Dementia July 22, 2015
The physical and mental health of older adults with dementia is affected by levels of social integration.
The development of dementia special care units (D-SCU) arose, in part, to facilitate more meaningful social interactions among residents implying greater social integration of D-SCU residents as compared to residents in a traditional nursing home (TNH). But, it is unknown whether D-SCU residents are receiving equal or greater benefits from living on a segregated unit intended to enhance their social environment and integration through both design and staff involvement.
The purpose of this study was to pilot test a comprehensive objective assessment to measure social integration among nursing home residents with dementia and to compare levels of integration of residents living on a D-SCU to those living in a TNH.
A total of 29 residents participated (15 D-SCU and 14 TNH) and data were gathered from medical charts, visitor logs, and through direct observations. Over 1700 interactions were recorded during 143 h of observation. Specifically, the location, context, type, quantity, and quality of residents’ interactions were recorded.
Overall, the majority of resident interactions were verbal and initiated by staff. Interactions were social in context, and occurred in public areas, such as the common room with a large screen TV. Average interactions lasted less than 1 min and did not change the resident’s affect. Residents spent between 10% and 17% of their time interacting with other people on average.
D-SCU staff were significantly more likely to initiate interactions with residents than TNH staff. D-SCU residents also experienced more interactions in the afternoons and expressed more pleasure and anxiety than residents in the TNH. This study helps to lay the groundwork necessary to comprehensively and objectively measure social integration among people with dementia in order to evaluate care environments.
via Measuring social integration among residents in a dementia special care unit versus traditional nursing home: A pilot study.
International Journal of Geriatric Psychiatry
Early diagnosis, initiation of Alzheimer’s disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health-related quality of life (HRQoL) in persons with AD and caregivers.
Kuopio ALSOVA study, a prospective, randomized intervention study with a 3-year follow-up, was carried out at memory clinics. Home-dwelling persons with very mild or mild AD (n = 236) and AD-targeted therapy and their family caregivers (n = 236) were randomized to the intervention or control group (1:2). Psychosocial intervention including education, counseling, and social support was given during the first 2 years (16 days). The primary outcome was the cumulative risk (controlled for death) of institutionalization over 36 months. Secondary outcomes were adjusted mean changes from baseline in disease severity, cognition, daily activities, behavior, and HRQoL for persons with AD; and change in psychological distress, depression, and HRQoL for caregivers.
No differences were found in nursing home placement after the 36-month follow-up between intervention and control groups. No beneficial effects of the intervention were found on the secondary outcomes.
The psychosocial intervention did not delay nursing home placement in persons with AD and had no effect on patient well-being, disease progression, or AD-related symptoms or caregiver well-being. Instead of automatically providing psychosocial intervention courses, individualized support programs may be more effective.
via Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers’ well-being: ALSOVA 3-year follow-up – Koivisto – 2015 – International Journal of Geriatric Psychiatry – Wiley Online Library.
Dementia July 2015 vol. 14 no. 4 436-449
Delay in diagnosis and difficulties in accessing appropriate health care services plague dementia care delivery in the community setting, potentiating the risk for misdiagnosis, inappropriate management, poor psychological adjustment and reduced coping capacity and ability to forward plan.
We evaluated a clinical nurse consultant role with a speciality in dementia to provide person-centred pre-diagnosis support in the community. Clients, with a six-month history of cognitive and functional decline in the absence of delirium but no formal diagnosis of dementia, were recruited from a Home Care Nursing Service and an Aged Care Assessment Service located in the Western Suburbs of Melbourne, Victoria, Australia.
The role of a clinical nurse consultant was highly regarded by clients and other health professionals. This paper discussing the CNC role and the outcomes of the role suggests it was successful in providing timely assistance and support for consumers and support for other health professionals.
via The role of a clinical nurse consultant dementia specialist: A qualitative evaluation.
Dementia July 2015 vol. 14 no. 4 418-435
Self-management programs are effective for people living with chronic illnesses. However, there has been little research addressing self-management for people with dementia in the early stages. This study presents a qualitative evaluation of the experiences of attending a novel self-management program and initial process evaluation.
The program was designed with and for people with dementia. It addresses: (a) relationship with family, (b) maintenance of an active lifestyle, (c) psychological well-being, (d) techniques to cope with memory changes and (e) information about dementia.
Six participants with early stage dementia completed the intervention that was co-delivered by lay and clinical professional tutors. Participants and tutors attended focus group and interviews at the end of the program to explore their perceptions of the intervention. These were audio-recorded, transcribed verbatim and analysed thematically. Participants reported enjoyment and benefits from the intervention. This was despite some reporting concerns relating to their memory difficulties.
The program’s flexible nature, focus on strengths and the opportunity to spend time with other people living with dementia were particularly well received. Participants and tutors outlined areas for further improvement. The program was feasible and its flexible delivery appeared to facilitate participant benefit. Emphasis should be placed on maintaining activity and relationships, improving positive well-being and social interaction during the program. Memory of the pleasant experience and strengths focus was evidenced, which may impact positively on quality of life.
The results highlight the usefulness and acceptability of self-management for people with early stage dementia and provide initial support for the program’s structure and content.
via Qualitative evaluation of a self-management intervention for people in the early stage of dementia.
The Care Quality Commission (CQC) has signed up to an important campaign to show the health and social care regulator’s commitment to best practice in the use of language when talking or writing about people living with dementia
Jointly led by The Dementia Engagement and Empowerment Project (deep) and the Dementia Action Alliance, the campaign has created a special guide – Dementia Words Matter – written by people living with dementia that sets out the words and descriptions they would prefer are avoided by the media and other organisations.
via CQC joins the ‘Call to Action’ Dementia Words Matter campaign | Care Quality Commission.
Alzheimer’s & Dementia: Published Online: July 16, 2015
The Mediterranean diet (MeDi) has been related to a lower risk of Alzheimer’s disease; yet, the underlying mechanisms are unknown. We hypothesized that protection against neurodegeneration would translate into higher gray matter volumes, whereas a specific association with preserved white matter microstructure would suggest alternative mechanisms (e.g., vascular pathways).
We included 146 participants from the Bordeaux Three-City study nondemented when they completed a dietary questionnaire and who underwent a 3-T magnetic resonance imaging at an average of 9 years later, including diffusion tensor imaging.
In multivariate voxel-by-voxel analyses, adherence to the MeDi was significantly associated with preserved white matter microstructure in extensive areas, a gain in structural connectivity that was related to strong cognitive benefits. In contrast, we found no relation with gray matter volumes.
The MeDi appears to benefit brain health through preservation of structural connectivity. Potential mediation by a favorable impact on brain vasculature deserves further research.
via Mediterranean diet and preserved brain structural connectivity in older subjects – Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
Innovations in Dementia have produced a quick checklist on how to perform an audit with the aim of making buildings more suitable for people with dementia. The “access audit” includes an assessment of how persons with dementia typically approach the building and navigate the inside. Use of suitable signs, lighting, flooring, seating areas, toilets etc. are covered. This brief guide signposts readers where to obtain further advice and guidance.
Full Text Link
Note: Credit goes to the Housing Learning and Improvement Network for making this document available.
via Practical Guide to Dementia-Friendly Environments: the Access Audit (Innovations in Dementia).
Alzheimer’s & Dementia – Published Online: June 18, 2015
Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS.
NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms.
We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives.
via Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment – Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
Researchers have discovered a new mechanism with which DNA is repaired that could lead to further developments in the treatment and prevention of neurodegenerative disorders such as Alzheimer’s disease.
Researchers have discoveredthat a special enzyme – the RNA polymerase II (Pol II) enzyme – can sense these SSBs by “riding” along the DNA coil. Acting almost like a proofreader of a text, when the Pol II enzyme encounters an SSB, it triggers a number of reactions that lead to repair enzymes fixing the damaged area.
“RNA polymerase can ‘crawl’ along the DNA loops nearly as well as on histone-free DNA regions, but when it stops near locations of the DNA breaks, it ‘panics,’ triggering the cascade of reactions to start DNA ‘repairs,'” Prof. Studitsky explains.
For the study, the researchers inserted SSBs into a model DNA system to observe how they would affect the progress of Pol II progressing along the coils. They discovered that this enzyme only stopped upon encountering breaks in the DNA connected to the histones and not in histone-free DNA.
“These observations raise the possibility that nucleosomal structure could affect the process of detection and repair of DNA damages,” the authors write.
Prior to the study, the researchers had thought that DNA repair was only possible in histone-free DNA, as reparation with the previously identified mechanism would require complete unwinding of the DNA coils to make the SSBs accessible.
via Novel DNA repair mechanism could lead to new Alzheimer’s treatments – Medical News Today.
Aging & Mental Health: Volume 19, Issue 10, 2015
Objectives: To identify general practitioners’ (GPs) knowledge, practices, and obstacles with regard to the diagnosis and management of dementia.
Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a purposive sample of GPs in Kathmandu, Nepal. Three hundred and eighty GPs responded (response rate = 89%).
Results: Knowledge of practitioners’ with regard to the diagnosis and management of dementia was unsatisfactory (<50%). Diagnosis and management barriers are presented with regard to GP, patient, and carer factors. Specifically, the results address the following issues: communicating the diagnosis, negative views of dementia, difficulty diagnosing early-stage dementia, acceptability of specialists, responsibility for extra issues, knowledge of dementia and aging, less awareness of declining abilities, diminished resources to handle care, lack of specific guidelines, and poor awareness of epidemiology.
Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with diagnosis, care, and management of dementia.
via Taylor & Francis Online.