Wertheimer, F. 18 November 2020| The Guardian |The music project helping dementia patients find their voice during lockdown The music project helping dementia patients find their voice during lockdown via The Guardian
This news story tells how a Manchester orchestra that usually provides session to care residents including people with dementia, had to stop its award-winning work due to the pandemic. Happily, the nine musicians and two music therapists who comprise Manchester’s Camerata Orchestra Music in Mind project are now delivering their sessions virtually.
NIHR | November 2020 | VOICE training for healthcare professionals aids communication with dementia patients
The NIHR highlights how a training course has improved the confidence and communication skills of healthcare staff in treating and caring for patients with dementia.
Around 25 per cent of hospital beds are occupied by patients with dementia and their difficulties with communication can make treating other co/multi-morbidities more challenging. In many cases these problems are made worse by admission to hospital because they are unsettled by the change of environment, illness and seeing unfamiliar faces.
Earlier studies underlined that clinicians currently receive very little or no dementia specific training to help them care for patients with dementia, despite the high number of patients with dementia in emergency care and acute settings. This enabled the NIHR to recognsie the potential benefit of appropriate dementia-specific training for healthcare professionals and, through its Health Services and Delivery Research (HS&DR) Programme, funded the VOICE (VideOing to Improve Communication Education) study to evaluate and deliver a new training programme.
Led by Professor Rowan Harwood at the University of Nottingham, the VOICE study has shown promising results that evidence-based communication skills training for health professionals can improve their communication with patients with dementia.
The researchers developed a practical skills training course and online e-learning resource with the help of experts in communication skills training and carers of people with dementia. Actors were specially trained in simulating people with dementia, by the researchers to recreate the types of situations that healthcare professionals face in their everyday roles. The training course was tested on forty healthcare professional to determine whether they experienced improvements in their confidence and skills in communicating with people with dementia. At the outset the clinicians were asked to self-assess their confidence and a month after completing the training course they repeated this self-assessment. The study demonstrates that the intervention improves the communication skills of the healthcare professionals which will benefit patients by improving determination of needs, provision of comfort, reduce distress, and enhance inclusion in decision making.
Now the VOICE training course has been delivered to more than 180 healthcare professionals across the UK. Included in this number are 31 healthcare professionals who “trained as trainers”, and the 54 they went on to train at five English hospital trusts. More training has been planned for the future. The full impact news story is available from NIHR
Project information for the VOICE study is available from NIHR
University College London | November 2020 |Leisure activity might not reduce dementia risk
Researchers at UCL report that activities such as gardening and reading in mid-life may not reduce an individual’s risk of dementia.
More than 8000 adults were studied, with the average age of the participant around 56 years of age. Each of the volunteers participation in leisure activities was recorded at the study’s outset, based on their participation in their activities, the researchers assigned them into different groups: low risk, medium risk and high risk. The subjects were followed up again, five and ten years later.
Using health records the team were able to identify who developed dementia. They also observed that some of the participants who gave up their hobbies later developed dementia. They found no association between participating in hobbies and the risk of developing dementia.
This document is aimed at psychologists and other health professionals supporting adults who are or have been subject to shielding, who have additional complex needs or considerations, including adults with learning/intellectual disabilities, autism spectrum conditions, and/or those living with dementia | The British Psychological Society
The considerations may also be relevant for those living with long term health conditions and their families. People living with these conditions often live with hidden disabilities and the difficulties they face can consequently be less obvious to services and society due to Covid-19.
The guidance specifically focusses on those in the ‘high’ risk category defined by the UK government but recognises that many people not officially in the ‘high risk’ category may have been shielding and therefore may face similar challenges, especially those shielding others, or those in ‘moderate risk’ categories.
This analysis from the BMJ discusses the relation between cerebrovascular diseases and impairment of cognition, with an emphasis on a chance to prevent dementia by preventing cerebrovascular diseases | BMJ 2020; 371:m3692
Cerebrovascular diseases and dementia are two leading contributors to impairment of brain health and neurological disability in older people. The prevalence of these two neurological disorders has increased in recent years as the population has aged and grown.
Globally, an estimated 42.4 million cases of stroke occurred in 2015, and approximately 50 million cases of dementia (including Alzheimer’s disease, vascular dementia, and other dementias) occurred in 2018. Strategies for preventing and treating stroke have progressed substantially in recent years, but no effective treatment yet exists for Alzheimer’s disease.
Recent studies have shown that many vascular risk factors and unfavourable lifestyle factors are shared predictors of stroke and dementia, and incident cerebrovascular diseases may precipitate a decline in cognitive function or dementia. This suggests that some cognitive impairment and dementia might be prevented by preventing cerebrovascular diseases.
People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of COVID-19-related outcomes in older inpatients in psychiatric units, who comprise people from these high-risk groups.
The authors aimed to describe the period prevalence, demographics, symptoms (and asymptomatic cases), management, and survival outcomes of COVID-19 in the older inpatient psychiatric population and people with young-onset dementia in five National Health Service Trusts in London, UK, from March 1 to April 30, 2020.
The study found that patients in psychiatric inpatient settings who were admitted without known SARS-CoV-2 infection had a high risk of infection with SARS-CoV-2 compared with those in the community and had a higher proportion of deaths from COVID-19 than in the community.
Implementation of the long-standing policy of parity of esteem for mental health and planning for future COVID-19 waves in psychiatric hospitals is urgent.
NICE| October 2020| NICE impact end of life care for adults
Many people are unable to access all the support they need at the end of their life.
NICE impact end of life care for adults, is a new report from NICE which highlights progress made by the health and care system in implementing NICE guidance on end of life care. This publication highlights how the quality of care can be variable depending on location, social and cultural background, and diagnosis.
Many people are unable to access support at the end of life. We need to understand and strengthen the impact of NICE guidance on people’s experience of end of life care
.Julie Pearce (chief nurse and executive director of caring services) and Dr Sarah Holmes (medical director, service transformation and innovation).
The report makes some of the following key points:
Care of people approaching the end of life
Care at the end of life should be identified in a timely way. If identification is effective and timely, this can allow people, and those important to them, to make decisions about their care.
90% of people did not have a care plan in place on arrival at their final hospital admission
People with conditions such as dementia, which are not always recognised as life-limiting, often face an additional barrier to dying in their preferred place. This is because certain care settings, for example hospices, are not always offered as an option for them.
Healthcare professionals did not always consider the communication needs of people with dementia and sometimes assumed that the person with dementia lacked capacity
Alzheimer’s Society| September 2020| Worst hit: dementia during coronavirus
A new report from the Alzheimer’s Society spotlights the impact of the pandemic on family and friends caring for a loved one with dementia. Worst hit: dementia during coronavirus reveals that 92 million extra hours of care have been given in response to what the report terms, the ‘double whammy of lockdown making dementia symptoms worse, and the chronically underfunded social care system leaving them nowhere else to turn.’
Almost half (45%) of those caregivers surveyed by the charity, felt the level of care their loved one with dementia needed was more than they could give. Half of carers have spent more than 100 hours a week looking after or helping the person they care for since 23 March.
Shim M, Tilley J.L., Im, S., Price, K., & Gonzalez, A. (2020) A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers| Journal of Geriatric Psychiatry and Neurology| doi:10.1177/0891988720957104
New research has analysed the evidence base for mindfulness interventions for patients with dementia, mild cognitive impairment and their carers. It has been published in the Journal of Geriatric Psychiatry and Neurology
The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.