Commissioning

A less healthy lifestyle increases the risk of dementia

The less healthy your lifestyle, the more you are at risk of developing dementia in later life, a new systematic review has shown. Researchers analysed the results of 18 studies with over 44,000 participants | BMJ Open | via National Institute for Health research

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Having two or more ‘modifiable risk factors’, including smoking, high blood pressure, poor diet, inactivity, obesity and excessive alcohol consumption, puts adults at greater risk of developing dementia.

The included studies followed up people without signs of cognitive decline to see who developed dementia of any cause.

A third of the studies could be combined in a meta analysis and these showed a 20% increase in the risk of dementia for one risk factor, which rose to 65% for two risk factors. The presence of three risk factors doubled the risk of dementia.

There was also a reduction in risk conveyed by having fewer risk factors and this, despite any direct evidence from intervention trials, holds out hope that interventions which either reduce or remove risk will lead to a reduction in the incidence of dementia diagnoses.

These results are consistent with our growing knowledge of the links between unhealthy lifestyles and dementia and are highly relevant to the promotion of healthy ageing behaviours in mid-life and beyond,  providing a compelling call to action in terms of public health and ageing.

Further detail at National Institute for Health Research

Full reference: Peters R, Booth A, Rockwood K et al. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. | BMJ Open | 2019 | 9:e022846.

Dementia care costs to nearly treble in next two decades

This report, commissioned by Alzheimer’s Society, provides projections of the number of older people (aged 65 and over) living with dementia and the costs of health care, social care and unpaid care for older people living with dementia from 2019 to 2040 in the UK | story via London School of Economics and Political Science 

The cost of social care for people living with dementia will nearly treble by 2040, according to a new report by the Care Policy and Evaluation Centre (CPEC).

The research shows that by 2040, while the number of people living with dementia in the UK is expected to nearly double (to 1.6 million), the cost of social care is expected to almost triple, increasing from £15.7 to £45.4 billion. It falls to people living with dementia and their families to pay the majority of these costs.

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Image source: http://www.lse.ac.uk/

 

The study also estimates that families are providing £13.9 billion a year in unpaid care for people living with dementia. This is also projected to increase to £35.7 billion by 2040.

The total cost of dementia to the UK economy has risen to £34.7 billion and will continue to rise to £94.1 billion by 2040. This includes costs to the NHS, paid social care and unpaid care.

 
Full research paper: Projections of Older People Living with Dementia and Costs of Dementia Care in the United Kingdom, 2019–2040 | CPEC Working Paper 5 | Raphael Wittenberg, Bo Hu, Luis Barraza-Araiza, Amritpal Rehill

See also: Dementia care costs to nearly treble in next two decades | London School of Economics and Political Science

Dementia: comorbidities in patients

Analysis of primary care data relating to other health conditions that patients with dementia live with in England | Public Health England

NHS England has published a data briefing on the analysis of a sample of primary care records of patients with dementia, relating to their other health conditions (comorbidities).

It examines whether:

  • patients with dementia are more likely to have comorbidities
  • patients with dementia are more likely to have multiple comorbidities
  • different subtypes of dementias lead to different patterns of comorbidities

The comorbidities considered in this study are conditions that:

  • can increase the risk of dementia such as hypertension, coronary heart disease (CHD) and diabetes
  • are associated with dementia such as stroke or transient ischaemic attack (stroke or TIA), depression, Parkinsonism, epilepsy, severe mental illness or psychosis (SMI)
  • are physical conditions not directly associated with dementia – such as asthma and chronic obstructive pulmonary disease (COPD)

The briefing asks commissioners and health and care providers to consider the plans they have in place to diagnose and treat the other conditions that people living with dementia experience, particularly those living with more severe dementias.

They should also consider how multiple morbidities can be successfully managed in a comprehensive personal care plan, as outlined in the NHS Long Term Plan, to improve health outcomes and provide better support – with an active focus on supporting people in the community.

Full detail: Dementia: comorbidities in patients – data briefing

An audit of dementia education and training in UK health and social care

Smith, S. et al. | An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards | BMC Health Services Research | volume 19, Article number 711 (2019)

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Abstract

Background

Despite people living with dementia representing a significant proportion of health and social care users, until recently in the United Kingdom (UK) there were no prescribed standards for dementia education and training. This audit sought to review the extent and nature of dementia education and training offered to health and social care staff in the UK against the standards described in the 2015 Dementia Training Standards Framework, which describes the knowledge and skills required of the UK dementia workforce.

Methods

This audit presents national data concerning the design, delivery, target audience, length, level, content, format of training, number of staff trained and frequency of delivery within existing dementia training programmes offered to health and social care staff. The Dementia Training Standards Framework was used as a reference for respondents to describe the subjects and learning outcomes associated with their training.

Results

The findings are presented from 614 respondents offering 386 training packages, which indicated variations in the extent and quality of training. Many training packages addressed the subjects of ‘person-centred care’, ‘communication’, ‘interaction and behaviour in dementia care’, and ‘dementia awareness’. Few training packages addressed subjects concerning ‘pharmacological interventions in dementia care’, ‘leadership’ and ‘end of life care’. Fewer than 40% of The Dementia Training Standards Framework learning outcomes targeted to staff with regular contact with people with dementia or in leadership roles were covered by the reported packages. However, for training targeted at increasing dementia awareness more than 70% of the learning outcomes identified in The Dementia Training Standards Framework were addressed. Many training packages are not of sufficient duration to derive impact; although the majority employed delivery methods likely to be effective.

Conclusions

The development of new and existing training and education should take account of subjects that are currently underrepresented and ensure that training reflects the Training Standard Framework and evidence regarding best practice for delivery. Lessons regarding the limitations of training in the UK serve as a useful illustration of the challenge of implementing national dementia training standards; particularly for countries who are developing or have recently implemented national dementia strategies.

Full article: An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards

Person-centered dementia care in acute hospital wards

Anthony Scerri et al. | Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes | Geriatric Nursing | available online 17 October 2019

Highlights

  • Achieving person-centered dementia care in hospitals is challenging for staff partly due to their lack of educational preparation.
  • Only 40% of participants (hospital staff) had previous training in dementia.
  • The more the staff were knowledgeable about dementia, the more critical they were about the level of person-centered care they delivered.
  • The more positive were the attitudes of the staff towards persons with dementia, the more they perceived were individualizing their care.

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Abstract

Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices.

A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards.

The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices.

The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.

Full detail at ScienceDirect