Family visits in care homes

Bruce Walmsley & Lynne McCormack | Severe dementia: relational social engagement (RSE) during family visits | Aging & Mental Health Vol. 21 , Iss. 12,2017

Abstract:

Objective: Few studies have utilised observation to investigate retained awareness when individuals with severe dementia interact with family members. Seeking evidence of retained awareness in those with severe dementia, interactive family visits in care homes were observed and analysed.

Method: Five family groups (14 individuals) completed 10/15-minute video recorded family interactions. Speech and non-speech interactions were analysed using Thematic Analysis.

Results: One superordinate theme: Distinctive family bonds; overarched two subthemes, in-step and out-of-step describing positive and negative familial interactions. In-step interactions revealed family groups reciprocating social support, having fun together, and willing to go on the ride together. Out-of-step interactions characterised social frustration, non-reciprocity, and sidelining of members with dementia. Although awareness fluctuated, complex awareness was observed in the speech/non-speech expressions of those with dementia. In response, visitors appeared to treat those expressions and behaviours as understandable. Observed outcomes were out-of-step when visitors sought to retain the familiar and in-step when visitors sought to optimise all communication possibilities.

Conclusion: Video recorded family interactions and analysis revealed: (a) awareness was retained in the participants with severe dementia beyond assessed levels; and (b) Relational Social Engagement (RSE) occurred within family groups despite positive or negative interactions. Implications are discussed.

Differences in aggression among people with dementia

Study shows that one-third of patients with the diagnosis Alzheimer’s disease or frontotemporal dementia were physically aggressive towards healthcare staff, other patients, relatives, animals and complete strangers. | via Science Daily

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Objective

To investigate the prevalence of physical aggression among patients with dementia of different types and to analyze potential differences in clinical traits, in terms of singular or repetitive behavior and occurrence in early or late stage of the disease. We also aimed at examining against whom the physical aggression was exerted.

Methods

We included 281 cases with a neuropathological dementia diagnosis from the brain bank at the Department of Pathology, Lund University, for this retrospective medical records review. The study covers cases with a post-mortem examination performed between 1967 and 2013.

Results

Of the 281 patients studied, 97 (35%) patients had a history of exerting physical aggression during the course of their disease. The patients with frontotemporal dementia exerted physical aggression earlier in the course of their disease than Alzheimer’s disease patients. The most frequent victims of the patients’ physical aggression were health staff and other patients. The aggression also affected family members as well as (to the demented patient) unknown people. The frequency of the physical aggression differed among the different diagnostic groups; frontotemporal dementia patients exhibiting a higher physical aggression frequency score than did Alzheimer’s disease patients.

Conclusions

The patterns of manifested physical aggression thus differ between the frontotemporal dementia and Alzheimer’s disease patient groups in this study. Knowledge about such differences may be of value in decision making in patient care.

Full reference: Madeleine Liljegren, Maria Landqvist Waldö, Elisabet Englund. Physical aggression among patients with dementia, neuropathologically confirmed post-mortem. International Journal of Geriatric Psychiatry, 2017

Not enough specialist support for people with dementia

Despite having complex needs, most of the healthcare received by people in the later stages of dementia is provided by GPs or emergency services, with little support from specialist healthcare professionals. | via Marie Curie

Researchers, from the Marie Curie Palliative Care Research Department at University College London, found that GPs were the main providers of medical care, with 96% of people with advanced dementia  seeing a GP in their last month of life. Paramedics also played a major role in assessment and healthcare towards the end of life, suggesting a reactive rather than planned response to patients’ needs – nearly one in five (19%) were seen by a paramedic in the month prior to their death.

Only 1% of people with advanced dementia were seen during the follow up period of the study by a geriatrician or an older persons’ psychiatrist.

Based on the findings, the researchers say that healthcare services are not currently tailored to the complex needs and symptoms of people with advanced dementia. Given that dementia is now the leading cause of death, they say there is urgent need to ensure an adequate standard of comfort and quality of life for patients.

Full story at Marie Curie

 

Enabling People with Dementia to Remain at Home: A Housing Perspective

Published to coincide with World Alzheimer’s Month this report has been produced on behalf of the Dementia and Housing Working Group, and supported by partners Homeless Link, Foundations and the Life Story Network

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Image source: Housing LIN

The report and the accompanying Executive Summary set out the key role housing providers, and in particular social housing providers, can play in supporting people living with dementia to stay independent in the home of their choice for as long as possible. Its findingse are divided into ones directly relevant to those working in the housing sector and those that provide a platform for wider application; for example, to become more dementia-friendly.

Post-diagnostic support for adults with an intellectual disability and dementia

Study finds, Post diagnostic support is essential for the general population, and within the intellectual disability field, needs to be individualized and adapted to the person’s needs as dementia progresses.

Abstract

Objectives: Post diagnostic support (PDS) has varied definitions within mainstream dementia services and different health and social care organizations, encompassing a range of supports that are offered to adults once diagnosed with dementia until death.

Method: An international summit on intellectual disability and dementia held in Glasgow, Scotland in 2016 identified how PDS applies to adults with an intellectual disability and dementia. The Summit proposed a model that encompassed seven focal areas: post-diagnostic counseling; psychological and medical surveillance; periodic reviews and adjustments to the dementia care plan; early identification of behaviour and psychological symptoms; reviews of care practices and supports for advanced dementia and end of life; supports to carers/ support staff; and evaluation of quality of life. It also explored current practices in providing PDS in intellectual disability services.

Results: The Summit concluded that although there is limited research evidence for pharmacological or non-pharmacological interventions for people with intellectual disability and dementia, viable resources and guidelines describe practical approaches drawn from clinical practice. Post diagnostic support is essential, and the model components in place for the general population, and proposed here for use within the intellectual disability field, need to be individualized and adapted to the person’s needs as dementia progresses.

Conclusions: Recommendations for future research include examining the prevalence and nature of behavioral and psychological symptoms (BPSD) in adults with an intellectual disability who develop dementia, the effectiveness of different non-pharmacological interventions, the interaction between pharmacological and non-pharmacological interventions, and the utility of different models of support.

Full reference:  Dodd, K et al. | Consensus statement of the international summit on intellectual disability and Dementia related to post-diagnostic support. | Aging & Mental Health | Published online: 07 Sep 2017

 

Sugary beverage intake and preclinical Alzheimer’s

Excess sugar consumption has been linked with Alzheimer’s disease (AD) pathology in animal models | Alzheimers & Dementia

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We examined the cross-sectional association of sugary beverage consumption with neuropsychological (N = 4276) and magnetic resonance imaging (N = 3846) markers of preclinical Alzheimer’s disease and vascular brain injury (VBI) in the community-based Framingham Heart Study. Intake of sugary beverages was estimated using a food frequency questionnaire.

Relative to consuming less than one sugary beverage per day, higher intake of sugary beverages was associated with lower total brain volume (1–2/day, β ± standard error [SE] = −0.55 ± 0.14 mean percent difference, P = .0002; >2/day, β ± SE = −0.68 ± 0.18, P < .0001), and poorer performance on tests of episodic memory (all P < .01). Daily fruit juice intake was associated with lower total brain volume, hippocampal volume, and poorer episodic memory (all P < .05). Sugary beverage intake was not associated with VBI in a consistent manner across outcomes.

Higher intake of sugary beverages was associated cross-sectionally with markers of preclinical AD.

Full reference: Pase, M.P. et a; (2017) Sugary beverage intake and preclinical Alzheimer’s disease in the community. Alzheimers & Dementia. Vol. 13 (Issue 9) pp. 955–964.

Can mindfulness-based interventions influence cognitive functioning in older adults?

An increased need exists to examine factors that protect against age-related cognitive decline. There is preliminary evidence that meditation can improve cognitive function | Aging & Mental Health 

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However, most studies are cross-sectional and examine a wide variety of meditation techniques. This review focuses on the standard eight-week mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

We conclude that eight-week MBI for older adults are feasible, but results on cognitive improvement are inconclusive due a limited number of studies, small sample sizes, and a high risk of bias. Rather than a narrow focus on cognitive training per se, future research may productively shift to investigate MBI as a tool to alleviate suffering in older adults, and to prevent cognitive problems in later life already in younger target populations.

Full reference: Berk, L. et al. (2017) Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research. Aging & Mental Health. Vol. 21 (Issue 11) pp. 1113-1120

Sustainable, competent, and empathetic support for patients with dementia during an acute hospital stay

Internationally, there has been a focus on the development of acute hospital workforces to support and care for people with dementia | The International Journal of Health Planning and Management

Recommendations and initiatives to improve person-centred care in acute hospitals have included: education and training, dementia-specific roles, clinical leads, and environment changes.

The aim of this literature review is to understand the elements of a sustainable, competent, and empathetic acute hospital workforce providing person-centred care for patients with dementia.

Emergent themes were as follows: understanding the current workforce, implementation and evaluation of training, and exploration of new and existing roles. An important element was the sustainability of acute hospital workforces competent in dementia care, as studies highlighted an ageing nursing population and a high turnover of staff. Dementia awareness training was sustainable, although there was a lack of consistency in the length, content, and delivery, which had a viable impact on the provision of empathetic and person-centred care. The lack of consistency of training and specialist dementia roles restricts recommendations from a robust evidence base.

Full reference: Brooke, J. & Ojo, O. (2017) Elements of a sustainable, competent, and empathetic workforce to support patients with dementia during an acute hospital stay: A comprehensive literature review. The International Journal of Health Planning and Management. Published online: 24 August 2017

Dementia-friendly public toilets

Many older adults avoid travelling and social interaction because of the scarcity of public toilets or their inaccessibility. Furthermore, where public toilets are provided, poor design and signage can preclude independent use, particularly for people living with dementia | The Lancet

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Image source: Martin Sotirov – Flickr // CC BY 2.0

In general, there is a gap between current public toilet provision and toilet design appropriate for individuals living with dementia, who might have behavioural change, poor level of motivation, loss of mobility and manual dexterity, or abnormalities in visual information processing. In response to research and anecdotal evidence, many guidelines are available to inform and improve the design and independent usability of toilet facilities for people living with dementia. Examples include the use of familiar or automatic flush systems, non-reflective surfaces, good lighting, contrast between doors and surroundings and between the toilet and toilet seat, sinks that do not resemble urinals, well labelled taps and soap dispensers, and the careful placing of mirrors.

However, as highlighted by a substantial amount of anecdotal evidence, the absence of simple and clear way-out signs negates any positive influence of a well designed toilet facility. Such an omission can result in distress, anxiety, embarrassment, and reluctance to use the toilet in the future. Common examples reported to investigators include instances of people having to enter opposite sex toilet facilities to guide their partners out, or going through the wrong door and into undesired or incorrect locations. A fire exit sign showing someone running with a directional arrow is also easily misunderstood as an exit sign, which can result in misdirection with people ending up outside the building and, in some cases, wandering on to a road. Similarly, doors that are both a fire exit and the route back to a public area can cause confusion, and might elicit a reluctance to open them, primarily because of the fear of setting off a fire alarm.

Full reference: Tales, A. et al. (2017) Dementia-friendly public toilets. The Lancet Vol. 390 (no. 10094) pp. 552–553

Less REM sleep tied to greater risk of dementia

People who get less rapid eye movement (REM) sleep may have a greater risk of developing dementia, according to a new study. REM sleep is the sleep stage when dreaming occurs. | Neurology | ScienceDaily

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People who get less rapid eye movement (REM) sleep may have a greater risk of developing dementia, according to a new study published in the August online issue of Neurology.

There are five stages of sleep. Stage one is light sleep. Stage two is when the body begins to prepare for deeper sleep, including stages three and four. Stage five is REM sleep. During this dream stage, the eyes move rapidly and there is increased brain activity as well as higher body temperature, quicker pulse and faster breathing. The first REM stage occurs about an hour to an hour-and-a-half into sleep and then recurs multiple times throughout the night as the cycles repeat.

The study looked at 321 people with an average age of 67 who participated in The Framingham Heart Study. During that study, sleep cycles were measured for each participant. Researchers collected the sleep data and then followed participants for an average of 12 years. During that time, 32 people were diagnosed with some form of dementia and of those, 24 were determined to have Alzheimer’s disease.

The people who developed dementia spent an average of 17 percent of their sleep time in REM sleep, compared to 20 percent for those who did not develop dementia. After adjusting for age and sex, researchers found links between both a lower percentage of REM sleep and a longer time to get to the REM sleep stage and a greater risk of dementia. For every percent reduction in REM sleep there was a 9 percent increase in the risk of dementia. The results were similar after researchers adjusted for other factors that could affect dementia risk or sleep, such as heart disease factors, depression symptoms and medication use.

Full story at ScienceDaily

Full reference: Pase, M.P. et al. Sleep architecture and the risk of incident dementia in the community. Neurology, 2017