Most deprived are nearly twice as likely to develop dementia

Older adults in England with fewer financial resources are more likely to develop dementia, according to new research | University College London | story via ScienceDaily

Researchers analysed data from over 6000 adults born between 1902 and 1943 and found that the 20% most deprived adults were 50% more likely to develop dementia than the 20% least deprived adults.

The study, published in JAMA Psychiatry, is the first of its kind to determine which socioeconomic factors influence dementia and found limited wealth in late life is associated with increased risk of dementia, independent of education.

Professor Andrew Steptoe, senior author of the study, explained: “Our study confirms that the risk of dementia is reduced among well-off older people compared with those who have fewer economic resources. Many factors could be involved. Differences in healthy lifestyle and medical risk factors are relevant. It may also be that better off people have greater social and cultural opportunities that allow them to remain actively engaged with the world.”

Full story at ScienceDaily

Full reference: Cadar, D. et al. | Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England: Evidence From a 12-Year Follow-up in the English Longitudinal Study of Ageing.  | JAMA Psychiatry | published online May 16, 2018

New film: ‘Living with Dementia in Extra Care’

Extra Care Housing allows people to live independently in their own homes, with the added benefit of flexible, on-site care and support | Housing LIN

The latest film in the ‘Spotlight on Extra Care Housing’ series, draws on the personal stories of Extra Care residents living with dementia, and their partners.

The views of care home staff in relation to experiencing and managing behaviour that challenges in dementia

Aim: To determine the views of care home (CH) staff in relation to experiencing and managing behaviour that challenges (BtC) in dementia and their experiences of training.

Method: Cross-sectional survey using a self-report questionnaire, distributed to staff employed in a 20% sample of all registered dementia-specialist CHs in England, either by postal or direct distribution.

Results: Questionnaires were returned from 352 care staff (25%), representing 5% of all dementia-specialist CHs, half were CH without nursing. Respondents estimated caring for 14,585 residents, 9,361 with dementia and 5,258 with BtC. 30.2% of residents with dementia were estimated as being prescribed a medicine to control BtC. BtC reported as experienced by most respondents were: shouting (96.6%), verbal aggression (96.3%) and physical aggression (95.7%), with physical aggression viewed as most difficult to manage. Top behaviours experienced every shift were: wandering (77.8%), perseveration (68.2%) and restlessness (68.2%).

Approaches such as assessing residents, knowing them and treating them as individuals, identifying triggers, having time for them and using an appropriate style of communication, were viewed as key to managing BtC, rather than guideline-specific interventions such as massage, aromatherapy and animal-assisted therapy.

Only 38% agreed/strongly agreed medicines were useful to control BtC, which was related to the extent to which they were prescribed. Training was available, but variable in quality with on-line training being least useful and on-the job training most desirable.

Conclusion: BtC are commonly and frequently experienced by care staff, who consider individual approaches, having time and good communication are key to successful management.

Full reference:
Charlotte Mallon, Janet Krska & Shivaun Gammie | 2018 | Views and experiences of care home staff on managing behaviours that challenge in dementia: a national survey in England |  Aging & Mental Health |  Published online: 25 May 2018

Dementia friendly swimming sessions help patients and carers, study finds

University of Nottingham | May 2018 | Dementia friendly swimming sessions help patients and carers, study finds

New research has been carried out by researchers at the University of Nottingham and the Institute of Mental Health looked at the impact of swimming sessions on people living with dementia and how they affect their carers.  The researchers intended to find out what impact swimming sessions have on the lives of people with dementia and how they affect the experience of their carers. The project also explored how and in what ways swimming sessions at public pools can be made ‘dementia friendly.’ 

Using interviews, the researchers interviewed people with dementia, their carers and staff who ran the swimming sessions at a leisure centre. According to the researchers the feedback from individuals with dementia and their carers was overwhelmingly positive, they also noted how the sessions boosted the confidence of the swimmers (University of Nottingham).

The full press release is available from the University of Nottingham 

A paper based on this research has been published in the journal   Dementia,

The article can be requested by Rotherham NHS staff here

After diagnosis of dementia: what to expect from health and social care services

Department of Health and Social Care | May 2018 | After diagnosis of dementia: what to expect from health and social care services

A new report from the Department of Health and Social Care examines the role of advanced care planning and explores the barriers to its implementation as identified by people with incurable cancer and health and social care professionals.  It also examines opportunities for change and sets out responsibilities of governments and policy makers.

This document is for anyone diagnosed with dementia and the people who care for them. It has details about what support they should get.  It also includes information about:

• what is in a care plan
• how health care and social care services can help
• support available to family and friends who are carers
• how to take part in research

The full guidance is available to read from Department of Health and Social Care 

New research on the impact of exercise for people with dementia

The BMJ has published a trial on the effects of moderate to high intensity exercise for people with dementia.  

Image source: bmj.com

Abstract

Objective To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.

Design Multicentre, pragmatic, investigator masked, randomised controlled trial.

Setting National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.

Participants 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.

Interventions Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.

Main outcome measures The primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.

Results The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm. This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).

Conclusion A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.

Trial registration Current Controlled Trials ISRCTN10416500.

Full reference:
Lamb,  S.E., Sheehan, B., Atherton N., Nichols V., Collins H., Mistry Dipesh et al|Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |BMJ |2018| 361 |k1675

The article is available at the BMJ 

In the media:

The Guardian Rigorous exercise does not halt dementia decline, study concludes

BBC News  Dementia exercise programmes ‘don’t slow brain decline’

Health, ageing and support survey: 2017

Results of Ipsos MORI research into the views of people aged 50 or over on health, ageing and support for 2017 | Department of Health and Social Care

This report provides the results from an Ipsos MORI survey of the views of people aged 50 or over on health, ageing and support. The survey was conducted on behalf of the Department of Health and Social Care, and fieldwork took place between 3 January and 19 February 2017.

Dementia/Alzheimer’s disease is still most commonly mentioned as among the biggest health problems facing older people (52% mention it now, and 48% did last year). Two thirds (66%) say they would talk to a family member if they were worried about losing their memory. Although this has not changed since last year, the proportion who say they would talk to their GP has fallen (from 70% to 60%). A lack of understanding of dementia persists, as around half (45%) think that living a healthy lifestyle makes no difference to the likelihood of developing dementia (48% did last year).

Key findings:

• People aged 50 and over are slightly less positive about their health than a year ago, but still take their physical and mental health seriously. Eating healthily is seen as important for both physical and mental health, though nearly half do not think a healthy lifestyle can prevent dementia.
• Fewer people than last year say they would talk to their GP if they were worried about their memory.
• Loneliness continues to be seen as a big problem for older people and most think society is not doing enough to prevent it.
• Views are less positive than a year ago about whether the government has the right policies about care and support services, and about whether care and support services work well with the NHS to provide co-ordinated care.
• People continue to be more confident about the safety of older people in hospitals than in nursing or residential homes.
• Concern about meeting the cost of care and support services has increased since last year. However, this has not translated into greater action and people are still not preparing substantially for the financial cost of care and support they might need.

This report is the second of 2 surveys. The first survey took place in 2016.

Full document: Health, ageing and support: survey of views of people aged 50 and over

Effectiveness of assistive technology in improving the safety of people with dementia

Study finds assistive technologies can improve safety for people with Dementia through reducing falls risk, accidents and other risky behaviour | Aging & Mental Health

Objectives: Assistive technology (AT) may enable people with dementia to live safely at home for longer, preventing care home admission. This systematic review assesses the effectiveness of AT in improving the safety of people with dementia living in the domestic setting, by searching for randomised controlled trials, non-randomised controlled trials and controlled before-after studies which compared safety AT with treatment as usual. Measures of safety include care home admission; risky behaviours, accidents and falls at home; and numbers of deaths. The review updates the safety aspect of Fleming and Sum’s 2014 systematic review.

Method: Seven bibliographic databases, the Social Care Institute for Excellence website and the Alzheimer’s Society website were searched for published and unpublished literature between 2011–2016. Search terms related to AT, dementia and older people. Common outcomes were meta-analysed.

Results: Three randomised controlled trials were identified, including 245 people with dementia. No significant differences were found between intervention and control groups in care home admission (risk ratio 0.85 95% CI [0.37, 1.97]; Z = 0.37; p = 0.71). The probability of a fall occurring was 50% lower in the intervention group (risk ratio 0.50 95% CI [0.32, 0.78]; Z = 3.03; p = 0.002). One included study found that a home safety package containing AT significantly reduced risky behaviour and accidents (F(45) = 4.504, p < 0.001). Limitations include the few studies found and the inclusion of studies in English only.

Conclusion: AT’s effectiveness in decreasing care home admission is inconclusive. However, the AT items and packages tested improved safety through reducing falls risk, accidents and other risky behaviour.

Full reference: Lucy Brims & Kathryn Oliver | Effectiveness of assistive technology in improving the safety of people with dementia: a systematic review and meta-analysis |  Aging & Mental Health | published online: 10 April 2018

See also: Assistive technology and dementia | Alzheimer’s Society

Depression in type 1 diabetes and risk of dementia

Study find that for people with Type 1 Diabetes, depression significantly increases dementia risk | Aging & Mental Health

Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Full reference: Gilsanz, P. et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Published online: 10 Apr 2018 DOI: 10.1080/13607863.2018.1455167

‘Exergaming’ may help those at risk of Alzheimer’s or related dementias

Older adults with mild cognitive impairment (MCI) showed significant improvement with certain complex thinking and memory skills after exergaming (video games that also require physical exercise) | Frontiers in Aging Neuroscience | via ScienceDaily

The results of a new study could encourage health care providers to pursue or prescribe exergames (video games that also require physical exercise) in hopes of slowing the debilitating effects of those with MCI, sometimes a stage between normal brain aging and dementia.

Previously published research had found that seniors who exercise using the features of interactive video games experienced greater cognitive health benefits than those who rely on traditional exercise alone.

For the latest study, researchers wanted to target older adults diagnosed with or at risk for MCI.  Researchers initially enrolled more than 100 seniors for the study. Over six months, 14 (evenly split between men and women) persisted with regular exergaming. The average age was 78.

The first group of seven was assigned to pedal along a scenic virtual reality bike path several times a week. The second group was given a more challenging task for the brain: pedal while playing a video game that included chasing dragons and collecting coins.

The results were compared against data collected from a separate group of eight seniors who played video games on a laptop but did not pedal, and also a group from the previous research who only rode a traditional stationary bike with no gaming component.

At the end of the randomized clinical trial, participants in both the group that pedaled along a virtual bike path and those that chased dragons and collected coins experienced significantly better executive function, which controls, in part, multi-tasking and decision making.

Benefits for both groups were also seen for verbal memory and physical function, suggesting it may be worth the effort for seniors to incorporate exergaming into a daily exercise regime.

The authors acknowledged that further research with a larger sample size is needed to confirm the team’s findings.  In the meantime, the research suggests benefits of exercising while also stimulating the brain with some mental challenge, such as navigating a scenic bike path or interactively playing a video game.

Full story at ScienceDaily

Full reference: Anderson-Hanley, C . et al. The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial. Frontiers in Aging Neuroscience, 2018; 10