NIHR: VOICE training for healthcare professionals aids communication with dementia patients

NIHR | November 2020 | VOICE training for healthcare professionals aids communication with dementia patients

The NIHR highlights how a training course has improved the confidence and communication skills of healthcare staff in treating and caring for patients with dementia.

Around 25 per cent of hospital beds are occupied by patients with dementia and their difficulties with communication can make treating other co/multi-morbidities more challenging. In many cases these problems are made worse by admission to hospital because they are unsettled by the change of environment, illness and seeing unfamiliar faces. 

Earlier studies underlined that clinicians currently receive very little or no dementia specific training to help them care for patients with dementia, despite the high number of patients with dementia in emergency care and acute settings. This enabled the NIHR to recognsie the potential benefit of appropriate dementia-specific training for healthcare professionals and, through its Health Services and Delivery Research (HS&DR) Programme, funded the VOICE (VideOing to Improve Communication Education) study to evaluate and deliver a new training programme. 

Led by Professor Rowan Harwood at the University of Nottingham, the VOICE study has shown promising results that evidence-based communication skills training for health professionals can improve their communication with patients with dementia.

The researchers developed a practical skills training course and online e-learning resource with the help of experts in communication skills training and carers of people with dementia. Actors were specially trained in simulating people with dementia, by the researchers to recreate the types of situations that healthcare professionals face in their everyday roles. The training course was tested on forty healthcare professional to determine whether they experienced improvements in their confidence and skills in communicating with people with dementia. At the outset the clinicians were asked to self-assess their confidence and a month after completing the training course they repeated this self-assessment. The study demonstrates that the intervention improves the communication skills of the healthcare professionals which will benefit patients by improving determination of needs, provision of comfort, reduce distress, and enhance inclusion in decision making.

Now the VOICE training course has been delivered to more than 180 healthcare professionals across the UK. Included in this number are 31 healthcare professionals who “trained as trainers”, and the 54 they went on to train at five English hospital trusts. More training has been planned for the future. The full impact news story is available from NIHR

Project information for the VOICE study is available from NIHR

UCL: Leisure activity might not reduce dementia risk

University College London | November 2020 |Leisure activity might not reduce dementia risk

Researchers at UCL report that activities such as gardening and reading in mid-life may not reduce an individual’s risk of dementia.

More than 8000 adults were studied, with the average age of the participant around 56 years of age. Each of the volunteers participation in leisure activities was recorded at the study’s outset, based on their participation in their activities, the researchers assigned them into different groups: low risk, medium risk and high risk. The subjects were followed up again, five and ten years later.

Using health records the team were able to identify who developed dementia. They also observed that some of the participants who gave up their hobbies later developed dementia. They found no association between participating in hobbies and the risk of developing dementia.

UCL press release Leisure activity might not reduce dementia risk

Primary paper is available from the journal Neurology

Leisure activity participation and risk of dementia 18 year follow-up of the Whitehall II Study

Dementia ward inpatients need better protection from COVID-19

The Mental Elf | November 2020| Dementia ward inpatients need better protection from COVID-19

Professor Gill Livingston, UCL and a team of researchers have explore the prevalence, management, and outcomes of COVID-19 infections in older adults and people with dementia of any age in mental health wards in London at the outset of the first wave of the pandemic. The Mental Elf reviews this primary paper, and also provides context for the impact of COVID-19 on people with dementia.

Dementia ward inpatients need better protection from COVID-19 [Mental Elf]

Summary

Background

People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of COVID-19-related outcomes in older inpatients in psychiatric units, who comprise people from these high-risk groups. We aimed to describe the period prevalence, demographics, symptoms (and asymptomatic cases), management, and survival outcomes of COVID-19 in the older inpatient psychiatric population and people with young-onset dementia in five National Health Service Trusts in London, UK, from March 1 to April 30, 2020.

Methods

In this retrospective observational study, we collected demographic data, mental health diagnoses, clinical diagnosis of COVID-19, symptoms, management, and COVID-19-related outcome data of inpatients aged 65 years or older or with dementia who were already inpatients or admitted as inpatients to five London mental health Trusts between March 1 and April 30, 2020, and information about available COVID-19-related resources (ie, testing and personal protective equipment). Patients were determined to have COVID-19 if they had a positive SARS-CoV-2 PCR test, or had relevant symptoms indicative of COVID-19, as determined by their treating physician. We calculated period prevalence of COVID-19 and analysed patients’ characteristics, treatments, and outcomes.

Findings

Of 344 inpatients, 131 (38%) were diagnosed with COVID-19 during the study period (period prevalence 38% [95% CI 33–43]). The mean age of patients who had COVID-19 was 75·3 years (SD 8·2); 68 (52%) were women and 47 (36%) from ethnic minority groups. 16 (12%) of 131 patients were asymptomatic and 121 (92%) had one or more disease-related comorbidity. 108 (82%) patients were compulsorily detained. 74 (56%) patients had dementia, of whom 13 (18%) had young-onset dementia. On average, sites received COVID-19 testing kits 4·5 days after the first clinical COVID-19 presentation. 19 (15%) patients diagnosed with COVID-19 died during the study period, and their deaths were determined to be COVID-19 related.

Interpretation

Patients in psychiatric inpatient settings who were admitted without known SARS-CoV-2 infection had a high risk of infection with SARS-CoV-2 compared with those in the community and had a higher proportion of deaths from COVID-19 than in the community. Implementation of the long-standing policy of parity of esteem for mental health and planning for future COVID-19 waves in psychiatric hospitals is urgent.

Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: a retrospective observational study

Dementia risk factors

Alzheimer’s Disease International| nd| Dementia risk factors

Alzheimer’s Disease International is highlighting a new infographic which shows the 12 risk factors for dementia, it is available to download from Alzheimer’s Disease International.

Image source: alz.co.uk

The infographic is taken from a paper published in The Lanet, where it is available to download

Related:

Age UK report: The impact of COVID-19 to date on older people’s mental and physical health

Age UK | October 2020 | The impact of COVID-19 to date on older people’s
mental and physical health

Carers, families, and friends of people living with dementia have told Age UK that they have seen rapid deterioration in their loved one’s cognitive function, which has affected memory, sleep, mood, and behaviour. They explained how hard it has been to help someone with dementia to understand why they cannot do the things they enjoy or see the people they love

Full details are available in Age UK’s report The impact of COVID-19 to date on older people’s mental and physical health

See also:

Age UK Age UK research lays bare the drastic impact of the pandemic on our older population’s health and morale

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

Kivimäki, M. et al |2020| Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia| JAMA Network Open3|9| e2016084-e2016084

Question  Are alcohol-induced loss of consciousness and heavy weekly alcohol consumption associated with increased risk of future dementia?

Findings  In this multicohort study of 131 415 adults, a 1.2-fold excess risk of dementia was associated with heavy vs moderate alcohol consumption. Those who reported having lost consciousness due to alcohol consumption, regardless of their overall weekly consumption, had a 2-fold increased risk of dementia compared with people who had not lost consciousness and were moderate drinkers.

Meaning  The findings of this study suggest that alcohol-induced loss of consciousness is a long-term risk factor for dementia among both heavy and moderate drinkers.

Importance  Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

Objective  To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

Design, Setting, and Participants  Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

Exposures  Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

Main Outcomes and Measures  Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

Results  Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22  for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men women during the first 10 years of follow-upa fter excluding the first 10 years of follow-up, and for early-onset and late-onset  dementia, Alzheimer disease, and dementia with features of atherosclerotic cardiovascular disease. The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate or heavy.

Conclusions and Relevance  The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Full article from JAMA

In the news:

Daily Mail : Passing out drunk could more than DOUBLE your risk of later developing dementia and even one drink per day raises risk by 22%, study warns

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Livingston, G., et al (2020)| Dementia prevention, intervention, and care: 2020 report of the Lancet Commission| The Lancet396|(10248)|P. 413-446.

The Lancet recently published the Lancet Commission’s 2020 report on dementia prevention, intervention and care.

Key messages

  • Three new modifiable risk factors for dementia
    • New evidence supports adding three modifiable risk factors—excessive alcohol consumption, head injury, and air pollution—to our 2017 Lancet Commission on dementia prevention, intervention, and care life-course model of nine factors (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact).
  • Modifying 12 risk factors might prevent or delay up to 40% of dementias.
  • Be ambitious about prevention
    • Prevention is about policy and individuals. Contributions to the risk and mitigation of dementia begin early and continue throughout life, so it is never too early or too late. These actions require both public health programmes and individually tailored interventions. In addition to population strategies, policy should address high-risk groups to increase social, cognitive, and physical activity; and vascular health.
  • Specific actions for risk factors across the life course
    • Aim to maintain systolic BP of 130 mm Hg or less in midlife from around age 40 years (antihypertensive treatment for hypertension is the only known effective preventive medication for dementia).
    • Encourage use of hearing aids for hearing loss and reduce hearing loss by protection of ears from excessive noise exposure.
    • Reduce exposure to air pollution and second-hand tobacco smoke.
    • Prevent head injury.
    • Limit alcohol use, as alcohol misuse and drinking more than 21 units weekly increase the risk of dementia.
    • Avoid smoking uptake and support smoking cessation to stop smoking, as this reduces the risk of dementia even in later life.
    • Provide all children with primary and secondary education.
    • Reduce obesity and the linked condition of diabetes. Sustain midlife, and possibly later life physical activity.
    • Addressing other putative risk factors for dementia, like sleep, through lifestyle interventions, will improve general health.
  • Tackle inequality and protect people with dementia
    • Many risk factors cluster around inequalities, which occur particularly in Black, Asian, and minority ethnic groups and in vulnerable populations. Tackling these factors will involve not only health promotion but also societal action to improve the circumstances in which people live their lives. Examples include creating environments that have physical activity as a norm, reducing the population profile of blood pressure rising with age through better patterns of nutrition, and reducing potential excessive noise exposure.

Taken from the Executive Summary

Full publication is available from The Lancet

Guidance for carers of people with dementia

University College London | September 2020 |Guidance developed for dementia carers when dealing with COVID-19 infection

A team of researchers from University College London (UCL) have developed a decision-making guide for dementia carers, to ensure they can provide the right support and with dignity, should those they care for become infected with coronavirus.

The researchers based at Marie Curie Palliative Care Research Department at UCL, have observed the challenges to carers who can’t be with their loved one or person they support, due to visiting restrictions and having to social distance or shield themselves.

This often means that dementia carers have to make quick healthcare or legal decisions over the phone with a health professional: someone who may have no knowledge of the care and interventions the person with dementia requires.

The new guide, which was developed with families of those with dementia, is funded by an Economic and Social Research Council COVID-19 grant and supported by end of life care charity Marie Curie, Alzheimer’s Society and Dementia UK.

The tool has been designed to support carers work through situations, medical and legal jargon so they can make informed decisions quickly under stressful circumstances.

This includes do not resuscitate orders, legal issues like power of attorney, and ensuring that health and social care professionals understand what is important to the person they are caring for when that patient’s loved ones can’t be by their side.

The research team hopes that the new guide will also ease the emotional burden that families can experience and help resolve any feelings of uncertainty about the decisions they have made for their loved ones (Source: UCL).

Full press release is available from UCL

The decision aid can be downloaded here

COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

Wessex Clinical Senate and Networks | July 2020| COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

The COVID-19 pandemic has impacted significantly on the delivery of NHS services. We have an opportunity to learn from the rapid and necessary service transformation and consider how we recover our services.

Dementia remains a diagnosis with significant impact with a need to balance the timeliness of diagnosis with patient experience and outcomes. Covid may become endemic and our adapted ways of working may become the new normal.

Recent webinars have brought clinicians, service managers and commissioners together to consider factors affecting the dementia pathway in a Covid environment. This document aims to give an overview of factors identified that affect the pathway.

The documents are available to download from the Wessex Senate

Alzheimer’s Research: Progressing towards a tau blood test for Alzheimer’s disease

Alzheimer’s Research UK | July 2020 | Progressing towards a tau blood test for Alzheimer’s disease

  • Four new studies presented at the Alzheimer’s Association International Conference (AAIC) and two published papers show that levels of tau, a hallmark protein of Alzheimer’s disease, in the blood could be used to detect the disease
  • The research focuses on a specific form of tau, p-tau217
  • The new data suggests blood levels of p-tau217 can predict the development of Alzheimer’s disease before symptoms appear, track well with levels of tau in the brain and distinguish Alzheimer’s from other diseases that cause dementia

Researchers from both the US and Europe have presented data that indicates levels of a specific form of tau, one of the hallmark proteins of Alzheimer’s disease, can be measured in blood to detect the disease, even before symptoms appear. 

Full details of the studies are available from Alzheimer’s Research UK

In the news:

The Independent ‘Exciting’ results on blood test that could detect Alzheimer’s 20 years before memory falter

BBC News Alzheimer’s: ‘Promising’ blood test for early stage of disease

The Telegraph Flu jab may reduce risk of dementia by a fifth, study finds