Living positively with dementia: a systematic review and synthesis of the qualitative literature

Aging & Mental Health: Published online: 16 Jun 2015

Abstract
Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

via Taylor & Francis Online.

More on the Association Between Dementia and Poor Sleep Quality (NHS Choices / Nature Neuroscience)

Summary

Recent US research found an apparent link between poor sleep quality and higher levels abnormal protein (beta-amyloid plaques) in the brain. The following NHS Choices Behind the Headlines critical appraisal puts the limitations of this interesting research into perspective.

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Reference: Mander, BA. Marks, SM. [and] Vogel, JW. [et al] (2015). β-amyloid disrupts human NREM slow waves and related hippocampus-dependent memory consolidation. Nature Neuroscience. July 2015, Vol.18(7), pp.1051-7. (Click here to view the PubMed abstract).

via More on the Association Between Dementia and Poor Sleep Quality (NHS Choices / Nature Neuroscience).

Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines

Dementia 1471301215591334, first published on June 24, 2015

Alzheimer’s disease results in marked declines in navigation skills that are particularly pronounced in unfamiliar environments. However, many people with Alzheimer’s disease eventually face the challenge of having to learn their way around unfamiliar environments when moving into assisted living or care-homes. People with Alzheimer’s disease would have an easier transition moving to new residences if these larger, and often more institutional, environments were designed to compensate for decreasing orientation skills.

However, few existing dementia friendly design guidelines specifically address orientation and wayfinding. Those that do are often based on custom, practice or intuition and not well integrated with psychological and neuroscientific knowledge or navigation research, therefore often remaining unspecific. This paper discusses current dementia friendly design guidelines, reports findings from psychological and neuropsychological experiments on navigation and evaluates their potential for informing design guidelines that decrease spatial disorientation for people with dementia.

via Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines.

Should UK society adjust to dementia?

The Joseph Rowntree Foundation has published How can and should UK society adjust to dementia? This paper aims to stimulate debate about new ways forward in understanding, and ways to meet the needs of the growing number of people living with dementia. The publication explores the application of the social model of disability to dementia. It looks in detail at what this social model is, and where it has come from, bringing together the authors’ interests in disability and ageing, and training in disability studies and health and social geography.

Benefits of Timely Diagnosis and Early Intervention in Dementia (BMJ)

Benefits of Timely Diagnosis and Early Intervention in Dementia (BMJ).

By 2050 an estimated 135 million people worldwide will have dementia. In 2010 the global cost of dementia care was estimated at $604bn (£396bn; €548bn) and estimated to increase to $1tr by 2030.1 Of all chronic diseases, dementia is one of the most important contributors to dependence and disability.

In the absence of a cure, a professional belief that nothing can be done has contributed to delays in diagnosis. However, increasing evidence showing that dementia may be preventable has led to an international focus on earlier diagnosis and intervention. This review aims to summarise current evidence and best practice in the diagnosis and early intervention in dementia care

via Dementia and Elderly Care News.

The needs of dental patients with dementia

Health Education England has launched a new film aimed at dental professionals to raise awareness of the issues faced by patients with dementia when attending a dental appointment. The film looks at the process of attending a dental appointment through the eyes of a dementia sufferer, highlighting just how daunting the whole process can be.  It aims provide dental teams with information on how difficult things can be for sufferers and provide some ideas on how to make arrangements to make the process smoother and easier for their patients.

Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective

Alzheimer’s & Dementia – June 2015 Volume 11, Issue 6, Pages 718–726

An estimated 47 million people worldwide are living with dementia in 2015, and this number is projected to triple by 2050. In the absence of a disease-modifying treatment or cure, reducing the risk of developing dementia takes on added importance.

In 2014, the World Dementia Council (WDC) requested the Alzheimer’s Association evaluate and report on the state of the evidence on modifiable risk factors for cognitive decline and dementia. This report is a summary of the Association’s evaluation, which was presented at the October 2014 WDC meeting.

The Association believes there is sufficient evidence to support the link between several modifiable risk factors and a reduced risk for cognitive decline, and sufficient evidence to suggest that some modifiable risk factors may be associated with reduced risk of dementia. Specifically, the Association believes there is sufficiently strong evidence, from a population-based perspective, to conclude that regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. The Association also believes there is sufficiently strong evidence to conclude that a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive decline.

Read the full report via Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective – Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Activity involvement and quality of life of people at different stages of dementia in long term care facilities

Aging & Mental Health – Jun 2015

Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account.

Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses.

Results: Despite resident’s cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small.

Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement.

Read the full article via Aging & Mental Health – Taylor & Francis Online.

Cognitive–behavioural therapy for anxiety in dementia

Background

Anxiety is common and problematic in dementia, yet there is a lack of effective treatments.

Aims

To develop a cognitive–behavioural therapy (CBT) manual for anxiety in dementia and determine its feasibility through a randomised controlled trial.

Method

A ten-session CBT manual was developed. Participants with dementia and anxiety (and their carers) were randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25). Outcome and cost measures were administered at baseline, 15 weeks and 6 months.

Results

At 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (–3.10, 95% CI –6.55 to 0.34) for CBT compared with TAU, which just fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (–5.37, 95% CI –9.50 to –1.25). Improvements remained significant at 6 months. CBT was cost neutral.

Conclusions

CBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now required.

Read the full article via Cognitive–behavioural therapy for anxiety in dementia: pilot randomised controlled trial | The British Journal of Psychiatry.