Dementia, spirituality and palliative care

Palmer, J. et al. | Research literature on the intersection of dementia, spirituality, and palliative care: A scoping review | Journal of Pain and Symptom Management | published online | January 2020

Abstract

Context

Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care.

Objectives

We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research.

Methods

The scoping review followed methods from The Joanna Briggs Institute Reviewers’ Manual (2015). We developed a priori a scoping review protocol outlining the Population, Concept and Context for study, data sources, search strategy, inclusion/exclusion criteria, and procedure for screening, extracting, and analyzing data.

Results

The final sample consisted of 19 studies with the following themes: Characterizing Spiritual Needs, Preferences, and Resources; Characterizing Palliative or Spiritual Care; Predicting Provision of Spiritual Care; and Assessing Spiritual Care Interventions. Eighteen studies were published in the past decade, and eleven were based in Europe. The majority of studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and in generalizability/ transferability and used less sophisticated research designs.

Conclusions

Research across dementia, spirituality, and palliative care needs to examine distinct stages of dementia, settings beyond long-term care, and formal spiritual care interventions plus utilize rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.

Dementia and housing

Dementia and Housing | Social Care Institutute for Excellence

dementia housing
image source: https://www.scie.org.uk/

The quality of life for someone living with dementia is affected by where and how they live. The Prime Minister’s Challenge on Dementia 2020 (2015) states that, by 2020 we wish to see an increased number of people with dementia being able to live longer in their own homes when it is in their interests to do so, with a greater focus on independent living.

Two-thirds of people with dementia live in the community in a range of different housing types. Most live in mainstream housing, with a third living on their own.

The British Standards Institute and the Alzheimer’s Society have developed a Code of Practice for the housing sector. It identifies key areas that will help to support people living with dementia. They include:

  • adaptations, built environment, design and access to outdoor space
  • assistive technologies, including telecare
  • training of all staff in the housing sector

Sometimes, simple changes made to an existing property can support the wellbeing and independence of someone with dementia, allowing them to remain in their home for longer, as well as reducing pressures on carers.

This resource from the Social Care Institutute for Excellence (SCIE) contains information and links on the subject of housing.

Full detail: Dementia and Housing | SCIE

Finding a life-changing treatment for dementia

Alzheimer’s Research UK has called on government to invest in six priority research areas, which will help to deliver a life-changing treatment for dementia

moonshot
Image source: https://www.alzheimersresearchuk.org/

In their 2019 manifesto, the Conservative party pledged to launch a “Dementia Moonshot” to find a cure for dementia – doubling research funding and speeding up trials for new treatments.

Alzheimer’ Research UK are now calling for action to deliver on those commitments. In this publication, Alzheimer’s UK puts forward the steps government must take to deliver its Moonshot ambition of finding a life-changing treatment for dementia.

 

 

These are:

  1. Find ways to detect the diseases that cause dementia 10-15 years earlier, to broaden the search for new treatments and intervene with those most at risk of developing dementia.
  2. Find ways to more effectively validate novel targets in early drug development to maximise chances of successful clinical trials.
  3. Make the UK the best place to conduct clinical dementia research.
  4. Expand research infrastructure to maintain the UK’s position as a world leader in dementia research.
  5. Further our understanding of dementia risk reduction and prevention and dementia in the context of multi-morbidities.

Full document: Delivering the Dementia Moonshot: A plan to find life-changing treatments 

Informal caregiving for dementia patients: the contribution of patient characteristics and behaviours to caregiver burden

Allen, A. P. et al. | Informal caregiving for dementia patients: the contribution of patient characteristics and behaviours to caregiver burden| Age and Ageing | Volume 49, Issue 1, January 2020 | Pages 52–56

Abstract
Objectives
The burden often associated with informal caregiving for patients with dementia is associated with negative effects on health, both physiologically and in terms of caregiver cognition. There is wide variation in the level of burden experienced by dementia caregivers. To better understand caregiver burden, it is thus important to understand the factors associated with level of burden.

Methods
In the current study, we collected carer burden and putative associated factors at baseline, 6 and 12 months. Hierarchical regression was used to assess the impact of these factors on caregiver burden. We assessed self-reported carer burden, patient behavioural and safety issues, and level of difficulty associated with providing assistance with activities of daily living (ADL). Patients’ age was also recorded, and trained nurses assessed patient cognitive performance using the quick mild cognitive impairment screen.

Results
At baseline, patients’ age, cognition and ADLs were associated with burden, and safety and challenging behaviour were both significantly associated with burden independent of the other factors. Change in burden was associated with change in carer-reported safety at 6-month follow-up, and with change in safety and change in carer-reported challenging behaviours at 12-month follow-up.

Conclusions
Safety issues and challenging behaviours are associated with carer burden, even after accounting for cognitive and functional impairment in the person with dementia. As dementia progresses, monitoring these factors may help to inform stress-management strategies for caregivers.

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