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Lennon JC, Aita SL, Del Bene VA, Rhoads T, Resch ZJ, Eloi JM, Walker KA. Black and White individuals differ in dementia prevalence, risk factors, and symptomatic presentation. Alzheimers Dement 2022; 18:1461-1471. [PMID: 34854531 PMCID: PMC9160212 DOI: 10.1002/alz.12509] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although dementia prevalence differs by race, it remains unclear whether cognition and neuropsychiatric symptom severity differ between Black and White individuals with dementia. METHODS Using National Alzheimer's Coordinating Center (NACC) data, we evaluated dementia prevalence in non-Hispanic Black and White participants and compared their clinicodemographic characteristics. We examined race differences in cognition, neuropsychiatric symptoms, and functional abilities in participants with dementia using multivariable linear and logistic regression models. RESULTS We included 5,700 Black and 31,225 White participants across 39 Alzheimer's Disease Research Centers. Of these, 1,528 (27%) Black and 11,267 (36%) White participants had dementia diagnoses. Despite having lower dementia prevalence, risk factors were more prevalent among Black participants. Black participants with dementia showed greater cognitive deficits, neuropsychiatric symptoms/severity, and functional dependence. DISCUSSION Despite lower dementia prevalence, Black participants with dementia had more dementia risk factors, as well as greater cognitive impairment and neuropsychiatric symptom severity than White participants.
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Affiliation(s)
- Jack C. Lennon
- Department of Psychology, Adler University, Chicago, IL 60602, USA
| | - Stephen L. Aita
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA
| | - Tasha Rhoads
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA
| | - Zachary J. Resch
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA
| | - Janelle M. Eloi
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA,Corresponding author: Keenan Walker, Ph.D., BRC BG RM 04B311, 251 Bayview BLVD., Baltimore, MD 21224, , Office Phone: 667-205-2657
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Jung G, Lee J. Behavioral and Psychological Symptoms and Associated Factors in Community-Dwelling Persons at the First Time of Dementia Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137765. [PMID: 35805421 PMCID: PMC9265813 DOI: 10.3390/ijerph19137765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022]
Abstract
Background: Community-dwelling residents at potential risk of dementia and their families have difficulty detecting symptoms of dementia during an outbreak of coronavirus disease-19 (COVID-19). We explored the characteristics of behavioral and psychological symptoms of dementia (BPSD) in community-dwelling persons at the first time of dementia diagnosis and identified their associated variables. Methods: A cross-sectional study using secondary data of dementia diagnosis tests was conducted. Data were reported by professional nurses and clinicians from 355 persons at the first time of dementia diagnosis in South Korea. BPSD and their associated variables were measured with the Neuropsychiatric Inventory, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) assessment handbook and electronic medical records. Results: The most common symptoms were apathy/indifference (72.1%), followed by irritability/lability (42.8%) and depression/dysphoria (42.0%). Hierarchical regression analyses showed that the strongest factor associated with BPSD was dementia type (β = −0.18, p = 0.001) mostly severer in frontotemporal dementia, followed by activities of daily living dependency (β = 0.15, p = 0.033), and number of medications (β = 0.10, p = 0.048). Conclusion: Providing information based on the study findings to families who are caring for persons at potential risk of dementia, may be able to detect dementia symptoms early and manage appropriate care.
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Affiliation(s)
- Gijung Jung
- Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Jia Lee
- College of Nursing Science, Kyung Hee University, Seoul 02447, Korea
- Correspondence:
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Pickering CEZ, Yefimova M, Wang D, Maxwell CD, Jablonski R. Dynamic structural equation modelling evaluating the progressively lowered stress threshold as an explanation for behavioural symptoms of dementia. J Adv Nurs 2022; 78:2448-2459. [PMID: 35118724 PMCID: PMC9545039 DOI: 10.1111/jan.15173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
Aim To evaluate the progressively lowered stress threshold (PLST) conceptual model as an explanation for behavioural symptoms of dementia and test several of its hypothesized propositions. The PLST model suggests that due to impairments in coping, persons living with dementia have a reduced threshold for stress and respond with more behavioural symptoms of dementia as stress accumulates throughout the day. Design Intensive longitudinal design. Methods A sample of N = 165 family caregivers completed brief daily diary surveys for 21 days between the dates of 7/2019 and 8/2020, reporting on a total of 2841 days. Dynamic structural equation modelling was used as the analytic technique to examine the impact of caregiver and care recipient environmental stressors on the diversity of behavioural symptoms of dementia to account for the nested data structure and autoregressive relationships. Findings Results show direct relationships between environmental stressors and diversity of behavioural symptoms of dementia that same day and the following day. Conclusion Findings provide support for the PLST model propositions. Further, findings suggest an extension to the conceptual model is warranted given evidence of an exposure/recovery trajectory and the lagged effects of stress exposure on behavioural symptoms of dementia presentation. Impact This study tested whether a commonly used nursing model does in fact explain the occurrence of behavioural symptoms of dementia. The main findings support using the model as an intervention framework and suggest the model should be adapted to consider recovery trajectories. Since behavioural symptoms of dementia represent complex and dynamic temporal phenomena, traditional longitudinal assessments and analyses are an insufficient measurement modality for testing models. Findings inform the design of environmental‐modification type interventions for behavioural symptoms of dementia management and the methods to evaluate such interventions.
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Affiliation(s)
| | - Maria Yefimova
- Division of Primary Care Population Health, Stanford University School of Medicine, Stanford, California, USA.,Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA
| | - Danny Wang
- School of Nursing, University of Alabama Birmingham, Birmingham, Alabama, USA
| | | | - Rita Jablonski
- School of Nursing, University of Alabama Birmingham, Birmingham, Alabama, USA
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Harel D, Band-Winterstein T, Goldblatt H. Between sexual assault and compassion: The experience of living with a spouse's dementia-related hypersexuality-A narrative case-study. DEMENTIA 2021; 21:181-195. [PMID: 34269088 DOI: 10.1177/14713012211032068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypersexuality is one of the behavioral and psychological symptoms of dementia. This symptom can lead to poor quality of life for the person who lives with dementia, as well as for his or her caregiver, who might be exposed to sexual assault. AIM This study aimed to highlight the experience of an older woman living and coping with a spouse who exhibits dementia-related hypersexuality. METHOD A narrative case-study of a single case was designed, composed of four semi-structured interviews conducted over a 10-month period. The data were analyzed through thematic, structural, and performance analysis. FINDINGS Four phases were revealed, depicting the experience of being a partner and caregiver of a spouse with dementia-related hypersexuality: a) "I need help": A distress call; b) "It depends how long I agree to go on with it": Living with the ambiguous reality of dementia-related hypersexual behavior within an ongoing intimate relationship; c) "It's as if I'm hugging someone who's no longer alive": The transition from the previous couplehood identity to a new couplehood identity; and d) "I am just taking care of him as if he is a child": A compassionate couplehood identity construction. CONCLUSIONS Living with a partner with dementia-related hypersexuality is a distressing experience for the caregiver-spouse. Yet, positive memories from a long intimate relationship can lead to the creation of a compassionate identity, which supports the caregiving process, and creates a sense of acceptance and meaning making. This, in turn, enables a positive aging experience. These finding have some practical implications for supporting and intervening in such cases.
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Affiliation(s)
- Dovrat Harel
- The Graduate Program in Drama Therapy, 26748Tel Hai College, Upper Galilee, Israel
| | - Tova Band-Winterstein
- Department of Gerontology, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
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Basnyat I, Chang L. Tensions in support for family caregivers of people with dementia in Singapore: A qualitative study. DEMENTIA 2021; 20:2278-2293. [PMID: 33913355 DOI: 10.1177/1471301221990567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family members as informal caregivers are considered the first line of support for people with dementia across the world. In Singapore, caregiving expectations revolve around the cultural expectations of providing care in the home environment. However, studies in Singapore have identified a lack of family support for primary caregivers. Family support has been discussed in the literature as the provision of care for people with dementia, and rarely as a resource for family caregivers. METHOD To understand family support among primary caregivers in Singapore, 24 semi-structured interviews were conducted. Thematic analysis found four themes: excuses for lack of physical support for the caregiver, tensions between cultural expectations of caregiving and the provision of support, unmet emotional support, and lack of awareness of dementia and caregiving needs. FINDINGS Caregivers rationalized and forgave the absence of physical support but were frustrated when the lack of support impacted people with dementia. This was seen as a lack of fulfilling cultural obligations of caring for elderly parents. The caregivers also felt frustrated with the lack of emotional support provided to them, but these were unspoken between the caregiver and the family members. Insufficient and unhelpful support giving was exacerbated with the perception of family members' limited understanding of the demands of caregiving. CONCLUSION The findings offer four practical suggestions to address unmet support needs. First, public education is needed to enhance general knowledge about the symptoms and progression of dementia. Second, help is needed to address miscommunication about support within the family. Third, the development of guidebooks is needed to help family caregivers communicate with family members about their various support needs. Fourth, the relationship between cultural expectation and caregiving must be understood within the context of modernity and urbanism.
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Affiliation(s)
- Iccha Basnyat
- School of Communication Studies, 3745James Madison University, VA, USA
| | - Leanne Chang
- Department of Communication Studies, 26679Hong Kong Baptist University, Kowloon, Hong Kong
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Parrotta I, De Mauleon A, Abdeljalil AB, De Souto Barreto P, Lethin C, Veerbek H, Stephan A, Saks K, Zabalegui A, Soto Martin ME. Depression in People With Dementia and Caregiver Outcomes: Results From the European Right Time Place Care Study. J Am Med Dir Assoc 2020; 21:872-878.e1. [PMID: 32307275 DOI: 10.1016/j.jamda.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the cross-sectional associations between depression in people with dementia and both caregiver burden and quality of life in 8 European countries, and to test these associations compared with the presence of other neuropsychiatric symptoms. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS In total, 1223 dyads comprised of informal caregivers and people with dementia living in a community-dwelling setting, recruited from the Right Time Place Care study, a cohort survey from 8 European countries. MEASURES To test the associations between depression (according to the Cornell Scale for Depression in Dementia) and informal caregiver burden (defined by the Zarit scale and hours of supervision in terms of Resource Utilization in Dementia), distress (defined by the Neuropsychiatric Inventory Questionnaire distress score), and quality of life (according to the visual analogue scale and 12-item General Health Questionnaire). RESULTS Linear regressions showed an association between depression and main outcomes (Zarit scale: β 3.7; P = .001; hours of supervision: β 1.7; P = .004; Neuropsychiatric Inventory Questionnaire distress score: β 1.2; P = .002). A similar association was found concerning psychological and overall well-being (12-item General Health Questionnaire: β 1.8; P < .001; Euroqol Visual Analogue Scale: β -4.1; P = .003). Both associations remained significant despite the presence of other NPS and after adjusting for confounders. CONCLUSIONS AND IMPLICATIONS Further studies are needed to assess whether providing tailored strategies for optimizing diagnosis and managing of depression in people with dementia might improve caregiver quality of life and reduce their burden in the community-dwelling setting.
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Affiliation(s)
- Ilaria Parrotta
- Department of Geriatric and Internal Medicine, La Sapienza University of Rome, Rome, Italy; Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | | | | | | | - Connie Lethin
- Faculty of Medicine, Department of Health Science, Lund University, Lund, Sweden
| | - Hilde Veerbek
- Department of Health Service Research, Maastricht University, Maastricht, Netherlands
| | - Astrid Stephan
- Wissenschaftliche Mitarbeiterin Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät Institut für Gesundheits- und Pflegewissenschaft, Wittenberg, Germany
| | - Kay Saks
- University of Tartu, Tartu, Estonia
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Teahan Á, Lafferty A, McAuliffe E, Phelan A, O'Sullivan L, O'Shea D, Fealy G. Resilience in family caregiving for people with dementia: A systematic review. Int J Geriatr Psychiatry 2018; 33:1582-1595. [PMID: 30230018 DOI: 10.1002/gps.4972] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this review is to critically examine, evaluate, and synthesize the literature on resilience in family caregiving for people with dementia. METHODS A systematic literature review was conducted according to PRISMA guidelines to identify articles which examined resilience and related concepts in family caregiving for people with dementia. The review was based on a systematic search of scholarly databases, to yield peer-reviewed articles and grey literature, published between 2006 and 2016. Two independent reviewers prescreened the search results and conducted formal assessments and quality appraisals of the retrieved articles. RESULTS A total of 13 863 articles were identified by the systematic search, and 52 articles were included in the review. Based on a critical narrative synthesis of the literature, the study proposes a model of resilience for family carers of people with dementia, which incorporates the context of caring, social and cultural characteristics, and psychological dimensions of caring. CONCLUSIONS The results indicate that there is no single approach to enhancing resilience among family carers of people with dementia. Resilience is a multifaceted response to the caregiving role, and is influenced by a multitude of interrelated factors. However, the factors and resources outlined have been addressed, with limited success in some cases, by psychosocial interventions in the field. While the work conducted to date to develop resilience-enhancing interventions has been marked with some success, the next wave of carer research could usefully examine ecological perspectives on carer outcomes, including carer resilience.
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Affiliation(s)
- Áine Teahan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Attracta Lafferty
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Amanda Phelan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | - Gerard Fealy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Ivey K, Allen RS, Liu Y, Parmelee PA, Zarit SH. Immediate and Lagged Effects of Daily Stress and Affect on Caregivers' Daily Pain Experience. THE GERONTOLOGIST 2018; 58:913-922. [PMID: 28977383 PMCID: PMC6137352 DOI: 10.1093/geront/gnx099] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Indexed: 01/01/2023] Open
Abstract
Purpose of the Study We examined the effect of daily stress, affect, and adult day service (ADS) use on the daily pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized ADS use, care-related and noncare-related subjective stress, and affect would significantly influence and interact in ways to exacerbate or buffer the experience of daily pain. Design Participants were 173 family caregivers of IWDs using ADS more than 2 days per week. Participants with IWDs diagnosed with "mild cognitive impairment" were excluded. Daily telephone interviews assessed stress, affect, and pain. Methods Multilevel models were used to examine the relation between daily stress and daily pain and interaction effects of other daily experiences within the context of ADS use. Results Multilevel models revealed a significant relation between care-related subjective stress and daily bodily pain as well as an interaction between noncare-related subjective stress and daily bodily pain. ADS use and affect did not predict daily pain. Lagged effects revealed a significant interaction between yesterday's ADS use and today's positive affect on today's bodily pain. Implications Findings suggest that further studies are warranted for understanding and controlling pain among caregivers. Addressing the physical health needs through pain management interventions, positive affect maximization, and ADS use may improve the overall wellbeing of caregiving dyads.
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Affiliation(s)
- Keisha Ivey
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Rebecca S Allen
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Yin Liu
- Department of Human Development and Family Studies, Pennsylvania State University, University Park
| | - Patricia A Parmelee
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Steven H Zarit
- Department of Human Development and Family Studies, Pennsylvania State University, University Park
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Taipale H, Gomm W, Broich K, Maier W, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Haenisch B. Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data. J Am Geriatr Soc 2018; 66:1123-1129. [DOI: 10.1111/jgs.15358] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Heidi Taipale
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Willy Gomm
- German Center for Neurodegenerative Diseases; Bonn Germany
| | - Karl Broich
- Federal Institute for Drugs and Medical Devices; Bonn Germany
| | - Wolfgang Maier
- German Center for Neurodegenerative Diseases; Bonn Germany
- Department of Psychiatry; University of Bonn; Bonn Germany
| | | | - Antti Tanskanen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital; University of Eastern Finland; Kuopio Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Department of Psychiatry; Kuopio University Hospital; Kuopio Finland
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Moniz-Cook E, Hart C, Woods B, Whitaker C, James I, Russell I, Edwards RT, Hilton A, Orrell M, Campion P, Stokes G, Jones RSP, Bird M, Poland F, Manthorpe J. Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, UK
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Cathryn Hart
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Chris Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Ian James
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Russell
- Swansea Trials Unit, Swansea University, Swansea, UK
| | | | - Andrea Hilton
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Martin Orrell
- Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Peter Campion
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Robert SP Jones
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Mike Bird
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
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KOCA E, TAŞKAPILIOĞLU Ö, BAKAR M. Caregiver Burden in Different Stages of Alzheimer's Disease. Noro Psikiyatr Ars 2017; 54:82-86. [PMID: 28566965 PMCID: PMC5439478 DOI: 10.5152/npa.2017.11304] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
Abstract
With an increasing number of patients being diagnosed with Alzheimer's disease (AD) daily, it has become one of the major problems in public health. The increase in the number of dementia patients in low- and middle-income countries is expected to be much more than that in developed countries. As a result, the economic burden of dementia, both worldwide and in Turkey, is growing. Moreover, AD leads to emotional burdens and psychological distress in family member(s) and caregiver(s) alongside the patient. Each stage of AD imposes different responsibilities on caregivers, increasing their burden. The suffering and emotional burdens of caregivers from these responsibilities lead to a decreased quality of life and disturbed body physiology. Incapacity, despair, weariness, and loneliness are the hidden emotions of this iceberg. This review aims to gather the results of studies on caregiver burden in different stages of AD, attract attention to those results that may have been ignored in Turkey, and shed light on the solutions required to overcome the problems in caregiving of AD patients.
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Affiliation(s)
- Elif KOCA
- Uludağ Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye
| | | | - Mustafa BAKAR
- Uludağ Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Bursa, Türkiye
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Abstract
PURPOSE OF REVIEW This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. RECENT FINDINGS As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient's insensitivity to others' feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, NT, Hong Kong. .,Department of Clinical Psychology, Noriwch Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
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Torrisi M, Cacciola A, Marra A, De Luca R, Bramanti P, Calabrò RS. Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue. Geriatr Gerontol Int 2016; 17:865-874. [PMID: 27489168 DOI: 10.1111/ggi.12854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 03/15/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non-pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work-up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865-874.
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Affiliation(s)
- Michele Torrisi
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Alberto Cacciola
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy.,Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Angela Marra
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Rosaria De Luca
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Placido Bramanti
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Rocco Salvatore Calabrò
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Czarnuch S, Ricciardelli R, Mihailidis A. Predicting the role of assistive technologies in the lives of people with dementia using objective care recipient factors. BMC Geriatr 2016; 16:143. [PMID: 27440237 PMCID: PMC4955267 DOI: 10.1186/s12877-016-0314-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 07/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population of people with dementia is not homogeneous. People with dementia exhibit a wide range of needs, each characterized by diverse factors including age, sex, ethnicity, and place of residence. These needs and characterizing factors may influence the applicability, and ultimately the acceptance, of assistive technologies developed to support the independence of people with dementia. Accordingly, predicting the needs of users before developing the technologies may increase the applicability and acceptance of assistive technologies. Current methods of prediction rely on the difficult collection of subjective, potentially invasive information. We propose a method of prediction that uses objective, unobtrusive, easy to collect information to help inform the development of assistive technologies. METHODS We develop a set of models that can predict the level of independence of people with dementia during 20 activities of daily living using simple, objective information. Using data collected from a Canadian survey conducted with caregivers of people with dementia, we create an ordered logistic regression model for each of the twenty daily tasks in the Bristol ADL scale. RESULTS Data collected from 430 Canadian caregivers of people with dementia were analyzed to reveal: most care recipients were mothers or husbands, married, living in private housing with their caregivers, English-speaking, Canadian born, clinically diagnosed with dementia 1 to 6 years prior to the study, and were dependent on their caregiver. Next, we developed models that use 13 factors to predict a person with dementia's ability to complete the 20 Bristol activities of daily living independently. The 13 factors include caregiver relation, age, marital status, place of residence, language, housing type, proximity to caregiver, service use, informal primary caregiver, diagnosis of Alzheimer's disease or dementia, time since diagnosis, and level of dependence on caregiver. The resulting models predicted the aggregate level of independence correctly for 88 of 100 total responses categories, marginally for nine, and incorrectly for three. CONCLUSIONS Objective, easy to collect information can predict caregiver-reported level of task independence for a person with dementia. Knowledge of task independence can then inform the development of assistive technologies for people with dementia, improving their applicability and acceptance.
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Affiliation(s)
- Stephen Czarnuch
- Department of Electrical and Computer Engineering and Discipline of Emergency Medicine, Memorial University, S.J. Carew Building, St. John's, NL, A1B 3X5, Canada.
| | - Rose Ricciardelli
- Department of Sociology, Memorial University, Arts and Administration Building, St. John's, NL, A1C 5S7, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy & Institute of Biomaterials and Biomedical Engineering, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
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15
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Barnes LL, Leurgans S, Aggarwal NT, Shah RC, Arvanitakis Z, James BD, Buchman AS, Bennett DA, Schneider JA. Mixed pathology is more likely in black than white decedents with Alzheimer dementia. Neurology 2015; 85:528-34. [PMID: 26180136 PMCID: PMC4540250 DOI: 10.1212/wnl.0000000000001834] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the burden of neuropathology in black and white participants with clinical Alzheimer disease (AD). METHODS Participants included 122 persons enrolled in the Rush Alzheimer's Disease Clinical Core, a prospective cohort study of AD. Forty-one black decedents were matched two-to-one to 81 white decedents according to age at death, sex, years of education, and cognition proximate to death. We examined common brain pathologies related to dementia (AD, Lewy body, and macroscopic and microinfarct pathology) and arteriolar sclerosis and atherosclerosis. We calculated the frequency of each dementia pathology both alone and in combination (mixed pathologies). Racial differences in the odds of a single pathology vs mixed pathologies, and in the odds of vessel disease and its severity, were examined using logistic regression analyses. RESULTS AD pathology was confirmed in >93% of both black and white decedents with AD dementia. However, black decedents were less likely to have Alzheimer pathology as a single dementia pathology than white decedents (19.5% vs 42.0%), and were more likely to have AD mixed with an additional pathology (70.7% vs 50.6%), particularly Alzheimer pathology and Lewy bodies, and Alzheimer pathology, Lewy bodies, and infarcts. Black decedents also had more severe arteriolar sclerosis and atherosclerosis. CONCLUSION Black decedents with AD dementia are more likely to have mixed brain pathologies compared with age-, sex-, education-, and cognition-matched white decedents with AD dementia.
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Affiliation(s)
- Lisa L Barnes
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
| | - Sue Leurgans
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Neelum T Aggarwal
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Raj C Shah
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Zoe Arvanitakis
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Bryan D James
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
| | - Julie A Schneider
- From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL
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Russ TC, Parra MA, Lim AE, Law E, Connelly PJ, Starr JM. Prediction of general hospital admission in people with dementia: cohort study. Br J Psychiatry 2015; 206:153-9. [PMID: 25395686 DOI: 10.1192/bjp.bp.113.137166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with dementia are extremely vulnerable in hospital and unscheduled admissions should be avoided if possible. AIMS To identify any predictors of general hospital admission in people with dementia in a well-characterised national prospective cohort study. METHOD A cohort of 730 persons with dementia was drawn from the Scottish Dementia Research Interest Register (47.8% female; mean age 76.3 years, s.d. = 8.2, range 50-94), with a mean follow-up period of 1.2 years. RESULTS In the age- and gender-adjusted multivariable model (n = 681; 251 admitted), Neuropsychiatric Inventory score (hazard ratio per s.d. disadvantage 1.21, 95% CI 1.08-1.36) was identified as an independent predictor of admission to hospital. CONCLUSIONS Neuropsychiatric symptoms in dementia, measured using the Neuropsychiatric Inventory, predict non-psychiatric hospital admission of people with dementia. Further studies are merited to test whether interventions to reduce such symptoms might reduce unscheduled admissions to acute hospitals.
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Affiliation(s)
- Tom C Russ
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
| | - Mario A Parra
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
| | - Alison E Lim
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
| | - Emma Law
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
| | - Peter J Connelly
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
| | - John M Starr
- Tom C. Russ, PhD, MRCPsych, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, National Health Service (NHS) Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, and Division of Psychiatry, University of Edinburgh; Mario A. Parra, PhD, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK, and UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Alison E. Lim, Alzheimer Scotland Dementia Research Centre, University of Edinburgh; Emma Law, RMN, MPH, Peter J. Connelly, MD, FRCPsych, Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth; John M. Starr, PhD, FRCPEd, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, and Scottish Dementia Clinical Research Network, NHS Scotland, Murray Royal Hospital, Perth, and Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, UK
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Mitoku K, Shimanouchi S. The decision-making and communication capacities of older adults with dementia: a population-based study. Open Nurs J 2014; 8:17-24. [PMID: 25002912 PMCID: PMC4083186 DOI: 10.2174/1874434620140512001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 11/22/2022] Open
Abstract
The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being "always capable"; 41.3% were reported as being "sometimes capable"). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being "always capable"; 15.4% were reported as being "sometimes capable"). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.
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Affiliation(s)
- Kazuko Mitoku
- Department of Nursing, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Setsu Shimanouchi
- Faculty of Nursing, Hiroshima Bunkagakuen, Kure-city, Hiroshima, Japan
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