Virtual reality can improve quality of life for people with dementia

Virtual reality (VR) technology could vastly improve the quality of life for people with dementia by helping to recall past memories, reduce aggression and improve interactions with caregivers, new research has discovered | University of Kent | via ScienceDaily

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Many people with dementia (PWD) residing in long-term care may face barriers in accessing experiences beyond their physical premises; this may be due to location, mobility constraints, legal mental health act restrictions, or offence-related restrictions.

In recent years, there have been research interests towards designing non-pharmacological interventions aiming to improve the Quality of Life (QoL) for PWD within long-term care.

The authors of this study explored the use of Virtual Reality (VR) as a tool to provide 360°-video based experiences for individuals with moderate to severe dementia residing in a locked psychiatric hospital.

The paper discusses the appeal of using VR for PWD, and the observed impact of such interaction. It also presents the design opportunities, pitfalls, and recommendations for future deployment in healthcare services. This paper demonstrates the potential of VR as a virtual alternative to experiences that may be difficult to reach for PWD residing within locked setting.

Full article: Tabbaa, L. et al. |  Bring the Outside In: Providing Accessible Experiences Through VR for People with Dementia in Locked Psychiatric Hospitals | Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2019 | DOI: 10.1145/3290605.3300466

See also: VR can improve quality of life for people with dementia | ScienceDaily

Caregivers’ resilience in mild and moderate Alzheimer’s disease

Rachel Dias Lopes da Rosa, et al. |  Caregivers’ resilience in mild and moderate Alzheimer’s disease | Aging & Mental Health | published online: 30 Nov 2018

Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer’s disease (PwAD) and the related sociodemographic and clinical characteristics.

Methods: Cross-sectional assessment of dyads of PwAD and family caregivers (N = 106). Caregivers were assessed for resilience, depression, anxiety, hopelessness, quality of life, burden and cognition. PwAD were assessed for severity of dementia, cognition, neuropsychiatric symptoms, functionality, quality of life and awareness of disease.

Results: Most of the caregivers (51.1%) reported emotional problems (symptoms of anxiety, stress and depression). In both mild and moderate PwAD groups, resilience was inversely related to self-reported emotional problems. There was not a significant difference between caregivers of mild and moderate PwAD resilience.

Upon analyzing the factors related to resilience, the study found some differences between the groups of caregivers of mild and moderate PwAD. Neuropsychiatric symptoms of PwAD and caregiver’s depressive symptoms were related to resilience of caregivers of mild PwAD. In the moderate group, caregivers’ higher levels of quality of life and co-residing with PwAD were related to resilience.

Conclusion: Caregivers’ resilience is driven by different factors according to disease severity. The findings suggest that resilience allows caregivers to manage and respond positively to stressful demands of care.

Exercise instructors to support mobility and independence in dementia care setting

Care staff at a dementia care setting in Wigan identified that the introduction of a qualified exercise instructor, ready to deliver regular exercise plans, would improve the quality of service and outcomes for residents at their site. To facilitate the introduction of this new service an exercise instructor role was developed.

The exercise instructors provide education, offer support and encouragement to each individual to participate in exercise as well as being a resource for staff. With full access to medical information and multi-disciplinary team, the exercise instructor designs bespoke individual exercise programmes in collaboration with residents and these are monitored and updated in accordance with the resident’s progress and changing health needs. The exercise instructor also works closely with resident’s families to support the development of exercise plans and support any risk assessments and specific support needs.

The new service and role has been well received by residents especially in cases of residents with limited social interactions, with residents reporting an increased quality of life.

Full story: Introduction of the exercise instructor role to support mobility and independence for elderly residents in a dementia care setting | Atlas of Shared Learning | NHS England

Setting personal goals for dementia care

Research finds that goal setting may help people with dementia work with healthcare professionals and caregivers to identify and achieve realistic goals that are most important to them. | Journal of the American Geriatrics Society | News Medical

New research published in the Journal of the American Geriatrics Society has concluded that “goal attainment scaling” (GAS) can be used in clinical care to help people with dementia and their caregivers set and achieve personalised health goals.

old-690842_1920The researchers developed a process for using GAS to set goals and to measure whether participants reached those goals. In a first phase of the study, they tested goal setting with 32 people who had dementia and their caregivers.

In the next phase, the dementia care managers helped an additional 101 people with dementia and their caregivers set care goals. The research team used a scale to measure how well the participants achieved their goals 6 and 12 months after setting them.

Most often, the goals focused on improving quality of life for the person with dementia, followed by caregiver support goals. Some commonly chosen goals for the person with dementia included:

  • Maintaining physical safety
  • Continuing to live at home
  • Receiving medical care related to dementia
  • Avoiding hospitalization
  • Maintaining mental stimulation
  • Remaining physically active

Commonly chosen caregiver goals included:

  • Maintaining the caregiver’s own health
  • Managing stress
  • Minimizing family conflict related to dementia caregiving

Full story: Personalized goal setting to improve dementia care | News Medical

Full reference: Lee A. Jennings et al. | Personalized Goal Attainment in Dementia Care: Measuring What Persons with Dementia and Their Caregivers Want | Journal of the American Geriatrics Society | 2018

 

Discussing the MARQUE Study – Managing Agitation in Dementia

University College London  | MARQUE

Scientists at University College London (UCL) are involved in MARQUE (Managaing Agitation and Raising Quality of life), a five year long study taking place all over England. MARQUE aims to increase knowledge about dementia, agitation and personhood. Agitation is extremely common in people with dementia and causes distress to themselves, family carers and paid carers. Agitation is currently tackled on an individual level, not an organisation level (via UCL).

The research responds to the government’s ‘Challenge on Dementia’ and aims to

  • Build on theories of personhood in dementia to understand agitation, resilience and compassion to improve public debate and discourse.
  • Make agitation as much as a part of dementia care as risk assessment.
  • To improve and maintain quality of life in people with dementia whether at home, in a care home or in hospital.

More information about MARQUE can be found from UCL here 

A podcast has been released by Dementia Researcher, in it researchers Francesca La Frenais, and Dr Penny Rapaport from the Division of Psychiatry at UCL talk about the MARQUE Study, and how their work is helping us to understand what causes agitation. The scientists also explain how the interventions tested in this study are improving quality of life for those living with dementia, and helping carers.

MARQUE
Image source: dementiaresearcher.nihr.ac.uk

You can listen to the podcast at Dementia Reseracher

Alternatively, you can listen via SoundCloud 

Dementia Researcher |  April 2018 | Discussing the MARQUE Study – Managing Agitation in Dementia

How best to assess quality of life in informal carers of people with dementia

Study finds Carer well-being and support questionnaire is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present

feedback-3239454_1920Background
In the UK, there are currently 800 000 people living with dementia. This number is expected to double in the next 20 years. Two-thirds of people with dementia live in the community supported by informal carers. Caring for a person with dementia has adverse effects on psychological, physical, social wellbeing and quality of life. The measurement of quality of life of carers of people with dementia is increasingly of interest to health and social care practitioners and commissioners, policymakers, and carers themselves. However, there is lack of consensus on the most suitable instrument(s) for undertaking this.

Methods
A systematic review of the literature.  Searching of electronic databases (Medline, PsycINFO, CINAHL and Web of Science), reference list and citation searching of key papers was undertaken. COSMIN methodology was used to simultaneously extract data from and assess methodological quality of included studies, and make a recommendation for the instrument with the most high quality evidence for its measurement properties.

Results
Ten instruments were suitable for inclusion in this review. The Carer well-being and support questionnaire (CWS) has the best quality evidence for the greatest number of measurement of properties. The Caregiver Well-Being Scale is also worthy of consideration. There is not presently a measure which could be recommended for use in economic evaluations, however the Impact of Alzheimer’s Disease on the Caregiver questionnaire (IADCQ) could potentially be used following further investigation of its measurement properties in a representative population.

Conclusion
The CWS is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present. All instruments included in this review would benefit from more rigorous evaluation of their measurement properties.

Full document: Dow J, et al. |  How best to assess quality of life in informal carers of people with dementia; A systematic review of existing outcome measures. | PLoS ONE  (2018) 13(3)

 

Health and Care without boundaries

Health and Care without boundaries | NHS England

When the NHS and local government work together residents quality of life improve. Wealden District Council and Herstmonceux GP John Simmons worked together to secure a health and wellbeing coach based at the GP surgery; reducing repeat visits by 61%. The scheme is now being expanded thanks to the local CCG.

NHS England has produced a short film which follows Angela, who was widowed around 18 months ago. Isolation soon followed, but through this scheme she has reconnected with others and now has the confidence to better manage her long term conditions.

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

Researchers from the University of Exeter in conjunction with King’s College London and Oxford Health NHS Foundation Trust aimed to  evaluate the efficacy of  person-centred care and psychosocial intervention incorporating an antipsychotic review on 800 patients with dementia. 

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The study  tested the WHELD programme, (Improving Wellbeing and Health for People with Dementia), the largest non-pharmacological randomised control trial in people with dementia living in care homes to date.

  • The programme combined staff training, social interaction, and guidance on use of antipsychotic medications, in 69 UK care homes  in a 9-month clinical trial.
  • It demonstrates that care homes receiving the WHELD programme saw improvements in quality of life as well as other important symptoms including agitation, behaviour, and pain in people with dementia.
  • For the care homes in the study, the WHELD programme was also shown to be cost-effective

The key findings include:

  • The WHELD approach is beneficial for people with dementia living in care homes.
  • WHELD could be provided in an affordable way to improve the lives of these individuals, who often do not receive the care they need.
  • They also suggest suggest that the WHELD intervention confers benefits in terms of  quality of life (QoL), agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes,

The full text article can be accessed through the PLOS Medicine website

Download it from PLOS here 

The full story is at Science Daily 

Touchscreen interventions and the well-being of people with dementia and caregivers

This article reviews touchscreen-based interventions designed to be used by people with dementia (PWD), with a specific focus in assessing their impact on well-being | International Psychogeriatrics

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Dementia can have significant detrimental impacts on the well-being of those with the disease and their carers. A range of computer-based interventions, including touchscreen-based interventions have been researched for use with this population in the hope that they might improve psychological well-being.

The data bases, PsycInfo, ASSIA, Medline, CINAHL, and Cochrane Reviews were searched for touchscreen-based interventions designed to be used by PWD with reported psychological well-being outcomes. Methodological quality was assessed using Pluye and Hong’s (2014) Mixed Methods Appraisal Tool (MMAT) checklist.

Sixteen papers were eligible. They covered 14 methodologically diverse interventions. Interventions were reported to be beneficial in relation to mental health, social interaction, and sense of mastery. Touchscreen interventions also reportedly benefit informal carers in relation to their perceived burden and the quality of their relationships with the people they care for. Key aspects included the user interface, provision of support, learning style, tailored content, appropriate challenge, ergonomics, and users’ dementia progression.

Whilst much of the existing research is relatively small-scale, the findings tentatively suggest that touchscreen-based interventions can improve the psychological well-being of PWD, and possibilities for more rigorous future research are suggested.

Full reference: Tyack, C & Cami, P.M. (2017) Touchscreen interventions and the well-being of people with dementia and caregivers: a systematic review. International Psychogeriatrics. Vol. 29 (Issue 8) pp. 1261-1280

Simulated presence therapy for dementia

Abraha, I. et al.

Review question: Can simulated presence therapy (SPT) treat problem behaviours, and improve quality of life for people with dementia?

Study characteristics: We looked for trials which compared SPT to usual care or to another treatment. Ideally, people with dementia should have been randomly allocated to one or other treatment, but we also included trials even if treatment allocation was not strictly random.

We found three trials which met our inclusion criteria. The 144 participants were all living in nursing homes. The majority were women with an average age of over 80 years and severe dementia. The way SPT was administered was different in each trial. All the trials used more than one comparison treatment, which differed between trials. The trials all attempted to measure an effect on agitated behaviours, but used different approaches.

Key findings: Because the trials were so different from each other, we were not able to pool the results. Individually, each trial reported different methods to assess the effect of SPT on behavioural problems and the results varied depending on the method used to measure the outcome.

None of the studies assessed quality of life, effect on daily activities, effects on caregivers, or how likely participants were to drop out of the study.

Read the full review here