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

Free lunchtime Centre for Dementia Research talks in Feb

Centre for Dementia | February 2021| Centre for Dementia research talks

Join the Centre for Dementia is hosting a series of talks this month live online for lunchtime discussions about their work, you can watch short videos about a range of studies on different aspects of dementia: prevention, treatment and care. There will also be opportunities after viewing each video to ask the presenters questions.

The talks have been released early online so you can watch them in advance of the event or at a convenient time if you prefer.

You can register to join the event

List of video topics:

Apathy in Dementia

What goes on in the brain

Dementia friendly communities

The Thinkability app

Young Onset Dementia – online support for the under 65’s

PRIDE – An app to promote independence

What is Patient and Public Involvement?

The full programme is available from the Centre for Dementia

Helen Green, Dementia Specialist Nurse on Dementia UK’s Admiral Nurse Dementia Helpline, charts the causes and progression of vascular dementia

Open Access Government | Feburary 15 2021 | Helen Green, Dementia Specialist Nurse on Dementia UK’s Admiral Nurse Dementia Helpline, charts the causes and progression of vascular dementia

This article charts the causes and progression of vascular dementia, it’s author Helen Green, Dementia Specialist Nurse on Dementia UK’s Admiral Nurse Dementia Helpline, explains more about the umbrella term dementia, vascular dementia and mixed dementia.

Causes and progression of vascular dementia

LGBT: Living with dementia

Alzheimer’s Society | nd | LGBT: Living with dementia

The Alzheimer’s Society has developed a webpage for individuals that are lesbian, gay, bisexual or trans and have dementia. On this page the UK’s leading dementia charity explains how LGBT people can live well with dementia.

This webpage focuses on the following:

  1. LGBT: Living with dementia
  2. LGBT: Memory problems and reminiscence
  3. LGBT: Your support
  4. LGBT: Your rights
  5. LGBT: Planning ahead
  6. LGBT: Services and support
  7. LGBT: Care settings
  8. LGBT – other resources

See Alzheimer’s Society for further details

One in 10 UK adults say brain health has deteriorated in pandemic

Alzheimer’s Research UK |  January 2021| One in 10 UK adults say brain health has deteriorated in pandemic

A poll conducted by Alzheimer’s Research UK shows that 14 per cent of UK adults feel that brain health has declined since the start of the COVID-19 pandemic. Two thirds of the respondents in this survey said they would consider making changes to improve their health as a result of the pandemic.

The charity’s findings in the poll, underline that people’s awareness of dementia has increased, 16 per cent of respondents reporting an increased awareness. The charity believes now is the opportune time to support people to take positive action, particularly with new lockdown measures in place.

Image is a still from the video Think Brain Health. It shows how looking after our brain can reduce our risk, by keeping connected, staying sharp and doing things to keep our hear healthy can also reduce

To this end they have launched a new campaign Think Brain Health, which aims to increase awareness of three rules for improving brain health:

  • Looking after heart health, by exercising regularly, eating a healthy diet and keeping blood pressure, weight and cholesterol in check.
  • Staying sharp, by taking part in activities that keep the brain active.
  • And keeping connected, by staying socially active and connecting with other people.

Alzheimer’s Research UK One in 10 UK adults say brain health has deteriorated in pandemic

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

Yeh, S-W et al. (2020) |High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis |Clinical Rehabilitation | https://doi.org/10.1177/0269215520961637

This systematic review underlines the impact of high intensity exercise on older people with dementia. The researchers reviewed some 15 articles describing six trials including older adults and controlled groups. They report that facilitated activities had an effect on of daily living and psychiatric well-being; with effects on activities of daily living being the most long-lasting. This review also highlights how adverse effects of high-intensity functional exercise were minimal to none.

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.

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis – Shu-Wei Yeh, Li-Fong Lin, Hung-Chou Chen, Li-Kai Huang, Chaur-Jong Hu, Ka-Wai Tam, Yi-Chun Kuan, Chien-Hsiung Hong, 2020

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 (Source: Yeh, S-W et al., 2020).

Rotherham NHS staff can request this article from the Library

SCIE: Safeguarding adults with dementia during the COVID-19 pandemic

Social Care Institute for Excellence| updated 5 January 2021| Safeguarding adults with dementia during the COVID-19 pandemic

Social Care Institute for Excellence in partnership with the Alzheimer’s Society has published a quick guide to support care providers and staff to safeguard people with dementia during the pandemic. There are increased concerns that, during this time, people may be more vulnerable to abuse or neglect.

This may be a result of:

The guide is available online from SCIE

NIHR Alert: Careful phrasing of requests by hospital staff could help people with dementia accept care

NIHR | December 2020 | Careful phrasing of requests by hospital staff could help people with dementia accept care

“Healthcare professionals in acute hospitals are not generally trained in how to communicate with people with dementia. This has an impact on their job satisfaction and stress levels. People with dementia and their relatives also report dissatisfaction with communication in hospital.”

Rebecca O’Brien, Study Author, Clinical Researcher School of Health Sciences/ Division of Rehab, Ageing and Well-being University of Nottingham
This study intended to provide healthcare professionals with ways to communicate more effectively with people living with dementia (PLWD). The authors analysed video recordings of HCPs and PWDs interactions from three inpatient wards. Their analysis led to a recognition of requests which led to patients agreement or refusal
The experts also recognise that no manner of verbal requesting would guarantee compliance or ultimately override a patient’s right to refuse to comply with a request. They identify several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. This indicates that by varying tone, phrasing and question construction led to a more positive response from patients who were confused or resisting care.

The authors want to equip health professionals with the skills to make requests in different ways. O’Brien also wants “policymakers to understand the importance of the need to train staff in communication skills.” (Source: NIHR and O’Brien et al, 2020)

O’Brien, R., Beeke, s., Pilnick, A. & Harwood, R.H. | 2020| When people living with dementia say ‘no’: Negotiating refusal in the acute hospital setting | Social Science and Medicine | Vol. 263 113188

Abstract

A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised by both policy makers and carers about the quality of communication between hospital staff and PLWD. PLWD may experience communication impairments such as word finding difficulties, limited ability to construct coherent narratives and difficulties understanding others. Since much healthcare delivery occurs through talk, healthcare professionals (HCPs) and PLWD are likely to experience increased communication barriers. Consistent with this, HCPs report stress and reduced job satisfaction associated with difficulty communicating with PLWD. HCPs face these challenges whilst striving to deliver person-centred care, respecting the autonomy and wishes of the patient before them. However, best practice recommendations in the field tend not to be based on actual interactional evidence. This paper investigates recurring interactional difficulties around HCP requests to carry out health and social care tasks and subsequent reluctance or refusal on the part of PLWD. Using conversation analysis, we examined 41 video recordings of HCP/PLWD interactions collected across three acute inpatient wards. We identify both the nature of the refusals, and any mitigation offered, and explore the requests preceding them in terms of entitlement and contingency. We also explore the nature of HCP requests which precede PLWD agreement with a course of action. We conclude that several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. Our findings underline the importance of examining the contextual interactional detail involved in the negotiation of healthcare, which here leads to an understanding of how design of HCP requests can impact on an important healthcare activity being carried out. They also emphasise the power of conversation analytic methods to identify areas of frequent interactional trouble in dementia care which have not previously been articulated.

Primary paper is available from Social Science & Medicine

NIHR Alert Careful phrasing of requests by hospital staff could help people with dementia accept care

NIHR: Dementia Care Mapping: Care home managers and staff need more support to improve care

“I was surprised at just how variable the implementation of DCM was, and how difficult many of the homes found it, particularly given it is an interevention already in use in care homes. We knew we would see some turnover of staff but there was much more managerial turnover than we expected and the impacts of this were greater on the intervention than we anticipated.”

Study Author Rachel Kelley,
Dementia Researcher, Leeds Beckett University
An NIHR- funded study looked at why implementation of the dementia care mapping has failed to lead to improvements in some care homes. The authors of the study found that implementation is patchy and vulnerable to issues such as staff and manager turnover, their confidence or skills to lead changes in practice, and inadequate staffing and funds.

Previous studies (not in the UK) reported that that DCM had mixed results across care homes. Where DCM was led by the researchers, there were some benefits for residents and staff. However, where DCM was led by care home staff, no benefits were found and there were problems implementing the tool.

This study explored the barriers and facilitators in introducing a complex tool like DCM, including the influence of care home managers. It interviewed almost 50 care home managers who were also participants in the intervention arms of a related trial.

Study Author Rachel Kelley said, “overall the findings show just how important support for care homes and their managers and staff is when we are trying to implement new interventions and practices. It is important to say there were definitely examples of care homes that implemented DCM well and where the staff thought it was beneficial. Other homes wanted to implement it, but were unable to for a variety of reasons, as our study showed.” (Source: NIHR)

Read the full NIHR article Dementia Care Mapping: Care home managers and staff need more support to improve care

The primary paper is available from BMC Geriatrics Kelley R, and others. The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mappingBMC Geriatrics. 2020;20:303