Dementia in older age: barriers to primary prevention and factors

Evidence review showing that changing some behaviours in midlife can reduce the chances of getting dementia in older age | PHE

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These documents help commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia.

This review, by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (2016), shows that there is evidence that the risk of dementia is increased by:

  • physical inactivity
  • current smoking
  • diabetes
  • hypertension in mid-life
  • obesity in mid-life and depression

It also shows that mental activity can reduce the risk of dementia.

To promote primary prevention of dementia, it is important to understand both the barriers to primary prevention and factors which facilitate primary prevention.

Read the full overview here

Increased risk of dementia in patients who experience delirium after surgery

This study finds those who developed postoperative delirium were three times more likely to suffer permanent cognitive impairment or dementia | ScienceDaily

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Over a ten year period, patients over the age of 65 enrolled at the Mayo Clinic Study of Ageing in Olmsted County Minnesota who were exposed to general anesthesia were included in an investigation involving over two 2000 patients. Their cognitive status was evaluated in regular 15 month periods before and after surgery by neuropsychologic testing and clinical assessment. Out of 2014 patients, 1667 were deemed to be cognitively normal before surgery. Of the 1152 patients who returned for follow-up cognitive evaluation, 109 (9.5%) had developed mild cognitive impairment (pre-dementia) or dementia, and those who had suffered postoperative delirium were three times more likely to be subsequently diagnosed with permanent cognitive decline or dementia. This research is the first to focus on the association between delirium and long-term cognitive decline in patients with normal mental capacity before surgery.

While previous studies have highlighted cognitive decline in the elderly following postoperative delirium, no others have involved such a detailed neuro-cognitive assessment identifying those with normal pre-operative cognitive abilities who go on to develop dementia. In conclusion, researchers believe that postoperative delirium could be a warning sign of future permanent cognitive impairment (dementia) in patients who at the time of surgery were still just above the threshold for registering cognitive decline. Alternatively, postoperative delirium could itself produce injury, which per se accelerates the trajectory of decline into dementia.

Dementia-Friendly Hospital Design

We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design | The Gerontologist

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This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia.

A total of 28 primary studies plus expert reviewers’ narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function.

Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.

Full reference: Parke, B. et al. (2017) A Scoping Literature Review of Dementia-Friendly Hospital Design. The Gerontologist. Vol. 57 (No. 4) pp. e62-e74.

Dementia Education: Does It Change Nursing Practice?

Although gerontological nurses are well positioned to care for older adults with dementia, barriers to implementing quality client care remain, including: limited knowledge, poor morale among care staff, lack of professional development opportunities, and unsuitability of acute care hospitals for this client group | Journal of Gerontological Nursing

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The solution most commonly offered is education. Many academic institutions, health care facilities, and even professional associations offer educational activities. The literature is rich with descriptions of activity formats, from workshops of less than 1 hour in duration to courses provided over 12 months or longer, offered in face-to-face format, print, or via online learning. Exceptional educational activities might be described as having a high degree of transference, meaning that the information learned in these activities can be easily applied to gerontological nursing practice.

Yet, I question whether these activities actually change nursing practice. Based on my review of the literature, most educational activities are evaluated in terms of attitude shifts, knowledge gained, and/or satisfaction with course content—few speak to changes in the quality of care provided to older adults with dementia. One reason may be that a large proportion of the published literature on the topic of dementia workforce education describes research studies, which are often by definition initiated by individuals external to a facility, time-limited, and not always sustainable. If we are to face the challenge of demographic aging and the projected increase it will bring in the number of older adults living with dementia, academic and health and human service organizations will need to ensure that their nursing workforce has the knowledge and, more importantly, the skills required to perform their work. However, the value of educational activities in determining clinical interventions and subsequently evaluating the direct effects of these interventions on outcomes for older adults with dementia has been limited.

Full reference: Hirst, S.P. (2017) Dementia Education: Does It Change Nursing Practice? Journal of Gerontological Nursing. Vol 43 (Issue 7) pp. 2-3

An Innovative Approach to Managing Behavioral and Psychological Dementia

The older adult population in long-term care is experiencing significant growth, which includes an increased number of minority admissions. An estimated 48% of long-term care patients are admitted with a diagnosis of dementia | The Journal for Nurse Practitioners

Highlights: 

  • Nurse practitioners are in a key position to provide culturally appropriate care in older adults with BPSD
  • Personalized music is an evidence-based, patient centered intervention to reduce BPSD
  • Regulatory agencies are closely monitoring the management of BPSD in long-term care facilities.
  • Personalized music can be an interdisciplinary approach in the management of BPSD

Patient-centered, culturally appropriate care is critical in the management of dementia and treatment of associated behavior and psychological symptoms of dementia (BPSD). The use of personalized music playlists has shown promise in the interdisciplinary treatment of BPSD. Regulatory agencies are closely monitoring the management of BPSD. Accurate diagnosis and treatment of BPSD is an increasingly important skill for the provider.

Full reference: Long, E.M. (2017) An Innovative Approach to Managing Behavioral and Psychological Dementia. The Journal for Nurse Practitioners. Vol. 13 (Issue 7) pp. 475-481

Social living models for people with dementia

In this blog for the Evidently Cochrane #dementiaspotlight series, Carrie Jackson from the England Centre for Practice Development looks at innovations in supported care in the community, social living models, that might help people to live well with dementia

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This blog looks at the potential for integrated community social living models such as Guest Houses with Care,  co-created with older people and people living with dementia (PLWD), their carers and families to be cascaded to the UK from the Netherlands and Belgium.  It will outline a new 4 year European funded project to cascade excellence in dementia policy and practice to the UK and consider what this may mean for the way in which we configure our services and approach to the concept of living well at home in the future.

The blog explores the question “How effective are models of housing and care used in countries other than the UK in supporting care in the community for PLWD and other long term conditions?”. This is increasingly important given the surge in younger onset dementia and our crisis in finding suitable funding models and appropriate services that will enable people to live independently for as long as possible at home.

Read the full post here

How physical exercise prevents dementia

Physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age, numerous studies have shown. Now researchers have explored in one of the first studies worldwide how exercise affects brain metabolism | ScienceDaily

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In order to further advance current state of knowledge on the positive influence of physical activity on the brain, gerontologists and sports physicians at Goethe University Frankfurt have examined the effects of regular exercise on brain metabolism and memory of 60 participants aged between 65 and 85 in a randomised controlled trial. Their conclusion: regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.

 

Mild Cognitive Impairment and Driving Cessation

Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this | Dementia and Geriatric Cognitive Disorders

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Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI.

One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period.

Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis.

A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics – such as age, cognition, and function – and changes in these measures over 6 months predict driving cessation.

Full reference: Connors, M.H. et al. (2017) Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study. Dementia and Geriatric Cognitive Disorders. Vol. 44 (no. 1-2) pp. 63-70

Daily crosswords linked to sharper brain in later life

Online trial finds that the more regularly people report doing word puzzles such as crosswords, the better their brain function in later life. |  Via ScienceDaily

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Image source: Jessica Whittle Photography – Flickr // CC BY-NC-ND 2.0

Experts at the University of Exeter Medical School and Kings College London analysed data from more than 17,000 healthy people aged 50 and over, submitted in an online trial.  The study, one of the largest of its kind, used tests from online cognitive test systems to assess core aspects of brain function. They found that the more regularly participants engaged with word puzzles, the better they performed on tasks assessing attention, reasoning and memory.

From their results, researchers calculate that people who engage in word puzzles have brain function equivalent to ten years younger than their age, on tests of grammatical reasoning speed and short term memory accuracy.

Read more at ScienceDaily

One in three cases of dementia preventable

A new report identifies powerful tools to prevent dementia and touts the benefits of nonmedical interventions for people with dementia | ScienceDaily

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Image source: The Lancet

Managing lifestyle factors such as hearing loss, smoking, hypertension and depression could prevent one-third of the world’s dementia cases, according to a report by the first Lancet Commission on Dementia Prevention and Care. Presented at the Alzheimer’s Association International Conference (AAIC) 2017 and published in The Lancet, the report also highlights the beneficial effects of nonpharmacologic interventions such as social contact and exercise for people with dementia.

The commission’s report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia — one in three cases — is attributable to these risk factors, the report says.

By increasing education in early life and addressing hearing loss, hypertension and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined.

In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact and managing diabetes could reduce the incidence of dementia by another 15 percent.