Caring for People with Dementia: a clinical practice guideline for the radiography workforce

Caring for People with Dementia: a clinical practice guideline for the radiography
workforce (imaging and radiotherapy) | The Society and College of Radiographers

Caring for people with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) is a comprehensive and evidence-based document. It has a set of recommendations for the whole radiographic workforce caring for people with dementia and carers when undergoing imaging and/or radiotherapy. It has been developed systematically using the best available evidence from research and expert opinion, including service users, and subjected to peer professional, lay and external review.

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Image source: http://www.sor.org

The guideline has recommendations for good practice for individual members of the radiographic workforce, service managers, academic institutions and the Society and College of Radiographers (SCoR).

As a whole, this guideline acts to highlight to practitioners that to offer the best service and healthcare outcomes for people with dementia and carers, care must be tailored to the needs of the invidual.

There have been minor changes to the language used in this second edition, which emphasises the ability of and need for people with dementia to continue to live well with a good quality of meaningful life.

Full document: Caring for People with Dementia: a clinical practice guideline for the radiography workforce

What hinders and facilitates the implementation of nurse-led interventions in dementia care?

Karrer, M., Hirt, J., Zeller, A. et al. | What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review. | BMC Geriatrics | 20, 127 (2020)

Abstract

Background

The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care.

Methods

We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories.

Results

We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families).

Conclusions

Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

Full article: What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review.

COVID-19: End of life care and dementia

This brief guidance was developed by Alistair Burns, National Clinical Director for Dementia at NHS England/Improvement, and has been incorporated into NHS England publications | via British Geriatrics Society

The majority of people with dementia (which is the leading cause of death in England and Wales) are aged over 70, have other long-term conditions and are frail, putting them into particularly vulnerable groups for developing complications if they are infected with COVID-19.

There are an estimated 675,000 people with dementia in England who are supported by a similar number of carers, most of whom are older people themselves. A quarter of people in acute hospitals and three quarters of residents of care homes have dementia.

This brief guidance may be useful to clinicians and planners when considering end of life care matters in people with dementia.

COVID-19: End of life care and dementia: Good practice guide.

Updated Coronavirus information for families looking after someone with dementia

Dementia UK are constantly updating the coronavirus hub on their website. Visit it to read the latest advice from dementia specialist Admiral Nurses, including the list of frequently asked questions coming through to the Dementia UK Helpline.

Coronavirus: advice for families looking after someone with dementia
The current government advice is for everyone over age 70 or with other health conditions to stay at home for up to 16 weeks. This does not specifically include people with dementia; but if the person you care for has other health considerations, or is in any way vulnerable, you might decide to follow this advice.  Full detail here

Coronavirus: questions and answers
Dementia UK have put together a list of commonly asked questions totheir Helpline, which will be updated as and when the situation develops. Full detail here

Leaflets and information
Information, blogs and ideas for people living with dementia during this time. Full detail here

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?

Hidden no more: Dementia and disability 

All Party Parliamentary Group | June 2019 | Hidden no more: Dementia and
disability 

A new report from the All Party Parliamentary Group aims to shine a spotlight on dementia as a disability, to enable people with dementia to assert their rights to services and for their rights as citizens to be treated fairly and equally. Thousands of people who responded to the All-Party Parliamentary Group (APPG) inquiry agreed that they see dementia as a disability. But they told the APPG that society is lagging behind and failing to uphold the legal rights of people with dementia.  Within the report the All Party Parliamentary Group identify six key areas for action which have a direct impact on people’s daily lives, these are: 

alzheimers.org.uk
Image source: alzheimers.org.uk
  1. Employment
  2. Social protection
  3. Social care
  4. Transport
  5. Housing
  6. Community life

Full details from the Alzheimer’s Society

What motivates people to care for someone with dementia?

This review looks to identify and describe informal carers’ motivations for caring for people living with dementia, including their motivations at the start of caring and motivations for continuing to care.  The authors also, where possible, aimed to qualitatively identify and describe any similarities or differences in motivations amongst different demographic groups e.g. in terms of gender and relationships (e.g. spouse versus adult child) and ethnic or cultural groups | BMC Geriatrics

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Background
Informal, often family carers play a vital role in supporting people living with dementia in the community. With ageing populations, the part played by these carers is increasing making it important that we understand what motivates them to take on the role. This systematic review aimed to identify and synthesise qualitative literature describing what motivates people to care for someone with dementia.

Methods
The review followed the Centre for Reviews and Dissemination (CRD) guidelines. Six electronic databases were searched from their first records until August 2018. Synthesis was narrative.

Results
Twenty-six studies fitting the inclusion criteria were identified. Carers described multiple, inter-related motives for caring for someone with dementia. Caring was generally described as a reflection of long-standing family relationships between carers and the care recipients, whether by blood or marriage. Commonly offered motivations included love, reciprocity, filial piety, duty and obligation.

Conclusions
Perhaps the most striking finding was the similarity in these motivations irrespective of gender or relationship with the care recipient. Family relationship and shared history underlay most motivations. Future research should include more longitudinal studies incorporating within study comparisons between different demographic groups to give greater confidence in identifying similarities and differences between demographic groups.

Full article: Nan Greenwood and Raymond Smith | Motivations for being informal carers of people living with dementia: a systematic review of qualitative literature | BMC Geriatrics | 2019 | 19:169 | published 17 June 2019

Needs and experiences of people with dementia living in nursing homes

Kate Shiells, Lara Pivodic, Iva Holmerová & Lieve Van den Block | Self-reported needs and experiences of people with dementia living in nursing homes: a scoping review | Aging & Mental Health | Published online 4th June 2019 

Objectives: With rates of dementia continuing to rise, the impetus on improving care for people with dementia is growing. Unmet needs of people with dementia living in nursing homes have been linked with worsening neuropsychiatric symptoms, higher levels of depression, and reduced quality of life. Furthermore, proxy accounts exploring the needs of people with dementia have frequently been shown to be unreliable. Therefore, this literature review aims to explore the self-reported needs and experiences of people with dementia in nursing homes.

Method: A scoping review of the literature was carried out using the databases PubMed and PsycINFO to search for relevant articles according to PRISMA guidelines. Search terms were designed to include both quantitative and qualitative study designs. Thematic synthesis was used to categorise findings into themes related to self-reported needs and experiences.

Results: A total of 41 articles met the eligibility criteria. An analysis of study characteristics revealed more than half of studies used a qualitative design. Thematic synthesis resulted in eight themes: activities, maintaining previous roles, reminiscence, freedom and choice, appropriate environment, meaningful relationships, support with grief and loss, end-of-life care.

Conclusion: Whilst the voice of people with dementia has previously been neglected in research, this review has shown that people with dementia in nursing homes are able to describe their experiences and communicate their needs. The findings in this review have provided a contribution towards guiding evidence-based practice that is tailored to the needs of nursing home residents with dementia.

Full article available at Aging & Mental Health 

Disrupted sleep – a cause or consequence of Alzheimer’s?

In this blog, Honor Pollard explores if sleep problems could have a long-term effect on the brain| Alzheimers Research UK 

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Growing evidence points to a link between poor quality of sleep and an increased risk of Alzheimer’s disease. We know that disturbed sleep can be one of the earliest signs of Alzheimer’s and it often occurs years before changes to memory and thinking skills start to show. But this is not the full story when it comes to sleep and dementia.

A number of studies have shown that interrupted sleep may speed up the progression of Alzheimer’s in the brain. But it’s difficult for researchers to tease apart cause and effect. They need to work out whether poor quality sleep might contribute to the development of the disease or vice-versa.

Full article at Alzheimers Research UK 

 

Can blood pressure drugs help reduce dementia risk?

A large study analising the medical data of thousands of people suggests that dementia incidence is lower among those who take blood pressure medication | via Medical News Today

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A large new study has found a link between taking various kinds of blood pressure-lowering drugs and a lower risk of dementia among older adults, adding to the discussion around the link between cognitive decline and high blood pressure.

In their study the researchers analised data from 12,405 people, aged 60 or over, with dementia who attended one of 739 general practices in Germany as patients in 2013–2017. The team had access to all of these participants’ blood pressure values, as well as their medication records. This data was compared with those of 12,405 participants without dementia who had visited a general practice in the same time period.

The team found that those who took certain antihypertensive drugs — including beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers — seemed to have a lower risk of dementia.

Moreover, among those who took calcium channel blockers — which are another type of blood pressure drug — for a longer period of time, the incidence of dementia also decreased.

Full story at Medical News Today

Full reference: Bohlken, Jensa;  Jacob, Louisb; Kostev, Karelc | The Relationship Between the Use of Antihypertensive Drugs and the Incidence of Dementia in General Practices in Germany | Journal of Alzheimer’s Disease | Published: 20 May 2019