Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT #covid19rftlks

Gathercole, R., et al. | 2021| Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT| Health Technol Assess | 25| 19| P. 1-156. doi: 10.3310/hta25190. PMID: 33755548; PMCID: PMC8020444.

A randomised controlled trial (RCT) led by a team of researchers at the University of Bristol set out to determine if assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated.

The research team report that a full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare.

Plain Language Summary

Many people with dementia living at home are recommended assistive technology and telecare to help them remain living safely and independently in the community. These devices are meant to assist and support activities such as taking medication or cooking, or to raise an alert when there is an issue, such as a fire; however, there is currently little evidence to support such claims. This trial investigated whether or not assistive technology and telecare could delay people moving into residential care and keep them any safer than alternatives, and whether or not they were cost-effective. We recruited 495 people with dementia and their unpaid caregivers, who were randomly assigned to receive either a package of assistive technology and telecare recommended by a health or social care professional or alternative support involving only basic assistive technology and telecare. We monitored the residential status, the use of health-care services and the health and well-being of participants with dementia and their caregivers over a 2-year period. Researchers also spent time with participants to see how they were living with the technology. The trial found no difference in the time that people with dementia with full assistive technology and telecare remained at home, nor any reduction in the number of safety incidents, compared with the participants who received basic assistive technology and telecare only. Full assistive technology and telecare did not increase health and social care costs. It did not improve the well-being of people with dementia or that of their caregivers. People with dementia who had full assistive technology and telecare rated their quality of life poorer than those with basic assistive technology and telecare did, but their caregivers rated their quality of life as about the same as caregivers of people with basic assistive technology and telecare. The technology sometimes averted crises but also disrupted people’s everyday lives. These results suggest that assistive technology and telecare for people with dementia provided in real-world conditions may not be as beneficial as previously claimed. The way that assistive technology and telecare services are organised bears further investigation to see how these services could be improved.

Abstract availble Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT

Paper can be read from NCBI

Feeling fearful and lonely are indicative experiences of emotional distress for people with dementia

Gruber R, Schwanda MFeeling fearful and lonely are indicative experiences of emotional distress for people with dementiaEvidence-Based Nursing 2021;24:50-51.

Mixed-methods research set out to explore the following research questions as part of a review:

How can emotional distress be characterised for individuals with dementia?

What descriptions of emotional distress exist?

What explanations for emotional distress exist?’

The review found that, besides forgetfulness, feeling fearful, lonely, worried, angry or sad are additional psychological conditions in caring for people with dementia, which should not be overlooked. Feelings of fearfulness were the most frequently experienced for people with dementia.

This Commentary is published in BMJ title Evidence-Based Nursing 

The primary paper on which this commentary is based on an earlier study Emotional distress with dementia: A systematic review using corpus‐based analysis and meta‐ethnography, which is available from the International Journal of Geriatric Psychiatry

Being overweight is linked with an increased risk of dementia in new research

Ma,Y., Ajnakina, A, Steptoe, A. & Cadar, D. | 2021 | Higher risk of dementia in English older individuals who are overweight or obese| International Journal of Epidemiology | Volume 49|z Issue 4 P 1353–1365|  https://doi.org/10.1093/ije/dyaa099

Researchers involved in The English Longitudinal Study of Ageing (ELSA) investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia; to facilitate this they tracked more than 6 500 people aged over 50 for more than a decade. For those with obesity at the outset of the study, their risk of developing the syndrome increased by a third ( 34 per cent). None of the participants had dementia at baseline.

Almost 7 per cent of participants (n equal to 453) developed dementia. When compared with a normal BMI and waist circumference ( WC ) group, the obese and high WC group had 28% higher risk of dementia.

Nearly three quarters (74 per cent) of the participants who developed dementia were overweight or obese at baseline, in comparison with 72 per cent of those who were not diagnosed with dementia by the end of the study period.

Obesity and larger waist circumference were associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health associated with a higher dementia risk across a decade follow-up period, independent of demographics, lifestyle behaviours, apolipoprotein E-ε4, hypertension and diabetes

From the various modifiable risk factors, obesity could represent a target for intervention, and these findings have significant implications for public health and dementia prevention.

Abstract

Background

Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults.

Methods

We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged more than or equal to 50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (more than or equal to 30 kg/m2). Central obesity was defined as a waist circumference (WC) more than 88 cm for women and over 102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score more than 3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years.

Results

From the overall sample, 6.9% (n  equal to  453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes. Women with central obesity had a 39% greater risk of dementia compared with non-central obese women . When compared with a normal BMI and WC group, the obese and high WC group had 28 per cent higher risk of dementia.

Conclusions

Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

Primary paper is available in the International Journal of Epidemiology

The findings of this study are highlighted in a recent NIHR Signal Being overweight is linked with an increased risk of dementia in new research

Exercise & socialising might be more efficacious than medication for dementia patients with depression, reports systematic review #covid19rftlks

Watt, J. A. et al. | 2021 | Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis| BMJ | 372| n532| doi:10.1136/bmj.n532

This systematic review and network meta-analysis (NMA) compares the efficacy of drug interventions with non-drug interventions for reducing symptoms of depression in people with dementia.  The evidence showed that non-drug and multidisciplinary approaches are highly efficacious interventions from which people with dementia will derive benefit.

Non-drug approaches were associated with a meaningful reduction in symptoms of depression in people with dementia and without a diagnosis of a major depressive disorder. Drug approaches alone, however, were not more efficacious than usual care

Objective To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder.

Design Systematic review and meta-analysis.

Data sources Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020.

Eligibility criteria for study selection Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia.

Main outcome measures Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses.

Results Of 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference −2.93, 95% credible interval −4.35 to −1.52), cognitive stimulation combined with a cholinesterase inhibitor (−11.39, −18.38 to −3.93), massage and touch therapy (−9.03, −12.28 to −5.88), multidisciplinary care (−1.98, −3.80 to −0.16), occupational therapy (−2.59, −4.70 to −0.40), exercise combined with social interaction and cognitive stimulation (−12.37, −19.01 to −5.36), and reminiscence therapy (−2.30, −3.68 to −0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients).

Conclusions In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder.

Full paper available from The BMJ

See also:

BMJ Opinion Social prescribing may help reduce symptoms of depression in people with dementia

In the news

iNews Exercise could be better than medication for dementia patients with depression, report claims

Menu specifically for people living with dementia

The Academy of Fabulous Stuff | 25 March 2021| Menu specifically for people living with dementia

 A tasty new menu specifically for patients living with dementia has been launched by University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).

Dianne Smith, Dementia Matron for UHMBT, has been working closely with colleagues from the Catering Teams and Dietitians at all three of the Trust’s main hospital sites to develop a menu that is even more ‘dementia friendly’ for patients.

As people with dementia can often find it difficult to eat a full meal, Dianne and the team have revamped the existing menu and incorporated more tempting ‘finger foods’ and mouth-watering snacks. Dianne and collaegue Hannah presented their idea of menu for patients with dementia at the National Dementia Congress in Birmingham and the concept is now widely used to support patients living with dementia. Examples of options on the menu include  a ‘spicy box’ with samosas, onion bhajis and other treats, a ‘picnic plate’ with delicious sandwiches, mini quiches and more, as well as hot finger foods such as burgers and mini pies. 

Dianne said: “People living with dementia can find it hard to eat much at one time. Finger foods aren’t as over-facing as a three course meal. It helps people to be more independent and to feel relaxed. It also promotes self-care and makes meal times less challenging.

“It can be hard for people with dementia to use cutlery so finger foods are ideal. Finger foods help people to eat little and often which is more manageable for them and, together with snacks, it keeps up their calorie intake. We consulted with numerous people over the new menu and asked what they wanted. We’ve had great feedback from patients, families, carers and ward staff who have all said they like the options on the new menu.”

Adapted from news story Menu specifically for people living with dementia

Cochrane Systematic Review: Medicines to treat people with vascular dementia and other vascular cognitive impairments

Battle,  C.E., Abdul-Rahim,  A.H., Shenkin,  S.D., Hewitt,  J., Quinn,  T.J. Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: a network meta‐analysis. Cochrane Database of Systematic Reviews | Issue 2. Art. No.: CD013306. DOI: 10.1002/14651858.CD013306.pub2. Accessed 23 March 2021.

This systematic review explores the question: What is the evidence for cholinesterase inhibitors (medicines designed to improve memory and thinking in people with dementia), when used with people who have vascular dementia?

Plain Language Summary

The reviewers found 8 studies including a total of 4 373 people with vascular dementia (or vascular cognitive impairment). The studies tested the drug donepezil at two different doses (5mg and 10mg daily), against each other and against placebo. Rivastigmine and galantamine were tested against placebo only. Rivastigmine is available as a skin patch, but the studies only tested the pill version. All eight studies evaluated participants when they first started taking the medicine or placebo and again six months later. Different tests were used to measure the effects. All studies included tests of memory, thinking and reported side effects.

People taking donepezil or galantamine had better scores on memory and thinking tests than people taking placebo, but the benefits were modest and may not be large enough to be evident in daily life. 

There was no evidence of a difference for rivastigmine, but the evidence was less certain, and the doses taken by some participants may have been too low to show an effect. We found evidence that when compared to placebo, side effects such as nausea and diarrhoea, were more common in people taking donepezil 10mg and galantamine, but probably not donepezil 5mg. We were unable to draw conclusions about side effects of rivastigmine from the studies.

No vascular dementia trials comparing the different cholinesterase against each other have been conducted. Using the information from the individual studies, we made indirect assessments of how the drugs would perform if tested head‐to‐head. The results suggested that donepezil 10 mg had the greatest effect on memory and thinking, but caused more side effects than donepezil 5 mg or galantamine.

There were only a small number of studies for each drug. Certainty in the results varied between drugs and between outcomes, from high to very low certainty. The studies showed only a small benefit at most; however, in the absence of any other treatments, people living with dementia may still wish to consider use of these drugs.

The review is available in full from the Cochrane Database of Systematic Reviews 

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis

Yeh, S.W. et al. | 2021 | High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis | Clin Rehabilation | 35| 2 | P.169-181| doi: 10.1177/0269215520961637. Epub 2020 Oct 11. PMID: 33040592.

Abstract

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer’s program.

Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer’s program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer’s program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

For access to the full paper contact The Library & Knowledge Service

NIHR: low-cost video technology may help care home residents feel more connected to peers

NIHR | March 2021 | Virtual quizzes involving several care homes are feasible and might reduce loneliness and social isolation

Twenty-two care home residents, from three homes, volunteered to take part in virtual quizzes (8), which included conversation of around fifteen minutes duration before 20 straightforward quiz questions. Care staff helped to facilitate, Skype TV was used in most cases and residents took it in turns to use webcams.

Participants talked about ‘our home’s pride’ and ‘top star’ residents who could answer questions. Many residents participated in multiple sessions and some who initially observed took part in later sessions.

Four themes emerged from interviews with staff and residents:

  1. Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
  2. Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
  3. Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
  4. The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.

Full details are available from the NIHR Alert

Primary paper by Zamir et al, 2021 is avaialble from Geriatrics

Hearing aids may protect against progression to dementia, study shows

Ulster University | 16 February 2021 | Hearing aids may protect against progression to dementia, study shows

The journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions, has this week published a paper which is the first to examine the effect of the use of hearing aids on the conversion from mild cognitive impairment (MCI) to dementia and risk of death. An international team of scientists led by an academic at Ulster Universiity, Dr Magda Bucholc, analysed data from the National Alzheimer’s Coordinating Center (NACC). A little over 2 000 adults aged 50 and over with hearing impairments participated in this piece of research. Their cognitive status ranged from MCI to dementia. This study is novel as it is the first of its kind to . MCI involves decline in cognitive abilities greater than normal age-related changes but not severe enough to meet diagnostic criteria for dementia. Many individuals with MCI do not progress to dementia and may even regain normal cognitive ability.

The experts tested if the use of hearing aids is independently associated with a decreased risk of incident all‐cause dementia diagnosis for MCI patients and reduced risk of death in individuals with dementia. This study also examined if the rate of cognitive decline is slower for hearing aid users when compared to those not using hearing aids.

They report that among hearing‐impaired adults, hearing aid use was independently associated with reduced dementia risk have (Sources: University of Ulster; Bucholc et al, 2021).

Primary paper Association of the use of hearing aids with the conversion from mild cognitive impairment to dementia and progression of dementia: A longitudinal retrospective study

University of Ulster [press release] Hearing aids may protect against progression to dementia, study shows