An adapted mindfulness intervention for people with dementia in care homes

Clarke, A.C. et al. International Journal of Geriatric Psychiatry. Published online: 7 February 2017

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Objective: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits.

Conclusions: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required.

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Nutrition and dementia care

Murphy, J L et al. | Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes | BMC Geriatrics. | DOI: 10.1186/s12877-017-0443-2 | Published: 14 February 2017

Background: There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia.

Methods: We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users.

Results: The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information.

Conclusions: This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

Technology-based tools and services for people with dementia and carers

Klara Lorenz et al. Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway. Published in Dementia, February 2017

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This paper provides an overview of the role of technology in dementia care, treatment and support by mapping existing technologies – by function, target user and disease progression.

Technologies identified are classified into seven functions: memory support, treatment, safety and security, training, care delivery, social interaction and other. Different groups of potential users are distinguished: people with mild cognitive impairment and early stages of dementia, people with moderate to severe dementia and unpaid carers and health- and social care professionals. We also identified the care settings, in which the technologies are used (or for which the technologies are developed): at home in the community and in institutional care settings.

The evidence has been drawn from a rapid review of the literature, expert interviews and web and social media searches. The largest number of technologies identified aim to enhance the safety and security of people with dementia living in the community. These devices are often passive monitors, such as smoke detectors. Other safety interventions, such as panic buttons, require active intervention.

The second largest number of interventions aims to enhance people’s memory and includes global positioning systems devices and voice prompts. These technologies mostly target people in the early stages of dementia. A third group focusing on treatment and care delivery emerged from the literature. These interventions focus on technology-aided reminiscence or therapeutic aspects of care for people with dementia and their carers.

While the review found a range of technologies available for people with dementia and carers there is very little evidence of widespread practical application. Instead, it appears that stakeholders frequently rely on everyday technologies re-purposed to meet their needs.

Footballers may be at heightened risk of brain trauma linked to dementia

Repeated headers during a footballer’s professional career may be linked to long-term brain damage, according to a small study by UK scientists. | BBC | OnMedica

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The researchers, from the Queen Square Brain Bank in London, base their findings on 14 retired footballers with dementia, who were referred to the Old Age Psychiatry Service in Swansea between 1980 and 2010.

Evidence of chronic traumatic encephalopathy (CTE) was found in four out of the six whose brains were examined after death. All six also had signs of Alzheimer’s disease.

Lead author Dr Helen Ling explained “This is the first time CTE has been confirmed in a group of retired footballers, Our findings…suggest a potential link between playing football and the development of degenerative brain pathologies in later life.”

But she cautioned: “However, it is important to note that we only studied a small number of retired footballers with dementia and that we still do not know how common dementia is among footballers.”

The association between CTE and Alzheimer’s disease isn’t clear, she said. “Previous studies have shown that the risk of Alzheimer’s disease is increased in people with previous head injuries. On the other hand, the risk of dementia is also increased with age and we don’t know if these footballers would have developed Alzheimer’s disease anyway if they hadn’t played football.

“The most pressing research question is therefore to find out if dementia is more common in footballers than in the normal population.”

Read more via  OnMedica | BBC

Full reference: Ling H, et al. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathologica, 2017. DOI: 10.1007/s00401-017-1680-3

Psychosocial interventions delivered by care home staff to people with dementia

Rapaport, P. et al. (2017) BMJ Open. 7:e014177

Objectives: This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes.

Conclusions: Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes.

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Direct medical expenditures associated with Alzheimer’s and related dementias

Deb, A. et al. Aging & Mental Health. Published online: 8 February 2017

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Objective: To estimate the excess direct annual healthcare expenditures associated with Alzheimer’s and related dementias(ADRD) among community-dwelling older adults in the United States.

Conclusion: ADRD in U.S. community-dwelling elders is associated with significant financial burden, primarily driven by increased home healthcare use.

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Do determinants of burden and emotional distress in dementia caregivers change over time?

Objectives: Caring for a patient with dementia is a real challenge and can have considerable psychological consequences in the long run. Many caregivers, mostly relatives, feel highly burdened. To develop effective caregiver support to prevent caregivers from getting overburdened, insight is needed into the determinants of burden. The objective of this study is to explore which patient and caregiver characteristics determine the different kinds of caregiver burden over time, both in the short and in the long run.

Method: The study was longitudinal. Data on patients and caregivers, general burden and emotional distress were collected at three times: at baseline, at the end of treatment and at nine months. The study was conducted in a psychiatric skilled nursing home with a unit for integrative reactivation and rehabilitation (IRR) and at different sites of home-/day care, assisted living arrangements and nursing home wards (usual care).

Results: General burden is shown to be determined by severity of patient’s neuropsychiatric symptoms, caregiver’s sense of competence, health-related quality of life. Emotional distress is determined by severity of patient’s neuropsychiatric symptoms, caregiver’s sense of competence, high affiliation and patient gender.

Conclusion: In preventing or treating caregiver burden, professional interventions need to aim specifically at diminishing the neuropsychiatric symptoms in dementia patients and improving the sense of competence in caregivers.

Survival after dementia diagnosis in five racial/ethnic groups

Mayeda, E.R. et al. Alzheimer’s & Dementia. Published online: 4 February 2017

Introduction: Information on anticipated survival time after dementia diagnosis among racially/ethnically diverse patients is needed to plan for care and evaluate disparities.

Discussion: Survival after dementia diagnosis differs by race/ethnicity, with shortest survival among whites and longest among Asian Americans.

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Prevalence and determinants of undetected dementia in the community

Lang, L. et al. (2017) BMJ Open. 7:e011146

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Objectives: Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.

Conclusions: The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.

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Factors associated with the quality of life of family carers of people with dementia

Farina, N. et al. Alzheimer’s & Dementia. Published online: 3 February 2017

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Introduction: Family carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia.

Discussion: The quality and level of evidence supporting each theme varied. We need further research on what factors predict carer QOL in dementia and how to measure it.

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