Hobday, J.H. et al. (2017) Research in Gerontological Nursing (10)2 pp. 58-65
The current project tested the feasibility and utility of the CARES® Dementia-Friendly Hospital™ (CDFH) program, a 4-module, online training program for nursing assistants (NAs) and allied hospital workers (AHWs) who provide care to individuals with dementia.
A single group pretest/posttest design was used for 25 hospital NAs/AHWs, and quantitative and qualitative data were collected to determine whether NAs’/AHWs’ knowledge of hospital-based dementia care significantly increased, and if CDFH was perceived as useful and acceptable.
Dementia care knowledge increased significantly (p < 0.001). Open- and closed-ended data suggested that the delivery of online training to NAs/AHWs to enhance dementia care is feasible, useful, and efficient.
Ongoing gaps in care exist for individuals with dementia in hospitals, and delivering robust training for NAs/AHWs may serve as an effective modality to enhance quality of dementia care in such settings.
Digby, R. et al. (2017) Journal of Clinical Nursing. 26(9-10) pp. 1152–1171
Aims and objectives: To identify and examine existing research exploring how people with dementia and nurses view acute hospital care.
Background: Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses.
Conclusions: Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals.
Relevance to clinical practice: Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role-modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia.
De Witt Jansen, B. et al. (2017) Journal of Clinical Nursing. 26(9-10) pp. 1234–1244
Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.
Background: Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.
Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.
Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.
Researchers reviewed 39 studies published up to the end of 2016 to assess the potential impact of varying types, intensities, and durations of exercise on the brain health of the over 50s | Alzheimer’s Society
Dr Doug Brown, Director of Research at Alzheimer’s Society, said:
‘The benefits of regular exercise to keep a sharp mind are becoming clearer. Previous studies show that people who exercise are less likely to develop dementia, but more research is needed to find out exactly what type and how much exercise is best to help reduce your risk of the condition.’
‘In this study, researchers reviewed results from 39 trials of people in their 50s who were given supervised exercise programmes. Taking up moderate or vigorous exercise improved people’s performance on tests of thinking skills, but the study didn’t look at whether this reduced their likelihood of developing dementia.’
Review question: Can simulated presence therapy (SPT) treat problem behaviours, and improve quality of life for people with dementia?
Study characteristics: We looked for trials which compared SPT to usual care or to another treatment. Ideally, people with dementia should have been randomly allocated to one or other treatment, but we also included trials even if treatment allocation was not strictly random.
We found three trials which met our inclusion criteria. The 144 participants were all living in nursing homes. The majority were women with an average age of over 80 years and severe dementia. The way SPT was administered was different in each trial. All the trials used more than one comparison treatment, which differed between trials. The trials all attempted to measure an effect on agitated behaviours, but used different approaches.
Key findings: Because the trials were so different from each other, we were not able to pool the results. Individually, each trial reported different methods to assess the effect of SPT on behavioural problems and the results varied depending on the method used to measure the outcome.
None of the studies assessed quality of life, effect on daily activities, effects on caregivers, or how likely participants were to drop out of the study.
Hung, L. et al. International Journal of Older People Nursing. Published online: 18 April 2017
Background: Recognising demographic changes and importance of the environment in influencing the care experience of patients with dementia, there is a need for developing the knowledge base to improve hospital environments. Involving patients in the development of the hospital environment can be a way to create more responsive services. To date, few studies have involved the direct voice of patients with dementia about their experiences of the hospital environment.
Conclusions: Patient participants persuasively articulated the supportive and unsupportive elements in the environment that affected their well-being and care experiences. They provided useful insights and pointed out practical solutions for improvement. Action research offers patients not only opportunities to voice their opinion, but also possibilities to contribute to hospital service development.
Gustafsson, M. et al. European Journal of Clinical Pharmacology | Published online: 8 April 2017
Purpose: To assess whether comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment.
Conclusion: Participation of clinical pharmacists in healthcare team conducting comprehensive medication reviews did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment; however, post-hoc and subgroup analyses indicated significant effects favoring the intervention. More research is needed.
A new prospective cohort study publishing in Stroke investigates if there is an increased risk of stroke and dementia after sugar and artificially sweetened beverage consumption | Science Media Centre
Dr James Pickett, Head of Research at Alzheimer’s Society said:
“This research does not show that artificially sweetened drinks cause dementia. But it does highlight a worrying association that requires further investigation
“Research into dietary factors is very complex and there are a number of issues that need clarifying, for example why drinks sweetened with sugar were not associated with an increased risk in this study, and teasing out links between all types of sugary drinks, diabetes and dementia.
“What we do know is that the things we eat and drink can have an effect on our brain health. Evidence shows that along with eating a healthy diet, including watching what you drink, the best way to reduce your risk of dementia is to take plenty of exercise and stop smoking.”
“Depression and cancer drugs offer hope for dementia sufferers,” Sky News reports. The headline is prompted by a study looking at the effect of two drugs – one used to treat depression and another being trialed for cancer treatment – on neurodegenerative diseases | NHS Choices
This early stage experimental research has demonstrated a beneficial neurological effect of trazodone and dibenzoylmethane on mice with diseases mimicking neurodegenerative diseases.
It is important to acknowledge that this is animal research and therefore the drugs might not have the same effect when they are trialled on humans.
That being said, trazodone is already an approved drug for depression and sleep problems and has therefore already passed safety tests. If the mechanisms of neurodegeneration in humans and mice are similar, it is possible trazodone could be used in the future in treating Alzheimer’s and other neurodegenerative diseases.
These early tests are promising. However, these drugs need to be proven effective and safe in people with neurodegenerative diseases before becoming available.
Even if these are proven safe and effective, it is often a lengthy process from the start of human clinical trials to drugs being marketed and available to healthcare providers. This is especially true for long-term conditions where progression may be slow. Therefore, it could well be several years before these drugs are available for the treatment of neurodegenerative diseases.