Risk of dementia and death in community-dwelling older men with bipolar disorder

Almeida, O.P. et al. The British Journal of Psychiatry .Aug 2016. 209 (2). pp. 121-126;

Image source: Susan Lockhart – Wellcome Images // CC BY-NC-ND 4.0

Background: Bipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking.

Aims: To investigate the 13-year risk of dementia and death in older adults with bipolar disorder.

Method: Cohort study of 37 768 men aged 65–85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest.

Results: Bipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80–2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28–1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system.

Conclusions: Bipolar disorder in later life is associated with increased risk of dementia and premature death.

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Retailers set to become more dementia friendly

Alzheimer’s Society. Published online: 28 July 2016

Alzheimer’s Society is launching a new guide for retailers to encourage them to become dementia friendly and support people living with dementia and their carers.

850,000 people live with dementia in the UK, and research * carried out by the charity has shown that 8 out of 10 of those with the condition list shopping as their favourite activity.

However, 63 per cent of people surveyed don’t think that shops are doing enough to help people with dementia and one in four people with dementia ** have given up shopping since being diagnosed. Many cite difficulties with shopping including finding their way around stores, picking up the wrong items, problems at the checkout and worries about staff and other shoppers’ reactions.

Getting out and about and performing everyday tasks like shopping are important because people with dementia want to live well within their own communities and remain independent for as long as possible.

Alzheimer’s Society has launched ‘Becoming a dementia friendly retailer, a practical guide’ at an exclusive industry event attended by retail leaders, including senior representatives from Sainsbury’s, East of England Cooperative, British Council of Shopping Centres and Tesco.

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Alzheimer’s disease and the law: positive and negative consequences of structural stigma and labeling in the legal system

Werner, P. & Doron, I. Aging & Mental Health. Published online: 27 Jul 2016

Objective: To explore the meaning and consequences of labeling on structural stigma in the context of Alzheimer’s disease (AD) in the legal system.

Method: This qualitative study was made up of three focus groups including social workers and lawyers (n = 26). Participants were asked to report their experience in circumstances in which persons with AD and their family members engage with the legal system. Thematic analysis using the constant comparative method was used.

Results: The discussions in the focus groups raised two overall themes. (1) The significance of the medical diagnostic labeling of AD in the legal system and (2) the consequences of labeling of AD within the legal system. This last theme included four sub-themes: (a) negative consequences of labeling; (b) reasons associated with negative consequences of labeling; (c) positive consequences of labeling; and (d) reasons associated with positive consequences of labeling.

Conclusion: Findings of the study provide a first foundation for future research on the meaning and consequences of labeling in legal cases involving persons with AD. They suggest that increasing judges’ knowledge about AD and reforming the existing ‘status-based’ legal capacity legislation might benefit by limiting the legal weight given today to the medical diagnosis.

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Clinicians’ experiences of anxiety in patients with dementia

Goyal, A.R. Dementia. Published online: 14 July 2016

Image source: Susan Lockhart – Wellcome Images // CC BY-NC-ND 4.0

Image shows illustration demonstrating the feeling of anxiety.

Since anxiety in patients with dementia is a complex, understudied phenomenon, this paper presents clinicians’ experiences of anxiety in this population. Semi-structured interviews were conducted with seven clinicians experienced with dementia in elderly patients (65 years and above), and then evaluated via qualitative content analysis.

Analysis revealed three main categories: A reaction to loss and worries, symptoms of anxiety and depression interfere with each other, and anxiety in dementia—a multidisciplinary task.

Anxiety in this population is perhaps best understood as a reaction to loss and worries, and existential in nature by the participants. Care interventions can reduce or prevent anxiety symptoms in this population. However, when anxiety co-exists with depression it might be difficult to attenuate these symptoms through care measures alone. To better identify and treat the condition, valid dementia-specific anxiety-screening instruments are necessary.

Read the abstract here

Does a dementia diagnosis have a silver lining? Study suggests it can.

ScienceDaily. Published online: 25 July 2016

Results from a study of patients with a diagnosis of mild cognitive impairment or early dementia indicates that their outlook isn’t as dark as expected.

A group of scientists from the University of Kentucky’s Sanders-Brown Center on Aging asked 48 men and women with early dementia or mild cognitive impairment (MCI) a series of questions about their quality of life and personal outlook post-diagnosis.

Called the Silver Lining Questionnaire (SLQ), the instrument measures the extent to which people believe their illness has had a positive benefit in areas such as: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy. The SLQ has been administered previously to patients with cancer diagnoses, but hasn’t been given to MCI/dementia patients, according to Gregory Jicha, MD, PhD, a professor at the Sanders-Brown Center on Aging and the study’s lead author.

Positive responses were even higher on certain scores, such as:

• appreciation and acceptance of life
• less concern about failure
• self-reflection, tolerance of others, and courage to face problems in life
• strengthened relationships and new opportunities to meet people.

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Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review

Disalvo, D. et al. BMC Geriatrics. 2016; 16: 114.

Image source: George Hodan // CC0

Background: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia.

Methods: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 – August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually.

Results: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals’ opinions on appropriateness of specific medications in different clinical scenarios.

Conclusions: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.

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New research uncovers factors that can protect against cognitive decline and dementia

Alzheimer’s Society.Published online: 25 July 2016

Research at the Alzheimer’s Association International Conference 2016 in Toronto, finds that certain genes and lifestyle factors can increase resilience against the development of Alzheimer’s disease.

These resilience factors may differ between men and women and may counteract the negative effects of a poor diet on cognition.

Factors such as the number of years spent in education, having a complex job and regularly doing activities that challenge the brain can contribute to resilience by helping to build up a ‘cognitive reserve’. Cognitive reserve is the ability of the brain to withstand certain levels of damage without any loss of function.

Read the full research overview here

 

Clinicians’ experiences of anxiety in patients with dementia

Knut Engedal & Siren Eriksen Clinicians’ experiences of anxiety in patients with dementia. Dementia July 14, 2016 Published online before print July 14, 2016

 

image source: Mark Lythgoe, Wellcome Images // CC BY-NC-ND 4.0

Since anxiety in patients with dementia is a complex, understudied phenomenon, this paper presents clinicians’ experiences of anxiety in this population.

Semi-structured interviews were conducted with seven clinicians experienced with dementia in elderly patients (65 years and above), and then evaluated via qualitative content analysis.

Analysis revealed three main categories: A reaction to loss and worries, symptoms of anxiety and depression interfere with each other, and anxiety in dementia—a multidisciplinary task.

Anxiety in this population is perhaps best understood as a reaction to loss and worries, and existential in nature by the participants. Care interventions can reduce or prevent anxiety symptoms in this population. However, when anxiety co-exists with depression it might be difficult to attenuate these symptoms through care measures alone. To better identify and treat the condition, valid dementia-specific anxiety-screening instruments are necessary.

Differences in quality of life in home-dwelling persons and nursing home residents with dementia

Olsen, C et al. Differences in quality of life in home-dwelling persons and nursing home residents with dementia – a cross-sectional study.  BMC Geriatrics published 11 July 2016

Background

Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.

Methods

The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.

Results

Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.

Conclusion

The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.

Full text available via BMC Geriatrics

An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes

Saini, G. et al. BMC Palliative Care. Published online: 7 July 2016

Background: Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice.

Methods: An ethnographic study in two nursing homes where the Compassion Intervention was delivered. The Compassion Intervention provides a model of end-of-life care engaging an Interdisciplinary Care Leader to promote integrated care, educate staff, support holistic assessments and discuss end of life with families. We used a framework approach, undertaking a thematic analysis of fieldwork notes and observations recorded in a reflective diary kept by the Interdisciplinary Care Leader, and data from in-depth interviews with 23 informants: family members, GPs, nursing home staff, and external healthcare professionals.

Results: Four major themes described strategies for improving practice: (i) educating families and staff about dementia progression and end–of-life care; (ii) appreciating the greater value of in-depth end-of-life discussions compared with simple documentation of care preferences; (iii) providing time and space for sensitive discussions; and (iv) having an independent healthcare professional or team with responsibility for end-of-life discussions.

Conclusions: The Interdisciplinary Care Leader role offers a promising method for supporting and improving end-of-life care discussions between families of people with advanced dementia and nursing home staff. These strategies warrant further evaluation in nursing home settings.

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