Dancing reduces the chances of falling

Age UK is urging older people to take up activities such as dance to improve their health.

Age UK’s Wellbeing in Later Life Index shows that 1 in 10 of the over-65s in the UK are regularly dancing and attending dance classes. The majority are women, many of them divorcees and widows. Dancing is a highly sociable activity and it may well be that for many of these older dancers, the opportunity to meet new friends is a major attraction of getting involved.

By participating in dance classes, these older people are also doing a lot to reduce their risks of falling, since research has found that just an hour of dancing a week lowers the chances of having a fall.

  • Falls and fractures among the over-65s account for over 4 million hospital bed days each year in England alone and are a serious threat to older people’s self-confidence and independence.
  • About 1 in 10 older people who have fallen are afraid to leave their homes in case they fall again.

Age UK is therefore urging older people to take up activities such as dance to improve their health.  Research with older people has found that dance classes are much more popular and engaging than traditional falls prevention programmes, which can seem rather dull.

Dancing and other forms of physical activity also help to keep the brain as well as the body in good working order as we age. In addition to the physical benefits, Age UK’s Wellbeing Index found that participating in ‘creative activities’ of all kinds, including dancing, was the single most effective thing any older person could do to improve their sense of ‘wellbeing’.

Full story at Age UK

The diagnostic accuracy of automated tests for cognitive impairment

Review finds some promising results for identifying MCI and early dementia, but notes shortcomings within available evidence | International Journal of  Geriatric Psychiatry

Abstract
Objective
The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment.

Methods
Six electronic databases (Medline, Embase, Cochrane, Institute for Scientific Information, PsycINFO, and ProQuest) were searched from January 2005 to August 2015 to identify papers for inclusion. Studies assessing the diagnostic accuracy of automated computerised tests for mild cognitive impairment (MCI) and early dementia against a reference standard were included. Where possible, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias.

Results
Sixteen studies assessing 11 diagnostic tools for MCI and early dementia were included. No studies were eligible for inclusion in the review of tools for monitoring progressive disease and response to treatment. The overall quality of the studies was good. However, the wide range of tests assessed and the non‐standardised reporting of diagnostic accuracy outcomes meant that statistical analysis was not possible.

Conclusion
Some tests have shown promising results for identifying MCI and early dementia. However, concerns over small sample sizes, lack of replicability of studies, and lack of evidence available make it difficult to make recommendations on the clinical use of the computerised tests for diagnosing, monitoring progression, and treatment response for MCI and early dementia. Research is required to establish stable cut‐off points for automated computerised tests used to diagnose patients with MCI or early dementia.

Aslam, R. W. et al. | A systematic review of the diagnostic accuracy of automated tests for cognitive impairment | International Journal of  Geriatric Psychiatry | Volume 33, Issue 4 | April 2018 | Pages 561-575

Emotional distress with dementia

This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia | International Journal of Geriatric Psychiatry

Abstract

Objective
More understanding is needed about the emotional experiences of dementia from the perspective of the individual. This understanding can then inform the provision of health care to meet individual needs. This systematic review aimed to present all available descriptions of emotional distress and explanations for emotional distress experienced by individuals with dementia, articulated personally and by others.

Methods
A systematic mixed‐method review identified literature that was screened and quality appraised. Data were analysed quantitatively and qualitatively using corpus‐based methods and meta‐ethnography.

Results
The 121 included studies showed that individuals with dementia have expressed emotional distress comprehensibly. Family, professional caregivers, clinicians, and academic writers have also observed and described extreme emotional experiences. Feeling fearful and lonely were predominant and show the importance of anxiety in dementia. Explanations for emotional distress included threats to universal, human needs for identity, belonging, hope, and predictability.

Conclusions
The variable and personal emotional experiences of individuals with dementia are well described and should not continue to be overlooked. Limitations, future research, and clinical implications are discussed.

Full reference: Petty, S. et al. | Emotional distress with dementia: A systematic review using corpus‐based analysis and meta‐ethnography | International Journal of Geriatric Psychiatry | First published: 2 March 2018

 

Dementia-related Stigma Research

Herrmann, Lynn K et al | A Systematic Review of Dementia-related Stigma Research: Can We Move the Stigma Dial?The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry | Mar 2018; vol. 26 (no. 3); p. 316-331

Abstract:

Stigma negatively affects individuals with cognitive impairment and dementia. This literature review examined the past decade (January 2004 to December 2015) of world-wide research on dementia-related stigma.

Using standard systematic review methodology, original research reports were identified and assessed for inclusion based on defined criteria. Initial database searches yielded 516 articles. After removing duplicates and articles that did not fit inclusion criteria (419), 97 articles were reviewed, yielding a final total of 51 publications, mainly originating in the United States and Europe. Studies were assessed for date, geographic region, sample description, methodology, and key findings.

Reports were evaluated on 1) how stigmatizing attitudes may present in various subgroups, including in racial or ethnic minorities; 2) stigma assessment tools; and 3) prospective or experimental approaches to assess or manage stigma.

Stigma impedes help-seeking and treatment, and occurs broadly and world wide. Stigmatizing attitudes appear worse among those with limited disease knowledge, those with little contact with people with dementia, in men, in younger individuals, and in the context of ethnicity and culture.

In some cases, healthcare providers may have stigmatizing attitudes. In research studies, there does not appear to be consensus on how to best evaluate stigma, and there are few evidence-based stigma reduction approaches.

Given the projected increase in persons with dementia globally, there is a critical need for research that better identifies and measures stigma and tests new approaches that can reduce stigmatizing attitudes.

 

Costs of potentially inappropriate medication use in residential aged care facilities

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This review found that the use of potentially inappropriate medications (PIMs) for older adults in residential care facilities is high and that these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes.

Harrison, S. L. et al | Costs of potentially inappropriate medication use in residential aged care facilities | BMC Geriatrics; 2018; vol. 18 (no. 9)

Three poems about dementia on World Poetry Day

flower-854377_1280Writing a poem about how you or a loved one has been affected by dementia can offer relief for both writer and reader. It can also provide a powerful insight into what dementia means for those living with it every day.

This blog post from the Alzheimer’s Society, published on World Poetry Day, features three poems written by people affected by dementia. Despite their experiences being very different, each poet chose to share their work in the hope it might help others in a similar situation.

Full details at Azheimer’s Society

 

 

 

Person-centred care improves quality of life for care home residents with dementia

A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care | National Institute for Health Research 

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Image source: discover.dc.nihr.ac.uk

The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.

This larger-scale NIHR trial conducted across 69 UK nursing homes focused on exploring the effects on quality of life and other symptoms. WHELD gave small-scale, but important improvements. It didn’t reduce antipsychotic use, as this was low to start with, which is in line with policy to limit use.

It supports the feasibility of the intervention, but there is a need to understand which components are most effective and could be implemented on a wide scale with sustainable effects.

Further detail at National Institute for Health Research

Full reference: Ballard C, Corbett A, Orrell M, et al. | Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. | PLoS Med. 2018;15 (2)

Three tour to spread the message of dementia research

Every third minute in the UK someone will begin living with dementia. Created by people living with dementia, Every Third Minute featured a programme of theatre, performance and live music exploring new ways of looking at dementia.

Clinical Research Network  Yorkshire and Humber is proud to sponsor the Three tour, a set of short plays co-written by people living with dementia, which have been commissioned by West Yorkshire Playhouse. The plays will tour care homes and community settings in and around Leeds.

Three, a trio of 15-minute plays performed one after the other, has been co-written by people with dementia and professional writers, and is part of the West Yorkshire Playhouse’s Every Third Minute festival.

More on Every Third Minute festival here

15 years of dementia treatment in 15 papers

Age and Ageing journal has published a free online collection of 15 papers to provide an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years.

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Image source: academic.oup.com

The published studies reflect the efficacy of the current anti-dementia treatments, preventive treatments of cardio and cerebrovascular incidents known to be risk factors for dementia, alongside the use of antidepressant medication and non-pharmacological interventions for treatment of behavioural and psychopathological symptoms of dementia. We also address the future preventative steps and therapeutic strategies currently in development to combat the devastating consequences of dementia.

 

These papers are all free to read, download and share from the Age and Ageing journal website. The full collection can be viewed here, or individual papers accessed below.

Currently available anti-dementia treatments

Non-pharmacological interventions

Management of vascular risk factors for dementia

Drug use in people with dementia