Reducing anxiety, agitation, and aggression in older people with dementia

Wendy Moyle et al. | Can lifelike baby dolls reduce symptoms of anxiety, agitation, or aggression for people with dementia in long-term care? Findings from a pilot randomised controlled trial | Aging & Mental Health | Published online: 24 November 2018

Abstract
Objectives: To compare a lifelike baby doll intervention for reducing anxiety, agitation, and aggression in older people with dementia in long-term care (LTC), with usual facility care; and explore the perceptions of care staff about doll therapy.

Method: Pilot, mixed-methods, parallel, randomised controlled trial, with follow-up semi-structured interviews. Thirty-five residents from five LTC facilities in Queensland, Australia were randomised to the lifelike baby doll intervention (three, 30-minute, individual, non-facilitated sessions per week) or usual care. Outcomes were changes in levels of anxiety, agitation, and aggression after the 3-week intervention, and short-term effects at week 1. Following intention-to-treat principles, repeated measure MANOVA was undertaken. Qualitative interviews involved five staff.

Results: The doll intervention did not significantly reduce residents’ anxiety, agitation, or aggression when compared to usual care at weeks 3 (primary outcome) and 1 (secondary outcome). However, there was a significant group-by-time interaction for the outcome of pleasure – the doll group showed a greater increase in displays of pleasure at week 3 compared to baseline than usual care. Staff perceived benefits for residents included emotional comfort, a calming effect, and providing a purposeful activity. Perceived limitations were that doll therapy may only be suitable for some individuals, some of the time, and the potential for residents to care for the doll at the expense of their health.

Conclusions: Doll therapy can provide some residents with enjoyment and purposeful engagement. Further research should focus on understanding the individual characteristics and circumstances in which residents most benefit.

Full abstract available here

Interventions maintaining eating independence in nursing home residents

Palese, A. et al. | Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study | BMC Geriatrics | 2018 18:292 | published online 27 November 2018

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Background
Despite 32 years of research and 13 reviews published in the field, no intervention can be considered a gold standard for maintaining eating performance among residents with dementia. The study aim was to highlight the interventions derived from tacit knowledge and offered daily in assisting eating by healthcare professionals (HCPs) in nursing homes (NHs).

Method
A multicentre descriptive qualitative study was performed in 2017. Thirteen NHs admitting residents with moderate/severe functional dependence in eating mainly due to dementia, were approached. A purposeful sample of 54 HCPs involved on a daily basis in assisting residents during mealtime were interviewed in 13 focus groups. Data analysis was conducted via qualitative content analysis.

Results
The promotion and maintenance of eating performance for as long as possible is ensured by a set of interventions targeting three levels: (a) environmental, by ‘Ritualising the mealtime experience by creating a controlled stimulated environment’; (b) social, by ‘Structuring effective mealtime social interactions’; and (c) individual, by ‘Individualising eating care’ for each resident.

Conclusions
In NHs, the eating decline is juxtaposed with complex interventions regulated on a daily basis and targeting the environment, the social interactions, and the residents’ needs. Several interventions that emerged as effective, according to the experience of participants, have never been documented before; while others are in contrast to the evidence documented. This suggests the need for further studies in the field; as no conclusions regarding the best interventions have been established to date.

Full document: Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

Neck scan could identify early symptoms of dementia in 5 minutes

British Heart Foundation | November 2018 | Neck scan predicts cognitive decline decade in advance

A research team lead by University College London (UCL) Professor John Deanfield, followed over 3000 participants over a fifteen-year period (3,191) middle-aged volunteers, who were given ultrasound in 2002 to measure the intensity of the pulse travelling towards their brain. Over the next 15 years, researchers monitored the participants memory and problem-solving ability.

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According to the research a five minute scan of blood vessels in the neck during mid-life predicts cognitive decline a decade before symptoms appear, according to new research  co-funded by The British Heart Foundation. The findings were presented recently at the American Heart Association’s AHA Scientific Sessions conference in Chicago.

The study’s findings would need confirming in larger stuides, but the scan could potentially be used n future to help doctors identify patients who might be at high risk of developing dementia earlier than  previously possible. 

Those participants with the highest intensity pulse (top quarter) at the outset of the study were  approximately 50 per cent  more likely to exhibit accelerated cognitive decline during the next ten years when compared to the rest of the participant cohort. The researchers controlled factors which might also contribute to cognitive decline, like age, BMI, blood pressure and diabetes.

One of the researchers, Dr Scott Chiesa from UCL commented on their findings:

“These findings demonstrate the first direct link between the intensity of the pulse transmitted towards the brain with every heartbeat and future impairments in cognitive function.”

“It’s therefore an easily measurable and potentially treatable cause of cognitive decline in middle aged adults which can be spotted well in advance.” (Source: British Heart Foundation)

Full press release available from BHF 

In the media:

BBC News Dementia risk: Five-minute scan ‘can predict cognitive decline’

Evening Standard Dementia Screening: ‘Five minute neck scan could spot early signs’ say researchers 

 

 

Improving outcomes for people with dementia following a fall

Bamford, C. et al. |  Equipping staff with the skills to maximise recovery of people with dementia after an injurious fall |  Aging & Mental Health | published online: 15 Nov 2018

Abstract
Objectives: People with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explores the importance of compensating for cognitive impairment when working with people with dementia.

Methods: Qualitative methods – interviews, focus groups and observation – were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. A thematic, iterative analysis was undertaken in which emerging themes were identified from each individual dataset, prior to an integrative analysis.

Results: A key theme across all datasets was the need to deliver services in ways that compensate for cognitive impairment, such as negotiating meaningful activities that can be embedded into the routines of people with dementia. Professionals varied in their ability to adapt their practice to meet the needs of people with dementia. Negative attitudes towards dementia, a lack of knowledge and understanding of dementia limited the ability of some professionals to work in person-centred ways.

Conclusion: Improving outcomes for people with dementia following a fall requires the principles of person-centred care to be enacted by professionals with a generic role, as well as specialist staff. This requires additional training and support by specialist staff to address the wide variability in current practice.

Full document available here

The effects of vitamin and mineral supplementation on cognitive function and the incidence of dementia in people with mild cognitive impairment.

This review investigated whether people with mild cognitive impairment can reduce their risk of developing dementia, or can prevent their memory or other thinking skills from deteriorating further, by taking vitamin or mineral supplements | Cochrane Database of Systematic Reviews

Vitamins and minerals have many functions in the nervous system which are important for brain health. It has been suggested that various different vitamin and mineral supplements might be useful in maintaining cognitive function and delaying the onset of dementia. In this review, the authors sought to examine the evidence for this in people who already had mild cognitive impairment (MCI).

The authors found eight randomised controlled trials (RCTs), which investigated four different types of vitamin or mineral pills by comparing them to a placebo (a dummy pill). The vitamins tested were B vitamins (vitamin B6, vitamin B12 and folic acid), vitamin E, and vitamin E and C given together. The only mineral tested was chromium.

However, the authors found the amount and quality of research evidence about vitamin and mineral supplements for treating MCI in people without nutritional deficiency is limited. They concluded that at the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.

Full reference: McCleery J, et al. |  Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment |  Cochrane Database of Systematic Reviews | 2018, Issue 11.

Dementia UK Publishes Carer’s Assessment Guidance

New advice on how people looking after someone with dementia can receive a Carer’s Assessment: an assessment of their financial and practical needs | Dementia UK

This resource raises awareness of the support that carers of someone with dementia can claim.

Image source: www.dementiauk.org

Through home visits from a social worker, the Carer’s Assessment establishes the impact that caring for a person with dementia is having on a carer’s life. It then identifies the relevant support to allow the carer to continue caring for a person with dementia for as long as they want to and are able to.

This support can include things like respite care to allow a carer to make time for themselves or even training to allow them to care for the person with dementia in the safest and most appropriate way.

Full document: Dementia UK Carers Assessment

New resource launched to improve dementia care

People living with dementia will benefit from improved care following the launch of a new resource for healthcare providers and carers | Health Education England

Success in dementia
Image source:hee.nhs.uk

Managing Success in Dementia is a resource commissioned by Health Education England (HEE) and developed by Skills for Care, Skills for Health and Leeds Beckett University to support leaders and managers working across health and social care to implement the training outcomes of the Dementia Training Standards Framework – in particular those responsible for implementing training at Tier 2 level.

Tier 2 training provides additional skills and knowledge for people who regularly work directly with people living with dementia.

Full document: Managing success in dementia care: A support resource for implementing Tier 2 of the Dementia Training Standards Framework in health and social care settings