Guidance on person centered care for those living with dementia, depression and delirium

Knowing Me! | Life Story Network

knowing me
Image source: http://www.lifestorynetwork.org.uk

Knowing Me! offers practical guidance on person centered care for those living with dementia, depression and delirium. The objectives of Knowing Me! are to raise awareness and understanding of the 3D’s, drive improvements in the standards of care, and improve the outcomes that can be achieved for those affected by the 3D’s.

Knowing Me! is not however a stand alone resource aimed at a particular staff group or a particular care environment but should be seen as a complimentary resource to raise the awareness and understanding of the 3Ds.

Knowing Me! builds on the values and principles of person centered care and support to improve the quality of life and provides useful and practical ways improvements can be made to really make a difference.

Full publication: Knowing Me! Dementia, Depression and Delirium – A person
centered education and training resource

Risk factors & Alzheimers Disease: Sleep disturbance, depression and anxiety

Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Shanna L. Burke et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety  | Aging & Mental Health | Published online: 27th Oct 2017

 

Physical function and depression in nursing home residents with dementia

Among elderly people in general, better physical function is associated with lower incidence of depressive symptoms. It is also related to better mental health, quality of life and well-being | BMJ Open

https://www.flickr.com/photos/simajr/4182166296/
Image source: sima dimitric – Flickr // CC BY 2.0

Objectives: The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.

Results: Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of 8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI −0.12 to −0.02, p=0.006), 30 s CST (95% CI −0.54 to −0.07, p=0.001) as well as maximum walking speed (95% CI −4.56 to −0.20, p=0.003) (indicating lower level of physical function).

Conclusion: Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design.

Full reference: Kvæl, L.A.H. et al.  (2017) Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open. 7:e016875.

Gender effects on components of burden and depression among dementia caregivers

Objective: Previous literature has examined burden and depression predominately as unitary constructs in relation to dementia caregiving. No studies thus far have examined gender differences in the specific components of burden and depression in dementia caregivers. The current study examined whether empirically validated dimensions of caregiver burden differed by gender for dementia caregivers.

Methods: The sample consisted of 211 dementia caregivers enrolled in a longitudinal intervention study. Only baseline functioning was evaluated in this study. Levels of burden were assessed using the Zarit Burden Interview (ZBI), and levels of depression were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D).

Results: Factor analysis revealed three facets of burden: impact of caregiving on the caregivers’ lives, guilt, and frustration/embarrassment, and four facets of depression: depressed affect, somatic activity, positive affect, and interpersonal feelings. Overall burden (p < .001) and impact of caregiving on the caregivers’ life (p < .001) were significantly higher in females. Overall levels of depression (p = .018), somatic and retarded activity (p = .018), depressed affect (p = .005), and positive affect (p = .012) were significantly higher in females.

Conclusions: Findings suggest that distressed male and female dementia caregivers experience caregiving differently. Results from this study could be used to identify gender-specific interventions related to subtypes of burden and depression to optimize quality of life for caregivers.

Sarah Pillemer, Jennifer Davis, and Geoffrey Tremont. Gender effects on components of burden and depression among dementia caregivers | Aging & Mental Health | Published online: 12 June 2017

Older people miss out on psychological therapies

Depression in older people is common, under-diagnosed, under-treated and attracts “therapeutic nihilism”, according to Professor Alistair Burns, NHS England’s National Clinical Director for Dementia | OnMedica

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Prof Burns say while one in five older people have clinical depression, “contrary to some popular and professional opinion, it is eminently treatable”. He wants clinicians to offer a wider range of treatments and therapies to target depression and anxiety which are both associated with increased risk of more serious physical and mental health problems.

“Treatments for depression in older people are largely the same as in younger people and there is high quality and convincing evidence that older people respond very well to interventions,”

While exercise is a “very effective” treatment for depression, Prof Burns cites the Health Survey for England which showed that only 18% of men and 19% of women aged 55-64 undertake the recommended amount of regular exercise, a figure falling to 10% and 2% for people aged 75-85.

Read the full news story here

An adapted mindfulness intervention for people with dementia in care homes

Clarke, A.C. et al. International Journal of Geriatric Psychiatry. Published online: 7 February 2017

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Objective: Depression and anxiety are common in dementia. There is a need to develop effective psychosocial interventions. This study sought to develop a group-based adapted mindfulness programme for people with mild to moderate dementia in care homes and to determine its feasibility and potential benefits.

Conclusions: The intervention was feasible in terms of recruitment, retention, attrition and acceptability and was associated with significant positive changes in quality of life. A fully powered randomised controlled trial is required.

Read the full abstract here

Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis

Cherbuin, N. et al. BMJ Open 2015;5:e008853

Objectives To perform a systematic review of reported HRs of all cause dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) for late-life depression and depressive symptomatology on specific screening instruments at specific thresholds.

 

Results Searches yielded 121 301 articles, of which 36 (0.03%) were eligible. Included studies provided a combined sample size of 66 532 individuals including 6593 cases of dementia, 2797 cases of AD and 585 cases of VaD. The increased risk associated with depression did not significantly differ by type of dementia and ranged from 83% to 104% for diagnostic thresholds consistent with major depression. Risk associated with continuous depression symptomatology measures were consistent with those for clinical thresholds.

 

Conclusions Late-life depression is consistently and similarly associated with a twofold increased risk of dementia. The precise risk estimates produced in this study for specific instruments at specified thresholds will assist evidence-based medicine and inform policy on this important population health issue.

Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia

Dementia: Published online October 29, 2015


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Depression, agitation, and wandering are common behaviors associated with dementia and frequently observed among nursing home residents. Even with pharmacological treatment, behaviors often persist, hindering quality of life for elders, their family, and paid caregivers.

This study examined the use of music therapy for treatment of these symptoms among 132 people with moderate to severe dementia in nursing homes. Participants were evaluated for depressive symptoms, agitation, and wandering to determine their predominate behavior. There were two assessments, two weeks apart, prior to intervention, followed by a two-week intervention, and two follow-up assessments, also two weeks apart. A repeated measures ANOVA determined that after two weeks of music therapy, symptoms of depression and agitation were significantly reduced; there was no change for wandering.

Multivariate analyses confirmed a relationship between music therapy and change in neuropsychiatric symptoms associated with dementia. Results suggest widespread use of music therapy in long-term care settings may be effective in reducing symptoms of depression and agitation.

via Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia.

Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis

The British Journal of Psychiatry Oct 2015, 207 (4) 293-298

Background

Anxiety and depression are common in people with dementia and mild cognitive impairment (MCI), but there is uncertainty about the effectiveness of both pharmacological and psychological therapies.

Aims

To evaluate the evidence of effectiveness of psychological treatments in treating depression and anxiety in people with dementia and MCI.

Method

We carried out a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological treatment versus usual care in people with dementia and MCI. Primary outcomes were symptoms of anxiety and depression. Secondary outcomes were quality of life, ability to perform daily activities, neuropsychiatric symptoms, cognition and caregivers’ self-rated depressive symptoms.

Results

We included six RCTs, involving 439 participants with dementia, which used cognitive–behavioural therapy, interpersonal therapy, counselling or multimodal interventions including a specific psychological therapy. We found beneficial effects for both depression and anxiety. Overall, the quality of the evidence was moderate for depression and low for anxiety, due to the methodological limitations of the studies we identified and the limited number of trials.

Conclusions

The evidence from six RCTs suggests that psychological treatments are effective in reducing symptoms of depression and anxiety for people with dementia. There is a need for high-quality, multicentre trials including standardised, well-defined interventions.

via Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis | The British Journal of Psychiatry.