Journal articles on the topic 'Dementia Patients Care Case studies'
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Custodio, Nilton, David Lira, Eder Herrera-Perez, Liza Nuñez del Prado, José Parodi, Erik Guevara-Silva, Sheila Castro-Suarez, and Rosa Montesinos. "Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru." Dementia & Neuropsychologia 9, no. 1 (March 2015): 32–41. http://dx.doi.org/10.1590/s1980-57642015dn91000006.
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Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries. OBJECTIVE: The aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru. Methods. We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs). Results. In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US$ 23 over three months, demented patients had costs of US$ 1500 or over (and more than US$ 1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US$ 570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US$ 222.22). Conclusion. Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patient's family.
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Angelopoulou, Efthalia, Nikolaos Papachristou, Anastasia Bougea, Evangelia Stanitsa, Dionysia Kontaxopoulou, Stella Fragkiadaki, Dimosthenis Pavlou, et al. "How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer’s Disease and Related Dementias? A Narrative Review." Medicina 58, no. 12 (November 22, 2022): 1705. http://dx.doi.org/10.3390/medicina58121705.
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Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Hutch, William, Trish O' Sullivan, and Tony Foley. "Dementia palliative care education and training for healthcare professionals: A scoping review protocol." HRB Open Research 5 (February 15, 2022): 13. http://dx.doi.org/10.12688/hrbopenres.13486.1.
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Background: Global mortality rates from dementia continue to rise. Evidence suggests that there is limited provision of palliative care for people with dementia and this is a cause of grave concern. The coronavirus disease 2019 (COVID-19) pandemic has further exposed the inequalities of care for this vulnerable population. Proactive palliative care, delivered by multidisciplinary healthcare professionals (HCPs), can offer significant benefits to people with dementia. However, little is known about the components of effective education and training for HCPs who care for people with advancing dementia at end of life. Objective: The aim of this scoping review is to identify effective education and training interventions for HCPs, who care for people with advanced dementia approaching end of life. Inclusion criteria: Studies that used a palliative care educational intervention for HCPs working with patients with dementia will be included. Studies that explore undergraduate or postgraduate education and training in dementia palliative care for HCPs will be included. Study designs such as quantitative, qualitative, mixed method studies, and case studies will be included. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used for this review. The following databases will be searched: CINAHL, ERIC, Medline, SocIndex, PsycINFO. In addition, grey literature searches will be limited to the first 100 searches using Google Scholar and Open-Grey. Study selection will involve the reviewer screening titles and abstracts. Then, two independent reviewers will further assess the studies in full for those that meet the inclusion criteria. In line with the JBI framework, data will be extracted using a draft data extraction tool. This will facilitate a chronological narrative synthesis of results in line with the study’s overall aim to identify effective education and training interventions for HCPs, who care for patients with dementia, nearing end of life.
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Hutch, William, Trish O' Sullivan, and Tony Foley. "Dementia palliative care education and training for healthcare professionals: A scoping review protocol." HRB Open Research 5 (January 20, 2023): 13. http://dx.doi.org/10.12688/hrbopenres.13486.2.
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Background: Global mortality rates from dementia continue to rise. Evidence suggests that there is limited provision of palliative care for people with dementia and this is a cause of grave concern. The coronavirus disease 2019 (COVID-19) pandemic has further exposed the inequalities of care for this vulnerable population. Proactive palliative care, delivered by multidisciplinary healthcare professionals (HCPs), can offer significant benefits to people with dementia. However, little is known about the components of effective education and training for HCPs who care for people with advancing dementia at end of life. Objective: The aim of this scoping review is to identify effective education and training interventions for HCPs, who care for people with advanced dementia approaching end of life. Inclusion criteria: Studies that used a palliative care educational intervention for HCPs working with patients with dementia will be included. Studies that explore undergraduate or postgraduate education and training in dementia palliative care for HCPs will be included. Study designs such as quantitative, qualitative, mixed method studies, and case studies will be included. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used for this review. The following databases will be searched: CINAHL, ERIC, Medline, SocIndex, PsycINFO. In addition, grey literature searches will be limited to the first 100 searches using Google Scholar and Open-Grey. Study selection will involve the reviewer screening titles and abstracts. Then, two independent reviewers will further assess the studies in full for those that meet the inclusion criteria. In line with the JBI framework, data will be extracted using a draft data extraction tool. This will facilitate a chronological narrative synthesis of results in line with the study’s overall aim to identify effective education and training interventions for HCPs, who care for patients with dementia, nearing end of life.
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Marra, Alexandre, Mireia Puig-Asensio, and Eli Perencevich. "Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s120. http://dx.doi.org/10.1017/ice.2020.627.
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Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None
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Garrison, Susan J., George M. Ringholz, and Jeff Lindeman. "Rehabilitation Issues in Patients with Vascular Dementia: Case Studies with Commentary." Topics in Stroke Rehabilitation 7, no. 3 (October 2000): 20–28. http://dx.doi.org/10.1310/bpt1-q37e-rb6l-cnhn.
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Koch, Tamar, and Steve Iliffe. "Implementing the National Dementia Strategy in England: Evaluating innovative practices using a case study methodology." Dementia 10, no. 4 (September 13, 2011): 487–98. http://dx.doi.org/10.1177/1471301211417169.
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With dementia ever-increasing in prevalence and cost on society, and with recent reports emphasizing the need for improved and standardized diagnosis and care for patients with dementia, the National Dementia Strategy (NDS) has been published by the English Department of Health. The NDS encourages the identification of successful innovations to implement on a wider scale. This paper uses case studies to describe some examples of innovative practice in the diagnosis and management of patients with dementia in primary care. It goes on to discuss methodological problems in the evaluation and comparison of innovations in practice, focusing on the potential to compare complex with simple interventions, and recognizing the role that commissioners play in making decisions about the choice and implementation of innovation.
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Kita, Motoko, and Reiko Yoshida. "Research Trends into Support for Families Coping with Dementia in Japan." International Journal of Studies in Nursing 2, no. 1 (April 6, 2017): 15. http://dx.doi.org/10.20849/ijsn.v2i1.144.
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In Japan, there is a growing need for family support of elderly patients with dementia because the number of sufferers is expected to increase over coming years. We conducted a review of 92 studies into the support provided to the families of patients with dementia in Japan. They were reviewed by care setting, study focus, and study design. Most studies were in home settings, followed by hospital settings, with the fewest in long-term care facilities. A wide range and quality of studies were performed in home settings, including quantitative descriptive and interventional studies; however, qualitative descriptive studies and case studies predominated. We identified a need to perform additional studies to verify support programs at home. Concerning family support in hospitals, studies were mainly performed in relation to early diagnosis of dementia and early discharge from hospital, and we observed a clear need to investigate the development of new support programs. Finally, although the need for family support is estimated to be high in long-term care facilities, we found only a few studies investigating this issue. In particular, more studies are needed on the topic of end-of-life care. To offer support that meets the needs of families in various care settings, there is an urgent need to accumulate evidence about patients and their families in each setting.
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Dooley, Jemima, Matthew Booker, Rebecca Barnes, and Penny Xanthopoulou. "Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences." BMJ Open 10, no. 9 (September 2020): e037673. http://dx.doi.org/10.1136/bmjopen-2020-037673.
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ObjectivesPeople with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.DesignScoping review. The search strategy and data synthesis were informed by people with dementia and carers.Data sourcesSearches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.Eligibility criteriaEmpirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.Data extraction and synthesisData were extracted using charting techniques and findings were synthesised according to content and themes.ResultsOf 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.ConclusionsThe scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
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Wang, Jing, and Bei Wu. "Improving Care for Persons With Cognitive Impairment in Community-Based Long-Term Care and Acute Care Settings." Innovation in Aging 5, Supplement_1 (December 1, 2021): 65. http://dx.doi.org/10.1093/geroni/igab046.251.
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Abstract The COVID-19 pandemic has highlighted the importance of providing person-centered care for our vulnerable populations across the globe. This symposium focuses on improving care for persons with cognitive impairment and dementia in various care settings. The first study explored dyadic experiences of living with early-onset dementia pre and during COVID-19 in China through a person-centered care lens. The second concept analysis presented four interrelated dimensions of Asian American caregiver support, including individual, family, community, and professional health system. The third study investigated undergraduate nursing students’ attitudes toward pursuing jobs of providing care for older adults with dementia in rapidly-aging urban areas in China and its associated factors. The fourth study examined the impact of social isolation on cognitive function and Quality of Life among acute ischemic stroke (AIS) patients in China. The last study explored an association between perceived control and cognitive function among acute ischemic stroke (AIS) patients in China. The last two studies suggested that perceived control and social isolation may be potential targets in cognitive interventions for AIS patients. This symposium presents the understanding of dementia caregiver support, the empirical evidence of living with dementia, the attitudes towards dementia care among the next generation of nursing workforce, and the impact of social factors on cognitive functions longitudinally. The presenters emphasize the importance of improving care in long-term care and acute care settings. There is a need to design person and family-centered care to improve health and wellbeing of persons with cognitive impairment.
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Paul, Constanca, Laetitia Teixeira, and Susana Sousa. "NEUROPSYCHIATRIC SYMPTOMS IN PRIMARY CARE PATIENTS WITH DEMENTIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 642–43. http://dx.doi.org/10.1093/geroni/igac059.2378.
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Abstract Neuropsychiatric Symptoms of dementia are mostly valued within care and burden of formal and informal caregivers and less considered as diagnosis predictors. Diagnosis of dementia in Primary Care Service (PCS) is frequently late and based mostly in general clinic assessment, and patient/family subjective complaints. We study the association of Neuropsychiatric Symptoms (NPI-Q) and existing diagnosis of dementia in PCS. The objectives are to know 1) the prevalence of symptoms identified by familial caregivers in people with a diagnosis of dementia and 2) if there is an association of symptoms with the existence of a diagnosis.Method: we randomly select a community based sample of a pool (N=2734) of primary care users with mental health concerns referred by General Physicians, (N=154), mean age 76 years (sd 7.8), 57% women. Caregivers (N=39) were interviewed and fulfil NPI-Q. Results of descriptive and logistic regression analysis showed that 39% (60) had a formal diagnosis of dementia not differentiating men and women. The neuropsychological symptoms frequency varied between 3.1% (hallucinations) and 16.3% (apathy/indifference), and the symptoms’ mean was 4.5(sd 2.1). The amount of symptoms was not associated with the diagnosis. The symptoms that predict the diagnosis were Apathy/ Indifference OR 5.24(1.25-22.0),p.024 and Motor Disturbance OR 5.70(1.17-27.6), p.031. Qualitative data from caregivers interview show that they are not very comfortable with the terminology of NPI-Q, which may limit the accuracy of assessment. Conclusion some neuropsychological symptoms identified by caregivers seems to be relevant as predictors of diagnosis of dementia in Primary Care.
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Abu Khait, Abdallah, Juliette Shellman, and Katherine Sabo. "Metasynthesis of Patients’ Perspectives about Reminiscence in Dementia Care." Western Journal of Nursing Research 42, no. 10 (January 21, 2020): 852–66. http://dx.doi.org/10.1177/0193945919897927.
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Dementia is a serious condition that has become a public health priority worldwide. Reminiscence is the process of recollecting personal memories from the distant past. This metasynthesis aims to present a thorough analysis of available qualitative literature concerning patients’ perspectives about reminiscence in dementia care. A search of CINAHL, PubMed, PsycINFO, Scopus, and ProQuest for qualitative studies published in English between 2005 and 2019 generated 110 studies. Eleven studies were retrieved, assessed for quality using the Critical Appraisal Skills Programme tool, and then synthesized according to Noblit and Hare’s seven-step approach. Metaphors were arranged in a list and translated into one another. Five reciprocal themes emerged: Promoting a Comfort Zone, Keeping the Conversation Going, Creating a Dynamic Life, Reliving Painful Memories and Emotional Turmoil, and Strengthening Inner Forces. Increased awareness of patients’ perspectives about reminiscence can help design a better framework for interventions that will serve this vulnerable population.
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Smith, Cathryn, and Gina Newbury. "Palliative care for community patients diagnosed with dementia: a systematic review." British Journal of Community Nursing 24, no. 12 (December 2, 2019): 570–75. http://dx.doi.org/10.12968/bjcn.2019.24.12.570.
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Despite many efforts made by health organisations to deliver effective end-of-life care to patients with dementia, research indicates that palliative care is predominantly aimed at patients with terminal cancer, and that patients with dementia face challenges in accessing end-of-life care. This article explores the views of health professionals on providing palliative care to those patients diagnosed with dementia within the community setting. A systematic review of seven qualitative studies was performed to identify the best available evidence. The findings show that effective palliative care for patients with dementia continues being affected by many barriers and challenges. Good practice seems to be inconsistent and fragmented throughout the UK and European countries, and many health professionals are faced with difficulties associated with services and financial implications, training and education, staff support, communication, family support and dementia care.
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Fowler, Mackenzie, Kristen Triebel, Gabrielle Rocque, Ryan Irvin, Richard Kennedy, and Nicole Wright. "Is Cancer History Related to Neurologic Specialty Care in Patients with Dementia?" Innovation in Aging 5, Supplement_1 (December 1, 2021): 608. http://dx.doi.org/10.1093/geroni/igab046.2329.
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Abstract Background: The incidence and prevalence of aging-related diseases such as dementia and cancer are increasing, as are cancer survival rates. Cancer and its treatments have been associated with cognitive effects for those who later develop dementia. Guidelines have suggested that cancer patients return to follow-up in primary care following remission and be referred to specialists for cognitive complications, but it is unclear how well these guidelines are followed. Methods: Electronic health record data at the University of Alabama at Birmingham were extracted from July 2003 May 2020. Rates of specialty care utilization on or after dementia diagnosis were compared by cancer history status in adults 50 years old or older at dementia diagnosis. Predictors of specialty care utilization were examined using logistic regression. Results: Rate of specialty care utilization was lower for those with cancer history compared to those without on the date of dementia diagnosis (11.3% vs. 17.1%) and after diagnosis (13.5% vs. 19.2%). Older age at dementia diagnosis, non-Hispanic Black race, anticholinergic burden, socioeconomic status, and vascular risk factors were associated with lower odds of specialty care utilization. Dementia medication use was associated with higher odds of specialty care utilization on and after dementia diagnosis. Conclusions: Cancer survivors with a dementia diagnosis are less likely to utilize specialty care than those with no history of cancer. Several factors predicted specialty care utilization. Additional studies should assess potential barriers in referring cancer survivors to specialty care for cognitive impairment.
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Gibson, Regina, Maneetha Kodali, Priya Priyambada, Priya Mendiratta, Danish Hasan, Melodee Harris, Jeanne Wei, and Gohar Azhar. "HEALTHCARE DISPARITY IN THE ASSESSMENT OF DEMENTIA IN THE PRIMARY CARE SETTING." Innovation in Aging 6, Supplement_1 (November 1, 2022): 494–95. http://dx.doi.org/10.1093/geroni/igac059.1901.
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Abstract Literature suggests racial implicit bias can significantly affect quality of care. Data demonstrates that older adult Blacks are twice as likely to have dementia as their White counterpart. Inappropriate cognitive screening by providers or diagnosing dementia just based on clinical impression could easily result in an over or under-estimation of the dementia. We reviewed the rate and method of cognitive screening in randomly selected patient records (n=75) at a primary care university clinic. Our results indicated that the cognitive screening rate for Black patients was lower compared to their White counterpart (43.4% Blacks vs 68.5% Whites, p < 0.05). We designed a quality improvement project to identify any contributory causes and challenges involved in screening for dementia with the goal to reduce racial disparity in dementia diagnosis. We identified knowledge deficits in providers in their approach towards patients with dementia and a lack of experience in their use of appropriate instruments for cognitive screening. A multipronged educational program, with videos, case conferences, presentations and one-to-one training by dementia experts and a neuropsychologist was employed to reduce the bias and train the providers in appropriate screening methods. Post-educational intervention, screening rates greatly improved in n=75 randomly selected patients from both races. In Whites, the screening rate increased by 20.9% to 89.4% and in Blacks by 38.9% to 82.3% (p < 0.05). Overall, the quality improvement driven educational intervention improved the self-efficacy of providers and improved the standardized dementia screening rates in Black patients to levels comparable to those of White patients.
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O'Sullivan, Trish, Tony Foley, Joseph G. McVeigh, and Suzanne Timmons. "Education and training to support physiotherapists working in dementia care: a scoping review protocol." HRB Open Research 4 (June 22, 2021): 27. http://dx.doi.org/10.12688/hrbopenres.13219.2.
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Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care. Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care. Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Qualitative, quantitative, mixed methods studies, case studies and observational studies will be included. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.
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Chunga, Richard. "Dementia-Related Care in Acute Care Settings: A Qualitative Meta-Synthesis of Patient and Family Perspectives." Innovation in Aging 5, Supplement_1 (December 1, 2021): 998–99. http://dx.doi.org/10.1093/geroni/igab046.3584.
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Abstract Researchers have long emphasized the importance of a person-centered approach to health care, especially regarding the treatment of individuals living with dementia. However, the fast pace of acute care settings can be a difficult place to provide such care to patients, where there are tensions between the emphasis on efficient treatment of acute medical co-morbidities and person-centered dementia care. This paper is a meta-synthesis of qualitative studies examining perspectives of patients and their family members regarding their acute care experiences. It takes an interpretive approach, using primarily inductive reasoning to generate themes across available studies’ findings. Emergent themes are organized under two major dimensions of the hospital environment: the physical environment, including sensory and tangible elements, and the social environment, including the hospital atmosphere and communication practices. Persons with dementia feel overly stimulated by the busy physical environment of the hospital, yet they are often left to languish alone, sometimes even physically restrained. Patients reported feeling lonely, fearful, and confused, identifying diverse physical and social environmental attributes like physical clutter, noise, and lack of empathy from care providers as contributors. Based on acute care experiences and reports from patients and family members, although the acute condition is treated, persons with dementia often leave the acute care environment in worse functional condition than when they entered. Given the increasing prevalence of persons with dementia in acute care settings, it is clear that we must prioritize innovations and programs aimed at improving hospital practices, educating staff, and creating more dementia-friendly environmental designs.
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Glass, Oliver M., Brent P. Forester, and Adriana P. Hermida. "Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) – a promising option." International Psychogeriatrics 29, no. 5 (January 18, 2017): 717–26. http://dx.doi.org/10.1017/s1041610216002258.
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ABSTRACTBackground:Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder).Methods:We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms “ECT agitation dementia;” “ECT aggression dementia;” “ECT Behavior and Psychological Symptoms of Dementia;” and “ECT BPSD.” The term “dementia” was also interchanged with “Major Neurocognitive Disorder.” No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients.Results:Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT.Conclusions:Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. ECT may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.
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Angunawela, Indra I., Andrew Barker, and Simon D. Nicholson. "The NHS and Community Care Act 1990." Psychiatric Bulletin 24, no. 5 (May 2000): 177–78. http://dx.doi.org/10.1192/pb.24.5.177.
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Aims and MethodThe Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia inpatients, prospective studies of inpatient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.ResultsThe proportion of patients discharged to their own homes and to residential/nursing homecare remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=O.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.Clinical ImplicationsThe new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and hig her in-patient costs.
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Mataqi, Mona, and Zoe Aslanpour. "Factors influencing palliative care in advanced dementia: a systematic review." BMJ Supportive & Palliative Care 10, no. 2 (April 3, 2019): 145–56. http://dx.doi.org/10.1136/bmjspcare-2018-001692.
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BackgroundDementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs.AimTo investigate the factors influencing provision of PC services for people with advanced dementia.MethodsA systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data.Key findingsIn total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning.ConclusionsEven though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.
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Mehegan, Laura, and David Parkes. "BOTH HEALTH CARE PROFESSIONALS AND PATIENTS HARBOR MISPERCEPTIONS ABOUT DEMENTIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 55. http://dx.doi.org/10.1093/geroni/igac059.213.
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Abstract Healthcare providers underestimate the willingness of adults to engage in a healthier lifestyle to potentially slow the progress of the disease and the willingness of patients to participate in research. Few adults recognize the impact lifestyle modifications have on the risk for cognitive decline and dementia, but some significant differences exists among perceptions amongst diverse communities. While most adults are willing to modify selected brain-healthy behaviors, relatively few currently engage in brain-healthy behaviors all or most of the time. Numerous discrepancies exist between the realities of dementia and overall feelings about a diagnosis. Among the more startling findings is 48% of adults believe they will likely have dementia — far more than will actually develop it. Health care providers substantially overestimate the worry that adults age 40 and older would feel if they had dementia. While one in five adults (19%) said they would feel ashamed or embarrassed if they had dementia, a staggering seven in 10 providers (69%) said their patients would feel ashamed or embarrassed. These negative perceptions by healthcare providers carry over into the interactions they have with patients when dealing with cognitive function. Nine in 10 adults age 40 and older (91%) want to be told of a dementia diagnosis, but only 78% of providers said they always tell patients the truth. There is a recognition by everyone that early diagnosis is beneficial, but most adults over 40 are not aware there are treatments available for dementia. More than half of adults do not know that dementia cannot be cured.
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Zhang, Min, Hui Zhao, and Fan-Ping Meng. "Elderspeak to Resident Dementia Patients Increases Resistiveness to Care in Health Care Profession." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 57 (January 2020): 004695802094866. http://dx.doi.org/10.1177/0046958020948668.
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Resistiveness to care is very common among patients of dementia as these patients do not take medicines, meals or bath very easily. Indeed, it is a very challenging task for health caregivers and there is a significant rise in time and cost involved in managing dementia patients. Amongst different factors, the type of communication between resident dementia patients and health caregivers is an important contributing factor in the development of resistiveness to care. Elderspeak (baby talk) is a type of communication in which health caregivers adjust their language and style while interacting with elderly and dependent patients. It involves the use of short sentences, simple grammar, slow and high pitch voice, repeating phrases to provide a comfortable and friendly environment to patients. Most of the time, caregivers tend to adapt elderspeak as they handle weak and fragile older patients for routine activities. Although elderspeak is meant to provide support, warmth and care to patients, yet patients perceive elderspeak as patronizing and it induces negative feelings about self-esteem. Scientists have found a correlation between the development of resistiveness to care and the extent of elderspeak in communication. Therefore, there have been strategies to develop alternative communication strategies by avoiding the use of elderspeak. Moreover, the beneficial effects of such communications have been documented as it improves the quality of life, reduces aggression, agitation and psychosocial symptoms. The present review discusses the scientific studies discussing the use of elderspeak in communication and development of resistiveness to care in resident patients of dementia.
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Brucki, Sonia Maria Dozzi, Ivan Aprahamian, Wyllians Vendramini Borelli, Victor Calil da Silveira, Ceres Eloah de Lucena Ferretti, Jerusa Smid, Breno José Alencar Pires Barbosa, et al. "Management in severe dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology." Dementia & Neuropsychologia 16, no. 3 suppl 1 (September 2022): 101–20. http://dx.doi.org/10.1590/1980-5764-dn-2022-s107en.
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ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.
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Annear, Michael J., and Peter Lucas. "Dementia in a regional hospital setting: contextual challenges and barriers to effective care." International Journal of Ageing and Later Life 12, no. 1 (August 13, 2018): 91–119. http://dx.doi.org/10.3384/ijal.1652-8670.17344.
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Dementia is a growing public health problem, which may be under-recognised and poorly managed in regional hospitals. With projections of increasing dementia among older adults in regional and rural areas, knowledge about dementia and capacity of professionals to provide best-evidence care is paramount. This research investigates the challenges of dementia care in a publicly funded regional hospital in Australia. The study elucidates prevalence of dementia-related admissions, costs of treatment, length of stay and capacity for dementia care. A mixed methodology was employed in this study, including analysis of hospital records (N = 2405), dementia knowledge surveys (n = 50) and semi-structured interviews with clinical staff (n = 13). Hospital records showed that dementia-related admissions were lower than population prevalence reported in regional Australia. Dementia patients, however, attracted significantly higher treatment costs and greater length of stay than age-matched admissions who did not have a diagnosis of dementia. Clinicians reported several obstacles to effective dementia care, including staff knowledge deficits, environmental challenges, resource constraints and organisational factors.
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O'Sullivan, Trish, Tony Foley, Joseph G. McVeigh, and Suzanne Timmons. "Education and training to support physiotherapists working in dementia care: a scoping review protocol." HRB Open Research 4 (March 10, 2021): 27. http://dx.doi.org/10.12688/hrbopenres.13219.1.
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Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care. Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care. Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Systematic reviews, qualitative, quantitative, mixed methods studies, case studies and observational studies will be included. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, Cochrane Database of Systematic Reviews, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.
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Tweedy, Maureen P., and Charles A. Guarnaccia. "Change in Depression of Spousal Caregivers of Dementia Patients Following Patient's Death." OMEGA - Journal of Death and Dying 56, no. 3 (May 2008): 217–28. http://dx.doi.org/10.2190/om.56.3.a.
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Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse's death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.
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Khiewchaum, Rungnapha. "CHILDREN CAREGIVERS’ EXPERIENCES OF OLDER ADULTS WITH DEMENTIA IN CARE TRANSITION: A QUALITATIVE SYSTEMATIC REVIEW." Innovation in Aging 3, Supplement_1 (November 2019): S841. http://dx.doi.org/10.1093/geroni/igz038.3098.
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Abstract Background/Purpose: Young and adult children have experienced caring for people who have been diagnosed with dementia. Caregiving needs affect family members who become the primary caregivers in care transition from hospital to home. This study aims to synthesize primary qualitative research on the experiences of children caregivers of older adults with dementia. Method: This is a systematic review describing young and adult child caregivers’ experiences in caring for patient with dementia in home-based care. Data sources were published literature written in English from CINAHL, Scopus, PubMed, and PsychoINFO (published from January 1976 to October 2018). The thematic synthesis approach was also applied to generate theory generating meta-synthesis research (TGMS). and to describe the process of caring for demented patients by caregivers. Result: Eight primary studies reporting 388 potential studies were included. Four themes emerged: 1) well-being which included encouraging and destructive well-being; 2) role transition which included positive or negative role transformations; 3) caregiver needs which included medical and nursing information or knowledges and health care services/community services; and 4) the challenge of dementia which included symptoms of dementia which were impairing. Conclusion The findings of this meta-synthesis study support evidence of well-being among adult children in caring for people with dementia in transition phases. We present thematic synthesis that could be useful to professionals working with caregivers and patients with dementia. We suggest that research importance should shift towards the development and evaluation of care transitions intervention, especially professionals preparing support after diagnosis.
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Reich, Caitlan D., Hannah Lyons, and Jayna M. Holroyd-Leduc. "Optimizing the Physical & Social Environment Within Hospitals for Patients with Dementia: a Systematic Review." Canadian Geriatrics Journal 25, no. 2 (June 1, 2022): 222–32. http://dx.doi.org/10.5770/cgj.25.494.
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BackgroundAs the population ages, the number of individuals living with dementia is increasing. This has implications for the health-care system, as people living with dementia are hospitalized more frequently and for longer periods. Because patients living with dementia are at increased risk for adverse events during admission, understanding how the acute care physical and social environments influence their outcomes is impera-tive. Thus, the objective of this review was to identify studies that modified the physical and/or social environment in acute care in order to improve care for hospitalized patients living with dementia. MethodsMEDLINE, Embase, and CINAHL databases were used to search for articles up to and including June 2021. PRISMA guidelines were followed. Two independent reviewers as-sessed citations and full texts against the following inclusion criteria: patients living with dementia/cognitive impairment, presence of a control group, and evidence of clinical or health systems outcomes. All published English-language articles meeting inclusion criteria were retrieved. ResultsFollowing the database search, 12,901 citations were retrieved with 11,334 remaining after duplication removal. Of these, 15 papers met inclusion criteria. Seven studies evaluated the physical environment (e.g., addition of electronic sensor alarms and environmental cues). The remaining studies evalu-ated specific programs (e.g., art, music, exercise, volunteer engagement, and virtual reality). The majority of studies were low to very low quality; only three studies were RCTs. Environmental cues may initially improve wayfinding, and exercise may reduce neuropsychiatric symptoms. ConclusionsAlthough there are several interventions, there is a lack of high-quality evidence available to determine what exactly needs to be incorporated into acute care settings to reduce adverse outcomes for patients with dementia.
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Clements-Cortes, Amy, and Lee Bartel. "Long-Term Multi-Sensory Gamma Stimulation of Dementia Patients: A Case Series Report." International Journal of Environmental Research and Public Health 19, no. 23 (November 23, 2022): 15553. http://dx.doi.org/10.3390/ijerph192315553.
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Dementia prevalence is increasing globally, and symptom management and treatment strategies require further investigation. Music-based interventions have demonstrated some efficacy with respect to quality of life and symptom reduction, though limited with respect to cognition. This study reports on three case studies where the use of gamma stimulation over one year contributed to maintenance of cognition and increases in mood for participants with Alzheimer’s disease or mild cognitive impairment. Auditory stimulation with isochronous sound at 40 Hz was delivered to participants via a commercially available vibroacoustic chair device five times per week for 30 min with assistance from caregivers. Further research is needed to assess the integration of this therapy in the overall care for persons with dementia.
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Voisine, Michael, Saurabh Dahiya, Behdad Besharatian, Jennifer Friderici, and James A. Stewart. "Early versus late referral to hospice care: A case-control study." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 127. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.127.
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127 Background: Hospice care can improve quality of life (QOL) for patients with advanced cancer. Studies suggest that hospice services are offered late in the course of terminal illness; limiting patient comfort and QOL. Limited literature exists on barriers to timely hospice referral. We examined demographic and clinical characteristics associated with late hospice referral. We hypothesized that age, malignancy type, and performance status (PS) may predict late referral to hospice. Methods: Patients were age 18+ cared for by oncologists of Baystate Medical Practices, referred to Baystate Hospice from 1/1/08 to 12/31/2010. Demographics and diagnosis (e.g., breast, lung, GI) were abstracted from the electronic medical record. Referral interval was calculated as date of death minus date of referral. Late referrals (“cases”) were classified as interval quintiles 1 and 2; early referrals (“controls”) quintiles 4 and 5. Fisher’s exact test and Wilcoxon Rank Sum identified demographic and clinical characteristics associated with late referral. Multivariable logistic regression was used to identify independent predictors of late referral. Results: 209 patients met inclusion criteria. The median referral interval was 29 days (IQR 12, 57). In the multivariable model, ECOG score (OR 1.51 95% CI 1.09 2.08); dementia (OR 0.08, 95% CI 0.01, 0.82); CNS cancer (OR 0.14, 95% CI 0.03, 0.73); and unclassified cancer (OR 0.32, 95% CI 0.14, 0.73) independently predicted late referral. Age, race, and sex were not associated in uni- or multivariable comparisons. Conclusions: In this study of 209 patients with advanced cancer enrolled to hospice, malignancy type, dementia, and performance status are associated with late hospice referral. We believe it is important to track timing of referral and look for ways to reduce barriers.
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Koller, Daniela, Hanna Kaduszkiewicz, Hendrik van den Bussche, Marion Eisele, Birgitt Wiese, Gerd Glaeske, and Falk Hoffmann. "Survival in patients with incident dementia compared with a control group: a five-year follow-up." International Psychogeriatrics 24, no. 9 (March 30, 2012): 1522–30. http://dx.doi.org/10.1017/s1041610212000361.
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ABSTRACTBackground: Dementia is an important disease in older age. Existing studies on dementia mortality face limitations. For instance, they are based on prevalent, small, or geographically limited samples or do not include controls. We aimed to study survival after the first diagnosis of dementia compared with a control group.Methods: We analyzed claims data of a German health insurance company, including 1,818 incident dementia cases and 7,235 age- and sex-matched non-dementia controls (53% male; mean age 78.8 years). The follow-up was five years. We assessed survival with the Kaplan–Meier curves and performed Cox proportional hazard regression, also including nursing care dependency and comorbidities.Results: The cumulative five-year mortality was 53.5% in the dementia cases and 31.1% in the control group (hazard ratio: 2.1). Even after adjusting for comorbidities and nursing care, the mortality risk was 1.5 times higher for patients with incident dementia than for controls. Nursing care dependency showed high influence on mortality, likewise in dementia patients and controls.Conclusions: Although some factors, such as education or the type and severity of dementia, could not be included in the analyses, our study shows a clear influence of dementia on mortality irrespective of age, sex, care dependency, and comorbidities. The strongest influence on mortality was found for dementia patients with nursing care dependency. Taking into account their mortality of around 70% in care level 1 and up to 80% in care levels 2 and 3, healthcare delivery to these patient groups should strongly consider elements of palliative care focusing on the quality of life.
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Ramirez, Madieska, Prabhash Kakarla, Marzena Gieniusz, Jessica Alvarez, Chris Nouryan, and Edith Burns. "A COMPREHENSIVE ALZHEIMER’S AND DEMENTIA CARE PROGRAM (ADCP) FOR PATIENTS AND CAREGIVERS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 766–67. http://dx.doi.org/10.1093/geroni/igac059.2778.
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Abstract Background Alzheimer’s and related dementias (ADRD) are progressive and associated with behavioral and psychological symptoms (BPSD) contributing to caregiver stress. We report initial impact of implementing UCLA-designed ADCP to support ADRD patients and caregivers. The program centralizes care, utilizing a nurse dementia-care specialist. Methods Prospective repeated measures of ADRD patient/caregiver dyads from 3/2021–7/2022. Measures: BPSD, ADL/IADL, cognition, and caregiver burden, distress and depression. Results Total of 154 patient/caregiver dyads enrolled to-date. 42 have been enrolled for one-year: 23 with complete data, 5 pending follow-up, 14 disenrolled (2 expired, 3 to hospice, 2 moved, 7 lost contact). For 23 patients with baseline and follow up, Neuropsychiatric Inventory Questionnaire decreased from 16.3 to 13.1 (p=0.170), Patient Health Questionnaire-9 (PHQ-9) for caregivers decreased (3.5 to 2.2, p=0.044), Montreal Cognitive Assessment decreased from 11.3 to 8.4 (p=0.045), and Dementia Burden Scale (DBS) showed nonsignificant decrease, 20.6 to 18.4 (p=0.312). Cornell Scale for Depression in Dementia was unchanged, 5.67 to 5.14 (p=0.380), and ADL and IADL decreased one year after enrollment, from 4.05 to 2.36 (p < 0.01) and 1.38 to 0.238 (p < 0.01) respectively. Conclusion Although attrition rate was high for the small sample (1/3 of dyads enrolled in the program for a year), there were improvements in some metrics for both patients and caregivers, despite the expected decline in cognitive function and ADL/IADL. As data is accrued, we anticipate it will identify patients and support resources that will be most beneficial.
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Yamanaka, Takashi, Maiko Mizuki, Kiwami Kidana, Ryonosuke Yamaga, and Masahiro Akishita. "CHARACTERISTICS OF LONG-TERM HOME CARE PATIENTS WITH DEMENTIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 524. http://dx.doi.org/10.1093/geroni/igac059.1998.
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Abstract This study aimed to clarify the characteristics of older adults with dementia receiving physician home visits. We prospectively registered 179 patients aged ≥65 years, estimated to receive physician home visits for over 6 months, in a clinic in Chiba, Japan, in 2020–2021. The patients’ mean (±SD) age was 85.1±7.4 years and ranged from 68 to 102 years. Out of the total patients, 57.5% were men. We collected clinical information; employed the Dementia Assessment Sheet in Community-based Integrated Care System 21 items (DASC-21) and EuroQOL five dimensions 5-level (EQ-5D-5L) every 6 months; and calculated the incidence of death. Eighty-two patients (45.8%) were diagnosed with dementia at the commencement of physician home visits. The characteristics of older adults diagnosed with dementia (D+ group) were compared with the characteristics of those who were not (D- group). The D+ group was older than the D- group (86.4±6.6 years vs. 84.1±8.0 years, p=0.04118). Total cholesterol levels and DASC-21 scores were higher in the D+ group compared to the D- group (180.2±41.7 vs. 163.7±51.2, p=0.04091; 62.3±14.5 vs. 50.2±16.2, p=0.00004, respectively). The EQ-5D-5L was not significantly different between the groups (0.439±0.255 vs. 0.397±0.267, p=0.32409). The proportion of those living in assisted living facilities or fee-based homes for the elderly was higher in the D+ group (χ2=8.5177, df=2, p=0.01414, V=0.2258). The mortality rate after 6 months was 20.7% in the D+ group and 16.5% in the D- group (χ2=0.5305, df=1, p=0.46641). In conclusion, the characteristics of patients with dementia should be further elucidated to provide better care.
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A˚kerlund, Britt Mari, and Astrid Norberg. "Powerlessness in Terminal Care of Demented Patients: An Exploratory Study." OMEGA - Journal of Death and Dying 21, no. 1 (August 1990): 15–19. http://dx.doi.org/10.2190/j3h1-n66w-gqbj-menn.
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Five caregivers in dementia care were interviewed about their ambivalent feelings toward spoon-feeding a severely demented patient. The caregivers were first inclined to recommend the use of a naso-gastric tube, but after a thorough discussion of the ethical aspects of this subject, they became more and more reluctant to use tube-feeding. Although tube-feeding was regarded as an easier way to provide nourishment, spoon-feeding was preferred because it provides more human contact and love. The act of spoon-feeding could be interpreted as a symbolization of love.
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Yeh, Tzu-Pei, Hsing-Chia Chen, and Wei-Fen Ma. "A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia." International Journal of Environmental Research and Public Health 18, no. 17 (August 24, 2021): 8901. http://dx.doi.org/10.3390/ijerph18178901.
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Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.
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Godfrey, Mary, John Young, Rosemary Shannon, Ann Skingley, Rosemary Woolley, Frank Arrojo, Dawn Brooker, Kim Manley, and Claire Surr. "The Person, Interactions and Environment Programme to improve care of people with dementia in hospital: a multisite study." Health Services and Delivery Research 6, no. 23 (June 2018): 1–154. http://dx.doi.org/10.3310/hsdr06230.
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Background Improving the care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal of service improvement. Objectives The Person, Interactions and Environment (PIE) Programme comprises an observation tool and a systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards, and develop insight into what person-centred care might look like in practice in this setting. Methods We performed a longitudinal comparative case study design in 10 purposively selected wards in five trusts in three English regions, alongside an embedded process evaluation. Data were collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records); and patient and ward aggregate data. Data were synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. A cross-case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data were analysed using simple descriptive statistics. A qualitative data analysis employed grounded theory methods. Results The study furthered the understanding of the dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’) or were ‘partial implementers’. The interaction between micro-level contextual factors [aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals] and meso- and macro-level organisational factors were the main barriers to PIE adoption. Evidence suggests that the programme, where implemented, directly affected improvements in ward practice, with a positive impact on the experiences of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations Although PIE has the potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes were not systematically collected, and PIE was not adopted on most study wards. Research implications Further research is required to identify more precisely the skill mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires a more in-depth understanding of the contextual factors that have an impact on the capacity of organisations to absorb and embed new practices. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Resnick, Barbara. "FUNCTION FOCUSED CARE FOR ACUTE CARE: OVERCOMING RECRUITMENT, MEASUREMENT, AND IMPLEMENTATION POST-COVID-19." Innovation in Aging 6, Supplement_1 (November 1, 2022): 389. http://dx.doi.org/10.1093/geroni/igac059.1532.
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Abstract To help patients spend more time engaged in physical activities and avoid the complications that occur Function Focused Care for Acute Care was developed (FFC-AC-EIT). FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. A total of 600 patients from 12 hospitals will be included. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reasons excluding COVID-19, and demonstrating evidence of dementia. Outcome measures are obtained at baseline, discharge, 1, 6 and 12 months post discharge and include physical function, physical activity, pain and pain management, psychological and behavioral symptoms associated with dementia, delirium and adverse events (falls, rehospitalizations, nursing home admissions). Due to COVID-19 innovative approaches were implemented to be able to initiate and continue with the study. These included: identifying potential participants that were COVID-19 free off site; transitioning some intervention activities with staff to online; completing verbal consent with proxies versus face to face; adjusting follow up MotionWatch 8 deliveries and placements to be done without face to face interaction; and adjusting recruitment time periods and intervention activities to fit with intermittently high periods of COVID-19. This symposium will describe intervention challenges, solutions and lessons learned, describe an effective process and measurement model for identification of participants with dementia; and provide optimal ways to measure pain and physical activity among older adults with dementia.
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Flint, Alastair J. "Effects of Respite Care on Patients With Dementia and Their Caregivers." International Psychogeriatrics 7, no. 4 (December 1995): 505–17. http://dx.doi.org/10.1017/s1041610295002249.
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The purpose of the literature review discussed in this article was to determine the effect of formal respite care on patients with dementia and their caregivers. Three computerized databases were searched for relevant English-language articles published from 1975 to 1994, and the bibliographies of retrieved articles were systematically reviewed for additional references. Five studies met the following inclusion criteria: original research; controlled trial of a defined respite intervention; sample including a dementia population; and at least one outcome measure relating to at least one of eight specified caregiver and patient variables. Four studies met validity criteria and were included for the review. There was little evidence that formal respite care has a significant effect on caregivers' burden, psychiatric status, or physical health; or on patients' cognition, function, physical health, or rate of institutionalization. However, given the small number of controlled studies found and their methodological and conceptual limitations, these data should be interpreted with caution.
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Vilela, Vitória Carvalho, Rafael Leite Pacheco, Carolina Oliveira Cruz Latorraca, Daniela Vianna Pachito, and Rachel Riera. "What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?" Sao Paulo Medical Journal 135, no. 3 (June 2017): 309–20. http://dx.doi.org/10.1590/1516-3180.2017.0092060617.
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ABSTRACT BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies.
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Tseng, Winger Sei-Wo, Wing-Kwong Wong, Chun-Chi Shih, and Yong-Siang Su. "Building a Care Management and Guidance Security System for Assisting Patients with Cognitive Impairment." Sustainability 12, no. 24 (December 15, 2020): 10516. http://dx.doi.org/10.3390/su122410516.
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The care of dementia patients presents a large challenge for caregivers and family members. Whether it is at home or in institutional care, patients have problems with spatial and environmental cognition. It often leads to abnormal behaviors such as a route recognition problem, wandering, or even getting lost. These behaviors require caregivers to keep an eye on the movement of the cognitively impaired elderly and the safety of these movement processes, to avoid them approaching dangerous areas or leaving the care environment. This paper used qualitative research methods (i.e., participatory interviews, case studies, and contextual observation methods) in the demand exploration phase and quantitative research methods in the product’s technological verification phase. In this study, we implemented a three-stage service design process—demand exploration, demand definition, and design execution—to analyze the care status and route recognition obstacles of elders with dementia, to identify hidden needs as a turning point for new product innovations in care management and guidance security. This study summarizes six service needs for care management and guides the surveillance and safety of elders with dementia: (1) offering indoor user-centered guidance, (2) providing the instant location information of elders with dementia to caregivers, (3) landmarks setting, (4) assistance notification, (5) environmental route planning, (6) use of a wearable device as a guide for indoor route guidance. Based on the potential deficiencies and demands of observation, the care management and guidance security system (CMGSS) was designed. The experimental results show that the use of ultra-wide band positioning technology used in the indoor guiding system can accurately guide the behavior of patients to the right position, provide accurate information for caregivers, and record their daily behavior. The error range of this technology was not only within 42.42 cm in indoor static positioning but also within 55 cm in dynamic positioning, even where wall thickness was 18 cm. Although the device was designed for institutional care, it can also be applied to the management and care of general home-based patients.
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Douglas, Natalie F., and Katie McDonald. "Interprofessional Care in the Management of Alzheimer's Dementia: Leaving Our Silos." Perspectives of the ASHA Special Interest Groups 1, no. 2 (March 31, 2016): 129–37. http://dx.doi.org/10.1044/persp1.sig2.129.
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As speech-language pathologists (SLPs), we are poised to become leaders in the caring of adults with dementia; however, because of the complexity of this health condition, and its impact on patients and families, we must move beyond discipline-specific approaches to intervention and embrace the opportunities that arise when working across professional silos. The application of principles of interprofessional education (IPE) and interprofessional practice (IPP) can be applied to maximize Alzheimer's dementia care. In this paper, the organizational characteristics supporting IPP will be highlighted, an outline of applications of training procedures to promote IPP in a rehabilitation environment will be reviewed, and real-world case studies will be provided to highlight salient principles.
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Woodman, Charles E. "Seeking Meaning in Late Stage Dementia." Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications 59, no. 4 (December 2005): 335–43. http://dx.doi.org/10.1177/154230500505900403.
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The author uses case studies to illustrate the effectiveness of two techniques which pastoral caregivers may teach to family carers of dementia patients. In the last stages of dementia, it is important to seek meaning and keep in significant contact as long as possible, both for family members as well as for the dementia patients. After a brief literature review, implications for care theory, practice, and policy are reviewed, and a scientific bias is illustrated. These techniques build on the work of C. G. Jung and James Hillman, utilizing metaphor in non-rational uses of language. It is suggested that pastoral caregivers could teach these techniques to families of this population, in the hope of prolonging meaningful connection with their loved one.
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Gordon, Alison, Hilda Hu, Anthony Byrne, and David J. Stott. "Dementia screening in acute medical and geriatric hospital admissions." Psychiatric Bulletin 33, no. 2 (February 2009): 52–54. http://dx.doi.org/10.1192/pb.bp.107.016550.
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Aims and MethodWe studied a representative cohort of 161 patients over 65 years of age, admitted non-electively to medical and geriatric wards of a large teaching hospital. Assessment for dementia was made using DSM–IV criteria. Psychiatric records were then examined, masked, to determine the involvement of psychogeriatric services.ResultsThere were 111 possible cases of dementia (69%), of which 30 (27%) had prior local psychogeriatric case notes; in 22 cases (20%) the patient had a prior psychiatric diagnosis of dementia. of 161 patients, 19 (12%) were seen by psychogeriatric services during their admission, of whom 12 (7%) were already known to psychiatric services. Dementia was diagnosed in 17 (complicated by delirium in 2), depression in 1 and hypomania in 1. Many patients with a possible diagnosis of dementia had no psychiatric assessment.Clinical ImplicationsPsychogeriatric assessment was performed on a minority of older people admitted to medical care. This population may include older people with undiagnosed dementia and unmet psychiatric care needs.
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Cantone, Daniela, Francesco Attena, Sabrina Cerrone, Antonio Fabozzi, Riccardo Rossiello, Laura Spagnoli, and Concetta Paola Pelullo. "Lying to patients with dementia: Attitudes versus behaviours in nurses." Nursing Ethics 26, no. 4 (November 21, 2017): 984–92. http://dx.doi.org/10.1177/0969733017739782.
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Background: Using lies, in dementia care, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. Objectives: In this article, we report results about the attitude and the behaviour of nurses towards the use of lies to patients with dementia. Research design: An epidemiological cross-sectional study was conducted between September 2016 and February 2017 in 12 elderly residential facilities and in the geriatric, psychiatric and neurological wards of six specialised hospitals of Italy’s Campania Region. Participants: In all, 106 nurses compiled an attitude questionnaire (A) where the main question was ‘Do you think it is ethically acceptable to use lies to patients with dementia?’, instead 106 nurses compiled a behaviour questionnaire (B), where the main question was ‘Have you ever used lies to patients with dementia?’ Ethical considerations: Using lies in dementia care, although topic ethically still controversial, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. Findings: Only a small percentage of the interviewed nurses stated that they never used lies/that it is never acceptable to use lies (behaviour 10.4% and attitude 12.3%; p = 0.66). The situation in which nurses were more oriented to use lies was ‘to prevent or reduce aggressive behaviors’. Indeed, only the 6.7% in the attitude group and 3.8% in the behaviour group were against using lies. On the contrary, the case in which the nurses were less oriented to use lies was ‘to avoid wasting time giving explanations’, in this situation were against using lies the 51.0% of the behaviour group and the 44.6% of the attitude group. Conclusion: Our results, according to other studies, support the hypothesis of a low propensity of nurses to ethical reflection about use of lies. In our country, the implementation of guidelines about a correct use of lie in the relationship between health operators and patients would be desirable.
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Poças, A., and S. Almeida. "Antipsychotics in Dementia." European Psychiatry 41, S1 (April 2017): S662—S663. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1122.
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Behaviour disorders and psychosis may represent a greater challenge in patients with dementia. There are evidence-based recommendations to assess psychological and behavioral symptoms of dementia and the practice guidelines of American psychiatric association (APA) reinforce general principles of good clinical care. However, when these patients initiate a psychotropic, the agents often continue to be prescribed for a long time, even after the symptoms disappeared. The recommendation of reduce/stop an antipsychotic medication within 4 months of initiation may seem counterintuitive when the patient is better, with remission of the original symptoms. However, the studies showed that a large amount of patients with dementia can discontinue antipsychotic medication without a return of agitation or psychosis. Older patients are a particularly susceptible population and the risk/benefit of any medication should be carefully considered. For most patients the risk of harm outweighs the profits of continuing treatment and we need a routine evaluation of this factor to identify these cases.It's important to reduce unnecessary medications but agitation and psychosis associated with severe distress also carry serious risks; discontinuing these medications can be dangerous so we need to manage it with caution evaluating each case as an individual one.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Solomon, Paul R., Michael Brush, Vivian Calvo, Felicity Adams, Richard D. DeVeaux, William W. Pendlebury, and Daniel M. Sullivan. "Identifying Dementia in the Primary Care Practice." International Psychogeriatrics 12, no. 4 (December 2000): 483–93. http://dx.doi.org/10.1017/s1041610200006608.
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Background: The purpose of this study was to evaluate the utility (i.e., positive and negative predictive value) of the 7 Minute Screen in identifying patients with probable Alzheimer's disease (AD) in a primary care practice. A second objective was to estimate the number of undiagnosed AD patients in a typical primary care practice. Methods: One hundred thirty-seven successive admissions (96%) of patients over the age of 60 to a primary care practice over a 53-day period who completed informed consent documents were administered the 7 Minute Screen. All patients who screened positive (n = 13) and a random sample of those who screened negative (n = 26) returned for full diagnostic evaluation. Positive predictive value (PPV) and negative predictive value (NPV) of the 7 Minute Screen were determined using the criterion standard of clinical diagnosis established by examination, history, and laboratory studies. Test-retest reliability and time for administration were also determined. Results: Of the 137 patients evaluated, 13 screened positive and 124 screened negative. Eleven of the 13 patients who screened positive were willing to return to the primary care practice for follow-up evaluation. A random sample of 26 patients who screened negative all agreed to return for follow-up evaluation. Of the 11 patients who screened positive who returned for evaluation, 10 were subsequently diagnosed with probable AD. The remaining patient was diagnosed with mixed dementia. The caregivers of the two patients who refused to return were contacted and both indicated that the patients were having significant cognitive problems as verified by an activities of daily living scale. Of the 26 patients who screened negative, 25 were judged to be cognitively normal and the 26th was judged to have mild cognitive impairment. Discussion: In successive admissions of patients over the age of 60 in a primary care practice, the 7 Minute Screen showed a PPV of 91% and an NPV of 96% in identifying patients who were subsequently identified with AD or other dementing disorder. These data suggest that this may be a useful instrument in identifying patients who should undergo diagnostic evaluation for AD and other dementing disorders. Additionally, extrapolation from the data in this practice suggests that there may be between 75 and 100 AD patients in the typical primary care practice, many of whom may not be diagnosed.
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Maryšková, Jana. "The Specific Character of Pastoral Care for Dementia Patients - Seelsorge as Leibsorge." Studia theologica 20, no. 4 (December 12, 2018): 141–57. http://dx.doi.org/10.5507/sth.2018.003.
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Ainsworth, Karen, and Cliff Richardson. "Multidisciplinary attitudes to people with dementia; training and environmental factors play a role in caring for people with dementia in a Cardiac Catheterisation Laboratory." Quality in Ageing and Older Adults 18, no. 4 (December 11, 2017): 235–45. http://dx.doi.org/10.1108/qaoa-10-2015-0050.
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Purpose The purpose of this paper is to explore multidisciplinary attitudes and environmental factors affecting dementia care in the Cardiac Catheter Laboratory (CCL). Design/methodology/approach Questionnaires (n=87) were distributed in a hospital CCL in the North of England. The authors utilised the Dementia Attitudes Scale which incorporates two subscales: Social Comfort and Dementia Knowledge. In addition, a newly devised questionnaire asking about perceptions of how the CCL environment affected care of patients with dementia was added. Findings The response rate was 71 per cent (n=62). Years’ experience in the CCL was associated with lower Social Comfort scores (p=0.026). Dementia training was associated with higher mean Dementia Attitudes Scale and Social Comfort scores (p=0.021, p=0.007). Participants who had undertaken “Professional studies” had higher Dementia Attitudes Scale and Dementia Knowledge mean scores (p=0.038, p=0.046) but “On-the-job” training was perceived as most beneficial (32 per cent, n=20). Unit co-ordinators and nurses felt the CCL was an unfavourable environment for patients with dementia. Care was perceived to be impaired by environmental functionality, equipment and the presence of ionising radiation. Research limitations/implications The small sample limits generalisability. Although the Dementia Attitudes Scale is a validated questionnaire it has not been widely used so reliability of these results is unclear. Practical implications Caring for patients with dementia has unique challenges especially in areas like the CCL. These results suggest that practical experience and training can affect the perception of staff to patients with dementia hence there may be a need to assess what would be the most appropriate training to give health professionals in the future. Originality/value The authors believe this to be the first multi-professional research study into care of patients with dementia in a specialised acute unit. This was the most diverse sample known to have attitudes to dementia measured quantitatively in an acute hospital department and the results need to be replicated before practice should be changed.
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Borsje, Petra, Peter L. B. J. Lucassen, Hans Bor, Roland B. Wetzels, Anne Margriet Pot, and Raymond T. C. M. Koopmans. "The course of neuropsychiatric symptoms in patients with dementia in primary care." Family Practice 36, no. 4 (December 4, 2018): 437–44. http://dx.doi.org/10.1093/fampra/cmy117.
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Abstract Background During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services. Objectives To investigate the course of NPS in people with dementia in primary care. Methods Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS. Results The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome. Conclusions GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care.
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Gopalakrishna, Ganesh, Jeremy Pruzin, Susan Alford, Carol Hamersky, Anup Sabharwal, and Stephen Brunton. "GERIATRICIAN PERSPECTIVES ON THE MANAGEMENT OF MILD COGNITIVE IMPAIRMENT/MILD ALZHEIMER’S DISEASE." Innovation in Aging 6, Supplement_1 (November 1, 2022): 776. http://dx.doi.org/10.1093/geroni/igac059.2807.
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Abstract Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia are characterized by cognitive impairment and in AD a progressive functional impairment. This study sought to understand the role of geriatricians in treating patients with MCI/mild AD dementia. An anonymous, online survey was conducted in the US with 301 healthcare professionals (HCPs), including 75 primary care providers who practice as board certified geriatricians, and treat ≥10 patients per month with MCI/mild AD dementia. Geriatricians reported that among their patients with MCI/mild AD dementia, they initially make this diagnosis 70% of the time. Geriatricians reported that the topics commonly discussed with patients at the time of diagnosis are treatment options (85%), care management strategies (81%) and disease progression (80%). When referring patients to other specialties for treatment, geriatricians most often referred to neurologists (41%). Most (83%) geriatricians considered themselves the coordinator of care for patients with MCI/mild AD dementia; however, only 5% of non-geriatrician HCP respondents view geriatricians as such. Geriatricians reported prescribing/recommending treatments for ongoing management of MCI/mild AD dementia, with the most common being mental exercises (76%), acetylcholinesterase inhibitors (75%), social interaction (73%), medications to manage comorbidities (72%), and lifestyle improvements (72%). Most (76%) geriatricians have received advanced formal training in MCI/mild AD dementia care with the majority (84%) expressing that they feel very confident in managing patients with MCI/mild AD dementia. Geriatricians are specialists that are well trained and confident in diagnosing, treating, and managing patients with MCI/mild AD dementia.