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Bollinger RM, Krauss MJ, Somerville EK, Holden BM, Blenden G, Hollingsworth H, Keleman AA, Carter A, McBride TD, Barker AR, Yan Y, Stark SL. Rehabilitation Transition Program to Improve Community Participation Among Stroke Survivors: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2437758. [PMID: 39374016 PMCID: PMC11581659 DOI: 10.1001/jamanetworkopen.2024.37758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/13/2024] [Indexed: 10/08/2024] Open
Abstract
Importance Interventions are needed to support the long-term needs of stroke survivors when they transition from inpatient rehabilitation to home, where they face new home and community environmental barriers. Objective To compare the efficacy of a novel, enhanced rehabilitation transition program with attentional control to improve community participation and activity of daily living (ADL) performance and to reduce environmental barriers in the home and community after stroke. Design, Setting, and Participants This phase 2b, parallel randomized clinical trial assessed patients 50 years or older who had experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in ADLs before stroke, and planned to be discharged home. Patients were assessed at an inpatient rehabilitation facility in St Louis, Missouri, and their homes from January 9, 2018, to December 20, 2023. Intervention Community Participation Transition after Stroke (COMPASS), including home modifications and strategy training. Main Outcomes and Measures The primary outcome was community participation (Reintegration to Normal Living Index). Secondary outcomes were daily activity performance (Stroke Impact Scale ADL domain and the In-Home Occupational Performance Evaluation [I-HOPE] activity, performance, and satisfaction scores) and environmental barriers in the home (I-HOPE environmental barriers score). Results A total of 185 participants (mean [SD] age, 66.3 [9.0] years; 105 [56.8%] male) were randomized (85 to the COMPASS group and 100 to the control group). The COMPASS and control participants experienced similar improvements in community participation by 12 months, with no significant group (mean difference, 0.3; 95% CI, -4.6 to 5.2; P = .91) or group × time interaction (between-group differences in changes over time, 1.3; 95% CI, -7.1 to 9.6; P = .76) effects. Improvements in I-HOPE performance and satisfaction scores were greater for COMPASS participants than control participants at 12 months (between-group differences in changes for performance: 0.39; 95% CI, 0.01-0.77; P = .046; satisfaction: 0.52; 95% CI, 0.08-0.96; P = .02). The COMPASS participants had greater improvements for I-HOPE environmental barriers than the control participants (P = .003 for interaction), with the largest differences at 6 months (between-group differences in changes: -15.3; 95% CI -24.4 to -6.2). Conclusions and Relevance In this randomized clinical trial of stroke survivors, participants in both groups experienced improvements in community participation. COMPASS participants had greater improvements in self-rated performance and satisfaction with performing daily activities as well as a greater reduction in environmental barriers than control participants. COMPASS reduced environmental barriers and improved performance of daily activities for stroke survivors as they transitioned from inpatient rehabilitation to home. Trial Registration ClinicalTrials.gov Identifier: NCT03485820.
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Affiliation(s)
- Rebecca M. Bollinger
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Melissa J. Krauss
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Emily K. Somerville
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Brianna M. Holden
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Gabrielle Blenden
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Holly Hollingsworth
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Audrey A. Keleman
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Alexandre Carter
- Division of Neurorehabilitation, Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Timothy D. McBride
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, Missouri
| | - Abigail R. Barker
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Susan L. Stark
- Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri
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Mun K, Kim J. Development of a Smart Home Modification Program: A Delphi Survey of Multidisciplinary Health Care Experts. Am J Occup Ther 2024; 78:7805205130. [PMID: 39101842 DOI: 10.5014/ajot.2024.050651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
IMPORTANCE There is a critical gap between the potential of smart home technologies to enhance the lives of people with physical disabilities (PwPD) and their limited use because of complex interfaces, high costs, technical issues, and insufficient institutional support. OBJECTIVE To bridge this gap and ensure that PwPD can fully benefit from smart home advancements to improve their daily living and quality of life by developing a smart home modification program. DESIGN A Delphi survey involving three rounds was conducted with experts in disability and smart home technologies. SETTING Online survey. PARTICIPANTS Thirty multidisciplinary health care experts. OUTCOMES AND MEASURES Experts rated the level of relevance in smart home modification with each survey. Consensus was set at ≥75%, content validity (CVR) was ≥.33, and convergence was ≤.5. RESULTS The first Delphi result selected 26 items, and the second included 59 items after adjusting for values that fell below a CVR of .33. In the third Delphi survey, 59 items were selected. The final Delphi study had an average CVR of .96 and a coefficient of variation of .10. The last survey's consensus point was .92, indicating a high level of agreement among participants. CONCLUSIONS AND RELEVANCE On the basis of expert consensus, the study provides a validated framework for smart home modifications to aid PwPD. Plain-Language Summary: This research highlights the role of smart home adaptations to promote responsible, independent living for people with physical disabilities. There is a critical gap between the potential of smart home technologies to improve the lives of people with physical disabilities and their limited use because of complex interfaces, high costs, technical issues, and insufficient institutional support. The study authors developed a smart home modification program with the goal of closing this gap and to ensure that people with physical disabilities can fully benefit from smart home advancements to improve their daily living and quality of life. Based on expert ratings, the study findings provide a validated framework that occupational therapists can use to recommend smart home modifications to help people with physical disabilities. The framework can also be used by occupational therapists to identify people who may need more extensive environmental modifications and interventions.
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Affiliation(s)
- Kwangtae Mun
- Kwangtae Mun, PhD, OT, is Researcher, Department of Occupational Therapy, University of Yonsei, Wonju, South Korea;
| | - Jongbae Kim
- Jongbae Kim, PhD, is Professor, Department of Occupational Therapy, University of Yonsei, Wonju, South Korea
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Suárez-González A, Savage SA, Alladi S, Amaral-Carvalho V, Arshad F, Camino J, Caramelli P, Comas-Herrera A, Cook J, Cooper C, García Díaz L, Grasso SM, Jokel R, Lavoie M, León T, Priya T, Ramos Franco T, Taylor-Rubin C, Townsend R, Thöne-Otto A, Slachevsky A, Volkmer A, Weidner W, O’Connor CMC. Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low-Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:790. [PMID: 38929036 PMCID: PMC11203756 DOI: 10.3390/ijerph21060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer's disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London (UCL), London WC1N 3BG, UK
| | - Sharon A Savage
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Viviane Amaral-Carvalho
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560030, India
| | - Julieta Camino
- Institute of Health and Social Care, London South Bank University, London SE1 0AA, UK
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TQ, UK
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AZ, UK
| | - Julia Cook
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester WR5 1JR, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Laura García Díaz
- School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Stephanie M. Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-1069, USA
| | - Regina Jokel
- Rotman Research Institute, Toronto, ON M6A 2X8, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille LEMAIRE, CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada;
| | - Tomás León
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Department of Psychiatry and Global Brain Health Institute, Trinity College, D02 K104 Dublin, Ireland
| | - Thomas Priya
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India;
| | - Teresita Ramos Franco
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
| | - Cathleen Taylor-Rubin
- Speech Pathology Department, War Memorial Hospital, Sydney, NSW 2024, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
- Max-Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Andrea Slachevsky
- Memory Unit, Neurology Department, Memory and Neuropsychiatric Center (CMYN), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago 7500922, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopatology Program—Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago 7500922, Chile
- Neurology and Psychiatry Department, Clínica Alemana-Universidad Desarrollo, Santiago 7650568, Chile
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London (UCL), London WC1H 0AP, UK
| | - Wendy Weidner
- Alzheimer’s Disease International, London SE1 4PU, UK
| | - Claire MC O’Connor
- Centre for Positive Ageing, HammondCare, Sydney, NSW 2170, Australia
- School of Psychology, Faculty of Sciences, University of New South Wales, Sydney, NSW 2052, Australia
- Neuroscience Research Australia, Sydney, NSW 2031, Australia
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Koh WQ, Heins P, Flynn A, Mahmoudi Asl A, Garcia L, Malinowsky C, Brorsson A. Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy. Disabil Rehabil Assist Technol 2024; 19:595-603. [PMID: 35972877 DOI: 10.1080/17483107.2022.2111610] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.
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Affiliation(s)
- Wei Qi Koh
- School of Nursing and Midwifery, College of Nursing, Medicine and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Pascale Heins
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Aysan Mahmoudi Asl
- Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | - Lesley Garcia
- Department of Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Camilla Malinowsky
- Department of Neurobiology, Care Sciences and Society (NVS), Huddinge, Sweden
| | - Anna Brorsson
- Department of Neurobiology, Care Sciences and Society (NVS), Huddinge, Sweden
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Shin JH, Shields R, Lee J, Skrove Z, Tredinnick R, Ponto K, Fields B. Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e52996. [PMID: 38466987 PMCID: PMC10980499 DOI: 10.2196/52996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/18/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. OBJECTIVE This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. METHODS mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps' effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. RESULTS A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the "good" quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app's functionality. CONCLUSIONS Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place.
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Affiliation(s)
- Jung-Hye Shin
- Department of Design Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Rachael Shields
- Department of Design Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jenny Lee
- Department of Design Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Zachary Skrove
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Ross Tredinnick
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, United States
| | - Kevin Ponto
- Department of Design Studies, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, United States
| | - Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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Poejo J, Gomes AI, Granjo P, Dos Reis Ferreira V. Resilience in patients and family caregivers living with congenital disorders of glycosylation (CDG): a quantitative study using the brief resilience coping scale (BRCS). Orphanet J Rare Dis 2024; 19:98. [PMID: 38439013 PMCID: PMC10913249 DOI: 10.1186/s13023-024-03043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Patients and family caregivers living with Congenital Disorders of Glycosylation (CDG) experience a heavy burden, which can impact their resiliency and quality of life. The study's purpose was to measure the resilience levels of patients and family caregivers living with CDG using the brief resilience coping scale. METHODS We conducted an observational, cross-sectional study with 23 patients and 151 family caregivers living with CDG. Descriptive analyses were performed to characterize patients with CDG and family caregivers' samples. Additionally, we assessed correlations between resilience and specific variables (e.g., age, academic degree, time until diagnosis) and examined resilience differences between groups (e.g., sex, marital status, occupation, professional and social support). RESULTS GNE myopathy was the most prevalent CDG among patients, while in family caregivers was PMM2-CDG. Both samples showed medium levels of resilience coping scores. Individuals with GNE myopathy had significantly higher scores of resilience compared to patients with other CDG. Resilience was positively correlated with educational degree in patients with CDG. Family caregivers had marginally significant higher scores of resilience coping if they received any kind of professional support or had contact with other families or people with the same or similar disease, compared with unsupported individuals. CONCLUSIONS Despite the inherited difficulties of living with a life-threatening disease like CDG, patients and family caregivers showed medium resilient coping levels. Resilience scores changed significantly considering the CDG genotype, individual's academic degree and professional and social support. These exploratory findings can empower the healthcare system and private institutions by promoting the development of targeted interventions to enhance individuals` coping skills and improve the overall well-being and mental health of the CDG community.
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Affiliation(s)
- Joana Poejo
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
| | - Ana Isabel Gomes
- Centro de Investigação Em Ciência Psicológica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisbon, Portugal
| | - Pedro Granjo
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
- UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Vanessa Dos Reis Ferreira
- CDG & Allies - Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Department of Life Sciences, School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal.
- UCIBIO - Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal.
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal.
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2819-516, Caparica, Portugal.
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Krauss MJ, Somerville E, Bollinger RM, Chen SW, Kehrer-Dunlap AL, Haxton M, Yan Y, Stark SL. Removing home hazards for older adults living in affordable housing: A stepped-wedge cluster-randomized trial. J Am Geriatr Soc 2024; 72:670-681. [PMID: 38103187 PMCID: PMC10947940 DOI: 10.1111/jgs.18706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Falls are the leading cause of injury, disability, premature institutionalization, and injury-related mortality among older adults. Home hazard removal can effectively reduce falls in this population but is not implemented as standard practice. This study translated an evidence-based home hazard removal program (HARP) for delivery in low-income senior apartments to test whether the intervention would work in the "real world." METHODS From May 1, 2019 to December 31, 2020, a stepped-wedge cluster-randomized trial was used to implement the evidence-based HARP among residents with high fall risk in 11 low-income senior apartment buildings. Five clusters of buildings were randomly assigned an intervention allocation sequence. Three-level negative-binomial models (repeated measures nested within individuals, individuals nested within buildings) were used to compare fall rates between treatment and control conditions (excluding a crossover period), controlling for demographic characteristics, fall risk, and time period. RESULTS Among 656 residents, 548 agreed to screening, 435 were eligible (high fall risk), and 291 agreed to participate and received HARP. Participants were, on average, 72 years, 67% female, and 76% Black. Approximately 95.4% of fall prevention strategies and modifications implemented were still used 3 months later. The fall rate (per 1000 participant-days) was 4.87 during the control period and 4.31 during the posttreatment period. After adjusting for covariates and secular trend, there was no significant difference in fall rate (incidence rate ratio [IRR] 0.97, 95% CI 0.66-1.42). After excluding data collected during a hiatus in the intervention due to COVID-19, the reduction in fall rate was not significant (IRR 0.93, 95% CI 0.62-1.40). CONCLUSIONS Although HARP did not significantly reduce the rate of falls, this pragmatic study showed that the program was feasible to deliver in low-income senior housing and was acceptable among residents. There was effective collaboration between researchers and community agency staff.
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Affiliation(s)
- Melissa J Krauss
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Szu-Wei Chen
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Abigail L Kehrer-Dunlap
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Meghan Haxton
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Kudlicka A, Martyr A, Bahar-Fuchs A, Sabates J, Woods B, Clare L. Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database Syst Rev 2023; 6:CD013388. [PMID: 37389428 PMCID: PMC10310315 DOI: 10.1002/14651858.cd013388.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Cognitive impairments affect functional ability in people with dementia. Cognitive rehabilitation (CR) is a personalised, solution-focused approach that aims to enable people with mild-to-moderate dementia to manage everyday activities and maintain as much independence as possible. OBJECTIVES To evaluate the effects of CR on everyday functioning and other outcomes for people with mild-to-moderate dementia, and on outcomes for care partners. To identify and explore factors that may be associated with the efficacy of CR. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group Specialised Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, and other clinical trial databases, and grey literature sources. The most recent search was completed on 19 October 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing CR with control conditions and reporting relevant outcomes for the person with dementia and/or the care partner. DATA COLLECTION AND ANALYSIS We extracted relevant data from published manuscripts and contacted trial authors if necessary. Within each of the comparisons, we pooled data for each outcome of interest and conducted inverse-variance, random-effects meta-analyses. We evaluated the certainty of the evidence using GRADEpro GDT. MAIN RESULTS We identified six eligible RCTs published in English between 2010 and 2022, which together included 1702 participants. The mean age of participants ranged from 76 to 80 and the proportion of male participants was between 29.4% and 79.3%. Most participants, in the studies where the type of dementia was reported, had a diagnosis of Alzheimer's disease (AD; n = 1002, 58.9% of the whole sample, 81.2% of the participants for whom the specific diagnosis was reported). Risk of bias in the individual studies was relatively low. The exception was a high risk of bias in relation to blinding of participants and practitioners, which is not usually feasible with psychosocial interventions. Our primary outcome of everyday functioning was operationalised in the included studies as goal attainment in relation to activities targeted in the intervention. For our main comparison of CR with usual care, we pooled data for goal attainment evaluated from three perspectives (self-rating of performance, informant rating of performance, and self-rating of satisfaction with performance) at end of treatment and at medium-term follow-up (3 to 12 months). We could also pool data at these time points for 20 and 19 secondary outcomes respectively. The review findings were strongly driven by one large, high-quality RCT. We found high-certainty evidence of large positive effects of CR on all three primary outcome perspectives at the end of treatment: participant self-ratings of goal attainment (standardised mean difference (SMD) 1.46, 95% confidence interval (CI) 1.26 to 1.66; I2 = 0%; 3 RCTs, 501 participants), informant ratings of goal attainment (SMD 1.61, 95% CI 1.01 to 2.21; I2 = 41%; 3 RCTs, 476 participants), and self-ratings of satisfaction with goal attainment (SMD 1.31, 95% CI 1.09 to 1.54; I2 = 5%; 3 RCTs, 501 participants), relative to an inactive control condition. At medium-term follow-up, we found high-certainty evidence showing a large positive effect of CR on all three primary outcome perspectives: participant self-ratings of goal attainment (SMD 1.46, 95% CI 1.25 to 1.68; I2 = 0%; 2 RCTs, 432 participants), informant ratings of goal attainment (SMD 1.25, 95% CI 0.78 to 1.72; I2 = 29%; 3 RCTs, 446 participants), and self-ratings of satisfaction with goal attainment (SMD 1.19, 95% CI 0.73 to 1.66; I2 = 28%; 2 RCTs, 432 participants), relative to an inactive control condition. For participants at the end of treatment we found high-certainty evidence showing a small positive effect of CR on self-efficacy (2 RCTs, 456 participants) and immediate recall (2 RCTs, 459 participants). For participants at medium-term follow-up we found moderate-certainty evidence showing a small positive effect of CR on auditory selective attention (2 RCTs, 386 participants), and a small negative effect on general functional ability (3 RCTs, 673 participants), and we found low-certainty evidence showing a small positive effect on sustained attention (2 RCTs, 413 participants), and a small negative effect on memory (2 RCTs, 51 participants) and anxiety (3 RCTs, 455 participants). We found moderate- and low-certainty evidence indicating that at the end of treatment CR had negligible effects on participant anxiety, quality of life, sustained attention, memory, delayed recall, and general functional ability, and at medium-term follow-up on participant self-efficacy, depression, quality of life, immediate recall, and verbal fluency. For care partners at the end of treatment we found low-certainty evidence showing a small positive effect on environmental aspects of quality of life (3 RCTs, 465 care partners), and small negative effects of CR on level of depression (2 RCTs, 32 care partners) and on psychological wellbeing (2 RCTs, 388 care partners). For care partners at medium-term follow-up we found high-certainty evidence showing a small positive effect of CR on social aspects of quality of life (3 RCTs, 436 care partners) and moderate-certainty evidence showing a small positive effect on psychological aspects of quality of life (3 RCTs, 437 care partners). We found moderate- and low-certainty evidence at the end of treatment that CR had negligible effects on care partners' physical health, psychological and social aspects of quality of life, and stress, and at medium-term follow-up for the physical health aspect of care partners' quality of life and psychological wellbeing. AUTHORS' CONCLUSIONS CR is helpful in enabling people with mild or moderate dementia to improve their ability to manage the everyday activities targeted in the intervention. Confidence in these findings could be strengthened if more high-quality studies contributed to the observed effects. The available evidence suggests that CR can form a valuable part of a clinical toolkit to assist people with dementia in overcoming some of the everyday barriers imposed by cognitive and functional difficulties. Future research, including process evaluation studies, could help identify avenues to maximise CR effects and achieve wider impacts on functional ability and wellbeing.
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Affiliation(s)
| | | | - Alex Bahar-Fuchs
- School of Psychology, Deakin University, Melbourne, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Julieta Sabates
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Linda Clare
- University of Exeter Medical School, Exeter, UK
- NIHR Applied Research Collaboration South West Peninsula, Exeter, UK
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Borgnis F, Borghesi F, Rossetto F, Pedroli E, Lavorgna L, Riva G, Baglio F, Cipresso P. Psychometric Calibration of a Tool Based on 360 Degree Videos for the Assessment of Executive Functions. J Clin Med 2023; 12:1645. [PMID: 36836179 PMCID: PMC9958906 DOI: 10.3390/jcm12041645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Over the last decades, interactive technologies appeared a promising solution in the ecological evaluation of executive functioning. We have developed the EXecutive-functions Innovative Tool 360° (EXIT 360°), a new instrument that exploits 360° technologies to provide an ecologically valid assessment of executive functioning. AIM This work wanted to evaluate the convergent validity of the EXIT 360°, comparing it with traditional neuropsychological tests (NPS) for executive functioning. METHODS Seventy-seven healthy subjects underwent an evaluation that involved: (1) a paper-and-pencil neuropsychological assessment, (2) an EXIT 360° session, involving seven subtasks delivered by VR headset, and (3) a usability assessment. To evaluate convergent validity, statistical correlation analyses were performed between NPS and EXIT 360° scores. RESULTS The data showed that participants had completed the whole task in about 8 min, with 88.3% obtaining a high total score (≥12). Regarding convergent validity, the data revealed a significant correlation between the EXIT 360° total score and all NPS. Furthermore, data showed a correlation between the EXIT 360° total reaction time and timed neuropsychological tests. Finally, the usability assessment showed a good score. CONCLUSION This work appears as a first validation step towards considering the EXIT 360° as a standardized instrument that uses 360° technologies to conduct an ecologically valid assessment of executive functioning. Further studies will be necessary to evaluate the effectiveness of the EXIT 360° in discriminating between healthy control subjects and patients with executive dysfunctions.
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Affiliation(s)
| | | | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Luigi Lavorgna
- Division of Neurology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Humane Technology Lab, Catholic University of the Sacred Heart, 20123 Milan, Italy
| | | | - Pietro Cipresso
- Department of Psychology, University of Turin, 10124 Turin, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
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Nakanishi K, Yamaga T, Ikeya M. Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15949. [PMID: 36498022 PMCID: PMC9738312 DOI: 10.3390/ijerph192315949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Persons with mild dementia can effectively maintain and improve their quality of life (QOL) by regularly performing their daily activities. However, research on activities of daily living (ADL) in this population often fails to distinguish between ADL performance and ADL capability, that is, actual independence in daily lives and potential independence in an ideal setting. This study aimed to identify the potential gaps between ADL performance and capability in individuals with mild dementia. A total of 137 community-dwelling older adults (aged ≥ 65 years) who had been diagnosed with dementia and assessed as 0.5 and 1 on a global clinical dementia rating (CDR). Participants were evaluated for basic ADL (BADL) and instrumental ADL (IADL) using the Hyogo Activities of Daily Living Scale (HADLS). Around 35 individuals who met the inclusion criteria were enrolled in the study. BADL performance and BADL capacity were not significantly different (p = 0.128); however, participants rated IADL capacity significantly higher than IADL performance (p < 0.01). Gaps between performance and capability were observed for IADL but not for BADL. This study distinguishes between ADL performance and capability in individuals with mild dementia and is the first to identify the IADL-specific gap between these two components; pertinent targeted interventions are vital in closing this gap. Environmental adjustments are important to improve QOL of persons with mild dementia.
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Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice. Am J Occup Ther 2022; 76:24009. [PMID: 36735994 DOI: 10.5014/ajot.2022.76s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This position statement describes the role and importance of occupational therapy practitioners in integrating inclusive environments into their professional services and into their underlying science. Primary documents that define the occupational therapy profession clearly support its role in creating and ensuring inclusive environments.
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Briskie-Semeniuk P, Bier N, Couture M, Vachon B, Belchior P. Describing Occupational Therapy Practice for Evaluating Older Adults with Cognitive Impairments. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2138676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Patricia Briskie-Semeniuk
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Nathalie Bier
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Quebec, Canada
| | - Mélanie Couture
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre for Research and Expertise in Social Gerontology (CREGRÉS), Côte Saint-Luc, Quebec, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montréal, Quebec, Canada
| | - Patricia Belchior
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Quebec, Canada
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Martínez-Campos A, Compañ-Gabucio LM, Torres-Collado L, Garcia-de la Hera M. Occupational Therapy Interventions for Dementia Caregivers: Scoping Review. Healthcare (Basel) 2022; 10:1764. [PMID: 36141376 PMCID: PMC9498417 DOI: 10.3390/healthcare10091764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE caregivers of people with dementia (PwD) often experience a significant caregiver burden. Occupational Therapy (OT) is a helpful discipline for improving quality of life and other health factors for these caregivers. We conducted a Scoping Review to describe OT interventions for caregivers of PwD. METHODS two authors searched PubMed, Scopus, EMBASE and Web of Science databases and OT journals indexed in the Journal Citation Reports. Terms included in the search strategy were: dementia, Alzheimer, Parkinson, caregivers and OT. We included articles with experimental design in which an OT intervention in caregivers of PwD was carried out, written in Spanish or English and with the full text available. RESULTS a total of 2121 articles were obtained, 31 of which were included; 22 of them described home-based OT interventions: Tailored Activity Program (TAP) (n = 5), Environmental Skill-Building Program (ESP) (n = 4) and Advancing Caregiver Training (ACT) (n = 3) and other household interventions (n = 10); the remaining studies described OT interventions in other settings (n = 9). CONCLUSIONS OT interventions for caregivers of PwD were mainly carried out at home. The most commonly used interventions were TAP focused on caregivers of people with Alzheimer's disease, aimed at lessening the burden, depression and stress experienced by caregivers.
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Affiliation(s)
- Alberto Martínez-Campos
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
| | - Laura Torres-Collado
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Manuela Garcia-de la Hera
- Unidad de Epidemiología de la Nutrición (EPINUT), Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, 03010 Alicante, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
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Jiménez S, Bueno B, Navarro AB. Do the caregiving spouses of people with dementia in Spain perceive the same barriers for taking part in interventions as caregiving offspring? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2385-e2394. [PMID: 34890481 DOI: 10.1111/hsc.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
The aim of this qualitative research is to examine the difficulties perceived by caregivers for taking part in an offered intervention, exploring whether there are differences depending on caregiver's degree of kinship. Forty-two family caregivers from Salamanca (Spain) were interviewed after declining an invitation to take part in an intervention programme. All the telephone conversations were transcribed verbatim. The transcriptions were subject to a thematic content analysis using QDA MINER software. The barriers identified were (1) difficulties adapting to the intervention's schedule due to a lack of time, or incompatibility with its dates or timetables, (2) belief among the caregivers that they do not need or are not interested in the support the intervention provides, (3) impossibility to separate from the family member to attend due to the absence of relief or a feeling of guilt, (4) caregiver's health issues, (5) difficulties with accessibility, and (6) belief that the therapies serve no useful purpose. Certain differences were identified depending on the caregiver's kinship. Understanding the difficulties caregivers face for taking part in the interventions will enable steps to be taken to remove and/or reduce such barriers, whereby more caregivers will benefit from interventions.
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Affiliation(s)
- Sara Jiménez
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
| | - Belén Bueno
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
| | - Ana B Navarro
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
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Fang S, Zhang S, Wang W, Li Y, Zhang X, Yu H, Sun J. Behavioural and psychological symptoms of early-onset and late-onset Alzheimer's disease among Chinese adults: analysis of modifiable factors. Psychogeriatrics 2022; 22:391-401. [PMID: 35345058 DOI: 10.1111/psyg.12829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To conduct a comprehensive comparison of behavioural and psychological symptoms of dementia (BPSD) in Chinese people with early-onset Alzheimer's disease (EOAD) and late-onset Alzheimer's disease (LOAD) and analyse the factors of differences. METHODS A cross-sectional survey of 93 EOAD and100 LOAD and their caregivers in China from November 2018 to May 2019. RESULTS The total Neuropsychiatric Inventory score was significantly higher in LOAD. A higher level of agitation in EOAD was related to a lower quality of life of caregivers and the emotional expression of ignoring people with dementia. Higher euphoria scores in LOAD were associated with reduced negative coping by caregivers and reduced stability and predictability at home. CONCLUSION The early identification and management of specific BPSD of EOAD and LOAD by family members and health professionals may improve the quality of care and life for people with dementia and that of caregivers.
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Affiliation(s)
- Shuyan Fang
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Wenxia Wang
- School of Nursing, Jilin University, Changchun, China
| | - Yijing Li
- School of Nursing, Jilin University, Changchun, China
| | - Xu Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Haisong Yu
- School of Nursing, Jilin University, Changchun, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, China
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Uccellatore L, Oliveira JAG, Riva G, Cipresso P. Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Front Psychol 2022; 13:833136. [PMID: 35478738 PMCID: PMC9036486 DOI: 10.3389/fpsyg.2022.833136] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life. Objective This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs. Methods We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function*.” Results and Conclusion We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Faculty of Psychology, eCampus University, Milan, Italy
| | | | - Lidia Uccellatore
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Pietro Cipresso
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Wang W, Lu Z. Influences of Physical Environmental Cues on People With Dementia: A Scoping Review. J Appl Gerontol 2022; 41:1209-1221. [PMID: 34689638 DOI: 10.1177/07334648211050376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physical environmental cues can provide important support to people with dementia (PwD). Compared to interventions involving construction, some cues can be achieved more easily, with less expense, and with fewer disruptions to PwD's daily lives. This review aims to examine existing empirical evidence about the impacts of cues on PwD's behaviors. We adopted the PRISMA scoping review approach and identified 32 articles. The results show visual cues have been frequently studied. The signage facilitates PwD's wayfinding. Concealed doors (e.g., concealing doorknobs) effectively prevent exit attempts. PwD also eat better with tableware of higher-contrasting colors or good lighting conditions. Clearer toilet signage results in better continence. Applying cues properly contributes to improving PwD's well-being and decreasing the burden for caregivers. However, knowledge gaps still exist in the impacts of other sensory cues (e.g., tactile, olfactory, and auditory), which require further research.
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Affiliation(s)
- Wenjin Wang
- Department of Architecture, 14736Texas A&M University, College Station, TX, USA
| | - Zhipeng Lu
- Department of Architecture, 14736Texas A&M University, College Station, TX, USA
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Røe C, Bautz-Holter E, Andelic N, Søberg HL, Nugraha B, Gutenbrunner C, Boekel A, Kirkevold M, Engen G, Lu J. Organization of rehabilitation services in randomized controlled trials - which factors influence functional outcome? A systematic review. Arch Rehabil Res Clin Transl 2022; 4:100197. [PMID: 35756983 PMCID: PMC9214333 DOI: 10.1016/j.arrct.2022.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions. Data Sources A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019. Study Selection In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0. Data Synthesis In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results. Conclusions Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.
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Affiliation(s)
- Cecilie Røe
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Corresponding author Cecilie Røe, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, P.O. Box 1089, Blidern, 0319 Oslo, Norway.
| | - Erik Bautz-Holter
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Helene Lundgaard Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | | | - Andrea Boekel
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Marit Kirkevold
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet University, Oslo, Norway
| | - Grace Engen
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia
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Nguyen H, Phan HT, Terry D, Doherty K, McInerney F. Impact of dementia literacy interventions for non-health-professionals: systematic review and meta-analysis. Aging Ment Health 2022; 26:442-456. [PMID: 33563025 DOI: 10.1080/13607863.2021.1884843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess evidence regarding the effects of interventions aimed at improving dementia literacy for different groups of non-health-professionals. METHODS A systematic search for relevant interventions was conducted using a range of online databases (e.g. CINAHL, Embase, Medline, ProQuest, and PsycINFO) and hand-searching of reference lists. Eligible interventions were identified based on predefined inclusion/exclusion criteria and methodological quality criteria. Meta analyses were performed using a random-effects model. RESULTS The final review included 14 interventions, which were either randomised controlled trials or non-randomised controlled trials. The interventions had varied contents, approaches, settings, and outcome measures. Evidence of improved dementia literacy in various aspects was found, and the intervention effects were strongest on knowledge of dementia. DISCUSSION There is evidence for the positive impact of dementia literacy interventions on different groups of non-health-professionals. Best practices in intervention contents, approaches, and outcome measures should be examined to guide future interventions.
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Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Daniel Terry
- Faculty of Health, Federation University, Ballarat, Australia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
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20
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Kwon MH, Kim SK. Effects of Client-Centered Occupational Therapy on Behavioral Psychological Symptoms, Social Interaction, Occupational Performance, Quality of Life, and Caregiver Burden among the Individuals with Dementia. Occup Ther Health Care 2022; 37:266-281. [PMID: 35192440 DOI: 10.1080/07380577.2022.2028330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to verify the effects of client-centered occupational therapy on individuals with dementia. Twenty participants were randomly assigned to an experimental group (client-centered occupational therapy) and a control group (general occupational therapy). A pretest, post-test, and follow-up tests were used to compare the effects of the intervention. The experimental group had significant changes in all variables, and the control group showed significant differences in verbal social interaction, quality of life, and burden of caregivers (p < 0.05). As a result of repeated measurement variance analysis, it was found that there was a significant effect within the group except for the NPI-Q distress items (p < 0.05), but the effect was not verified in all areas between the groups. Client-centered customized occupational therapy can be more effective than general occupational therapy in problem behavior, social interaction, quality of life, caregiver burden, and occupational performance of individuals with dementia.
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Affiliation(s)
- Mi-Hwa Kwon
- Department of Occupational Therapy, Dongnam Health College, Suwon, Republic of Korea
| | - Su-Kyoung Kim
- Department of Occupational Therapy, Konyang University, Daejeon, Republic of Korea
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21
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, El-Gilany AH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial. BMJ Open 2022; 12:e049741. [PMID: 35168963 PMCID: PMC8852666 DOI: 10.1136/bmjopen-2021-049741] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers' perceived needs and incorporated three evidence-based dimensions (psychoeducation, skill-building and peer support). DESIGN A prospective randomised control trial. SETTING A community-based study conducted in Egypt. PARTICIPANTS A total of 110 caregivers aged ≥18 years who cared for a survivor within 6 months of stroke, with modified Rankin Scale scores of 3-5, and without other physical disabilities or terminal illnesses were recruited between December 2019 and May 2020. Participants were assigned to the intervention group (IG; n=55) and control group (CG; n=55) through open-label, parallel 1:1 randomisation. INTERVENTION The IG was provided with tailored multidimensional interventions for 6 months until November 2020, including three home visits, six home-based telephone calls and one peer-support session. The CG received simple educational instructions at a single visit. OUTCOME The participants completed the Zarit Burden Interview (primary outcome) and the WHO Quality of Life-BREF (secondary outcome) before the intervention (T0), at 3 months (T1) and at 6 months (T2). RESULTS No differences were observed between the characteristics of the groups at baseline (T0). The independent t-test showed no significant differences in the care burden and Quality of Life (QoL) at T1 and T2 between the groups. The intervention had no significant effect on the outcomes between or within groups over time, as shown by the repeated-measures analysis of variance. However, the group and time interaction had significant main effects on caregivers' QoL (psychological and social domains). CONCLUSION The main results showed that participants in the IG did not experience an improvement in the main outcomes. Nevertheless, the improvement in the psychological and social domains may have been attributed to our intervention. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Nursing Department, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Egypt Ministry of Health and Population, Mansoura, Egypt
| | - Maha Hazem Khalil
- Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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22
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Yeni C, Yilmaz M. Nurse-led home modification interventions for community-dwelling older adults with dementia and their impact on falls prevention. Br J Community Nurs 2022; 27:78-88. [PMID: 35137618 DOI: 10.12968/bjcn.2022.27.2.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This quasi-experimental study aimed to investigate the effects of nurse-led home modification interventions on the family members of home-dwelling older adults with dementia. The sample consisted of 42 older adults diagnosed with dementia and their family members. A number of validated tools were used. Three home visits were undertaken, a training package with family members was instigated, and the patients were followed up for a 6-month period. It was determined that there was a decrease in falls in the first 3-month period (p=0.002). The number of falls in the second 3-month period was lower in the older adults who had their homes modified (p=0.000). Family-centred, nurse-led home-modification interventions can be effective in the prevention and reducing of falls in older adults with dementia.
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Affiliation(s)
- Cansu Yeni
- Associate Professor, Department of Public Health Nursing, Faculty of Health Sciences, İzmir Kâtip Çelebi University, Izmir, Turkey
| | - Medine Yilmaz
- Associate Professor, Department of Public Health Nursing, Faculty of Health Sciences, İzmir Kâtip Çelebi University, Izmir, Turkey
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Hwang NK, Shim SH. Use of Virtual Reality Technology to Support the Home Modification Process: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11096. [PMID: 34769616 PMCID: PMC8583645 DOI: 10.3390/ijerph182111096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
Healthcare is a field in which the benefits of virtual reality (VR), such as risk-taking without consequences, direct experience, and service outcome prediction, can be utilized. VR technology has been used to help clients face environmental barriers by implementing a home environment in virtual reality without a home visit by an expert. This scoping review was conducted to identify the areas and implementation methods of the home modification process supported by VR technology. Twelve studies met the research criteria. The following three types of tools supported by VR technology for the home modification process were identified: educational tools for clients or specialists, home environment measurement tools, and intermediaries for decision making and collaboration between clients and specialists. Most of the studies reported positive results regarding the usability and acceptability of the technology, but barriers have also been reported, such as technical problems, inappropriate population groups for technical use, cost-related issues, the need for training, and fear that the technology could replace home visits. Thus, VR technology has potential value in the home modification process. However, for future clinical applications, additional studies to maximize the benefits of these VR technologies and address the identified problems are required.
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Affiliation(s)
- Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul 02062, Korea;
| | - Sun-Hwa Shim
- Department of Occupational Therapy, College of Medical Science, Jeonju University, Jeonju 55101, Korea
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24
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Camino J, Kishita N, Trucco AP, Khondoker M, Mioshi E. A New and Tidier Setting: How Does Environmental Clutter Affect People With Dementia's Ability to Perform Activities of Daily Living? Alzheimer Dis Assoc Disord 2021; 35:335-341. [PMID: 34393190 DOI: 10.1097/wad.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between the physical environment and the person with dementia's (PwD) activities of daily living (ADLs) task performance is controversial. Although the general assumption is that this population benefits from their home environment when performing ADLs, very few experimental studies have been conducted to date. OBJECTIVES The aim was to investigate the influence of the environment (home vs. Research-lab) and the role of clutter on ADL performance. METHODS Sixty-five PwD were evaluated with a performance-based ADL assessment (at home and clutter-free Research-lab). Paired t tests compared ADL performance and level of clutter in both environments. Multiple regression analysis investigated factors associated with better ADL performance. RESULTS Overall, PwD performed better at home even though clutter was significantly lower in the Research-lab. When stratified by dementia stage, PwD in the moderate stage of the disease performed better at home. CONCLUSION Absence of clutter in the Research-Lab did not appear to play a beneficial role in ADLs. When stratified by dementia stage, only PwD in the moderate stage appeared to benefit from their home environment when performing ADL tasks. Future studies are required to elucidate the wider role of the environment in supporting engagement in daily activities in different dementia stages.
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Affiliation(s)
| | | | | | - Mizanur Khondoker
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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25
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Stark S, Keglovits M, Somerville E, Hu YL, Barker A, Sykora D, Yan Y. Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2122044. [PMID: 34463746 PMCID: PMC8408671 DOI: 10.1001/jamanetworkopen.2021.22044] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. OBJECTIVE To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. INTERVENTIONS The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. MAIN OUTCOMES AND MEASURES The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. RESULTS A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02392013.
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Affiliation(s)
- Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yi-Ling Hu
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Abigail Barker
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Dave Sykora
- St Louis Area Agency on Aging, St Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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26
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Stefanac S, Grabovac I, Andrews MR, Oppenauer C, Ramos R, Reichardt B, Stögmann E, Stamm T. Utilization of occupational therapy services and relation to survival in people taking dementia-specific medication in Austria-A retrospective population-based study with a 13-year observation period. Int J Geriatr Psychiatry 2021; 36:1179-1187. [PMID: 33565100 PMCID: PMC8359268 DOI: 10.1002/gps.5506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Evidence-based treatment of dementia includes pharmacological and non-pharmacological methods of which psycho-social interventions are an important component, commonly administered by occupational therapists. The aim of this study was to investigate the utilization of occupational therapy (OT) services and its association with survival in people taking dementia-specific medication in a population-based Austrian dataset compared to a two times as large control group without dementia-specific medication. METHODS/DESIGN A retrospective study with a 13-year observation period (2003-2016) was conducted on real-world data. Two stratifications were done and we used descriptive statistics, Chi-squared/Fisher's Exact Tests and survival analyses including three Cox models. RESULTS Data from 286,553 participants were analysed. Only 4.5% (n = 12,950) received OT services. In the dementia-medication group (n = 111,033), participants who received OT services (3.6%; n = 4032) had significantly more comorbidities (4.7%) compared to those without OT (3.5%; p < 0.001) and were also more likely to be male (4 vs. 3.5%; p < 0.001). While persons taking dementia-specific medication showed a slightly reduced survival with OT (p < 0.001) compared to those without, the result in the control group without dementia-specific medication showed a slightly better result of the participants who received OT (p < 0.001). The reduced survival in the dementia-medication group with OT is likely to be related to the higher number of comorbidities in this group. CONCLUSION People receiving dementia-specific medication were more likely to receive OT if they had additional comorbidities, however our analysis showed that utilization of OT services in Austria was very low indicating an overall insufficient accessibility of OT services for patients who needed it.
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Affiliation(s)
- Sinisa Stefanac
- Ludwig Boltzmann Institute for Arthritis and RehabilitationViennaAustria,Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Igor Grabovac
- Department of Social and Preventive MedicineCentre for Public HealthMedical University of ViennaViennaAustria
| | - Margaret R. Andrews
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Claudia Oppenauer
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Romualdo Ramos
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | | | | | - Tanja Stamm
- Institute of Outcomes ResearchCentre for Medical Statistic, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
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27
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Al Ghassani A, Rababa M. Factors Associated with Home Care Outcomes among Community-Dwelling Older Adult Patients with Dementia. Dement Geriatr Cogn Dis Extra 2021; 11:99-109. [PMID: 34178013 PMCID: PMC8215980 DOI: 10.1159/000516086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background With the increase in the proportion of people with dementia (PWD), it is necessary to address dementia-related issues among older adults who live at home; however, there is no integrative review on this issue. Objectives To describe and analyze quantitative and qualitative studies from primary sources in order to identify the factors which impact home care outcomes among PWD. Methods A computer search of PsycINFO, MEDLINE (PubMed), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed. This study was guided by Whittemore and Knafl's integrative review method. Results This review of the literature identified 3 main factors related to home care outcomes among PWD. These factors are environmental factors, caregiver-related factors, and social network factors. Conclusions Further research is required to investigate the impacts of multiple social and environmental factors on home care outcomes among PWD; which can eventually be used by nurses and family caregivers when providing care for older adult PWD.
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Affiliation(s)
- Amal Al Ghassani
- Department of Community and Mental Health, Oman College of Health Sciences, Muscat, Oman
| | - Mohammad Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Riva G, Cipresso P. A Simple and Effective Way to Study Executive Functions by Using 360° Videos. Front Neurosci 2021; 15:622095. [PMID: 33912001 PMCID: PMC8072005 DOI: 10.3389/fnins.2021.622095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Executive dysfunctions constitute a significant public health problem due to their high impact on everyday life and personal independence. Therefore, the identification of early strategies to assess and rehabilitate these impairments appears to be a priority. The ecological limitations of traditional neuropsychological tests and the numerous difficulties in administering tests in real-life scenarios have led to the increasing use of virtual reality (VR) and 360° environment-based tools for assessing executive functions (EFs) in real life. This perspective aims at proposing the development and implementation of Executive-functions Innovative Tool 360° (EXIT 360°), an innovative, enjoyable, and ecologically valid tool for a multidimensional and multicomponent evaluation of executive dysfunctions. EXIT 360° allows a complete and integrated executive functioning assessment through an original task for EFs delivered via a mobile-powered VR headset combined with eye tracker (ET) and electroencephalograms (EEG). Our tool is born as a 360°-based instrument, easily accessible and clinically usable, that will radically transform clinicians’ and patient’s assessment experience. In EXIT 360°, patients are engaged in a “game for health,” where they must perform everyday subtasks in 360° daily life environments. In this way, the clinicians can obtain quickly more ecologically valid information about several aspects of EFs (e.g., planning, problem-solving). Moreover, the multimodal approach allows completing the assessment of EFs by integrating verbal responses, reaction times, and physiological data (eye movements and brain activation). Overall, EXIT 360° will allow obtaining simultaneously and in real time more information about executive dysfunction and its impact in real life, allowing clinicians to tailor the rehabilitation to the subject’s needs.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Faculty of Psychology, eCampus University, Novedrate, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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Aging in Place with Age-Related Cognitive Changes: The Impact of Caregiving Support and Finances. SOCIETIES 2021. [DOI: 10.3390/soc11020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the United States, aging in place is a common concept that refers to older adults’ desire to remain in their homes as they age. However, this ability to age in place is a complex process that is not only impacted by the home’s accessibility or individual functional abilities. This paper aims to examine different factors, such as home environment and home modification, caregivers, finances, and other supports present in the participants’ lives, that impact older adults with age-related cognitive changes (ARCC) (in)ability to age in place. Qualitative interviews with older adults with ARCC (n = 5) and their caregivers (n = 5) were conducted. The participants’ experiences while aging in place indicate that finances and caregiving support greatly impacted their lives at home and ability to age in place. Personal finances dictated where some of the participants could age and the support, they could afford from home health aides. Additionally, informal and formal caregivers were an important source of support that aided in the older adults’ ability to remain home. As researchers, we need to continue to address personal finances and the support that the individual has in their lives to most effectively promote aging in place and their life at home.
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Baruah U, Varghese M, Loganathan S, Mehta KM, Gallagher-Thompson D, Zandi D, Dua T, Pot AM. Feasibility and preliminary effectiveness of an online training and support program for caregivers of people with dementia in India: a randomized controlled trial. Int J Geriatr Psychiatry 2021; 36:606-617. [PMID: 33491811 DOI: 10.1002/gps.5502] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Internet-based interventions involving elements of cognitive behavior therapy, psychoeducation, relaxation and skills training for caregivers of people with dementia have been found to be promising in Western countries. Given these outcomes, the adapted version of a multi-component online caregiver skills training and support program of the World Health Organization, called iSupport, was tested for feasibility and preliminary effectiveness in India. METHODS One hundred fifty-one caregivers of family members with a diagnosis of Alzheimer's disease or dementia were randomized to either the intervention arm (iSupport; n = 74) or to the control group (an education-only e-book program; n = 77). Participants were assessed using self-rated measures of depression and perceived burden, which were the primary outcome measures, at baseline and 3-month follow-up. Person-centered attitude, self-efficacy, mastery and self-rated health were also assessed. RESULTS Fifty-five caregivers (29 in the iSupport group and 26 in the control condition) completed the study. The recruitment and retention rate of the study were 44.67% and 36.42% respectively. No significant differences were found between the two groups at 3-month follow-up on the primary outcomes. Among the secondary outcomes, significant improvement was only seen in caregivers' person-centered attitude towards persons with dementia in the iSupport group (t = 2.228; p < 0.05). CONCLUSIONS Despite efforts to recruit and retain participants to the online program, this study had a low recruitment and retention rate, which require closer attention and indicates a need for further adaptations of the Indian version of the iSupport program to improve its acceptability and accessibility. The lessons learned from this study will guide the further development of caregiver training and support interventions in India. The trial was registered with the Clinical Trials Registry-India (Trial Registration No. CTRI/2017/02/007876).
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Affiliation(s)
- Upasana Baruah
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Santosh Loganathan
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Betty Irene Moore School of Nursing, University of California, Davis, California, USA
| | - Diana Zandi
- Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
| | - Anne Margriet Pot
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
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Wan Z, Dong W, Sun D, Ma D, Zhao Y, Li H, Sun J. Modifiable factors associated with behavioural and psychological symptoms of dementia among patients residing at home: The impacts of patient, caregiver and environmental variables. Geriatr Nurs 2021; 42:358-365. [PMID: 33556902 DOI: 10.1016/j.gerinurse.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
The present study aimed to explore the modifiable factors of behavioural and psychological symptoms of dementia (BPSD) among patients residing at home in terms of patient, caregiver and environmental factors. A cross-sectional survey of 193 patients with dementia residing at home and their caregivers who visited the memory clinic of the Department of Neurology in a tertiary (the highest level) hospital in China from November 2018 to May 2019 was performed. Exacerbated BPSD were associated with patient (old age, high education level, increased dementia severity, and the use of psychotropic drugs), caregiver (low positive aspects and high expressed emotion) and environmental (poor home environment) factors. The use of psychotropic drugs by the patient, positive aspects and expressed emotions of the caregiver, and home environment were modifiable factors that provided evidence for the direction of intervention for BPSD among patients residing at home.
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Affiliation(s)
- Zhenzhen Wan
- School of Nursing, Jilin University, Changchun, People's Republic of China; Nursing department, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Wanhui Dong
- Department of Neurology, Jilin University First Hospital, Changchun, People's Republic of China
| | - Dan Sun
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Dongfei Ma
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, People's Republic of China.
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Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041444. [PMID: 33557091 PMCID: PMC7913882 DOI: 10.3390/ijerph18041444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.
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Raj SE, Mackintosh S, Fryer C, Stanley M. Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review. Am J Occup Ther 2021; 75:7501205060p1-7501205060p27. [PMID: 33399054 DOI: 10.5014/ajot.2020.040782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. OBJECTIVE This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients' performance of daily occupations and reduced caregiving burden and improved caregivers' sense of competence. DATA SOURCES Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. STUDY SELECTION AND DATA COLLECTION Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. FINDINGS From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. CONCLUSIONS AND RELEVANCE Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers' sense of competence. Further research on leisure and home management occupations is warranted. WHAT THIS ARTICLE ADDS The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.
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Affiliation(s)
- Sujatha E Raj
- Sujatha E. Raj, BOT, MSc(OT), is PhD Candidate, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia;
| | - Shylie Mackintosh
- Shylie Mackintosh, PhD, MSc, BAppSc(Physio), is Associate Professor and Dean of Allied Health Programs, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Caroline Fryer
- Caroline Fryer, PhD, Grad Dip (Clin Epi), BAppSc(Physio), is Senior Lecturer, Physiotherapy Program, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- Mandy Stanley, PhD, MSc(OT), BAppSc(OT), is Associate Professor, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Ritter PL, Sheth K, Stewart AL, Gallagher-Thompson D, Lorig K. Development and Evaluation of the 8-item Caregiver Self-Efficacy Scale (CSES-8). THE GERONTOLOGIST 2020; 62:e140-e149. [PMID: 33146727 DOI: 10.1093/geront/gnaa174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This paper describes the development and evaluation of a short caregiving self-efficacy measure. The self-administered 8-item Caregiver Self-efficacy Scale (CSES-8) was developed to reflect components of typical caregiver-support interventions and to be practical for inclusion in future self-efficacy and caregiving research. RESEARCH DESIGN AND METHODS We administered the CSES-8 in two samples: participants in an intervention for caregivers of persons with cognitive disabilities, and a voluntary on-line survey for caregivers of adults. We evaluated the completion rate, item-scale correlations, reliability, descriptive statistics, and preliminary construct validity of the CSES-8 in both samples, and sensitivity to change in the intervention sample. RESULTS The intervention caregivers' sample (N=158) was 85% female (mean age=65 years). The on-line survey sample (N=138) was 90% female (mean age=78). In both samples, the CSES-8 had excellent internal-consistency reliability (0.89 and 0.88) and good distribution with sufficient variability to detect change. Test-retest reliability was good in the on-line sample (0.73). As evidence of construct validity, most hypotheses were confirmed in both samples. The CSES-8 was sensitive to change at 6 months for caregivers in the intervention program (p < .001). DISCUSSION AND IMPLICATIONS The CSES-8 is short, comprehensive with respect to common components of interventions to improve caregivers' quality of life, and sensitive to change. It can serve a useful role exploring mechanisms by which caregiver intervention studies work, and it can be helpful in examining whether self-efficacy mediates the effect of these intervention on various outcomes such as psychological well-being.
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Affiliation(s)
- Philip L Ritter
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Khushboo Sheth
- VA Palo Alto Healthcare System, Palo Alto, VA, Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Anita L Stewart
- Institute for Health and Aging, Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA
| | | | - Kate Lorig
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
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36
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Quinn C, Nelis SM, Martyr A, Morris RG, Victor C, Clare L. Caregiver influences on 'living well' for people with dementia: Findings from the IDEAL study. Aging Ment Health 2020; 24:1505-1513. [PMID: 31104475 DOI: 10.1080/13607863.2019.1602590] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: The capability to 'live well' in people with dementia can be influenced by many factors, including those related to the experiences of their informal caregiver. How caregivers experience their own role can affect not only their well-being but also the way they provide care and hence the experience of the person with dementia. The aim of this study is to identify the potential impact of the caregiver's perception of the caregiving experience on how people with mild to moderate dementia self-rate their QoL, well-being and satisfaction with life.Method: This study utilised time-point 1 data from 1283 informal caregiver and the 1283 people with dementia whom they provide care from the IDEAL cohort study. Multivariate modelling was used to investigate the associations between measures related to the caregiver's perception of the caregiving experience (caregiving stress, perceived social restrictions, caregiving competence, positive aspects of caregiving, and coping) and the self-ratings of QoL, satisfaction with life, and well-being by the person with dementia.Results: Lower QoL ratings by the person with dementia were associated with high caregiver stress (-1.98; 95% CI: -2.89, -1.07), high perceived social restrictions (-2.04; 95% CI: -2.94, -1.14) and low caregiving competence (-2.01; 95% CI: -2.95, -1.06). Similar associations were found for satisfaction with life and wellbeing. Positive aspects of caregiving and coping were not associated with outcomes for the person with dementia.Conclusion: The findings indicate that how the caregiver experiences caregiving can affect the person with dementia. This finding reinforces the importance of providing support to caregivers.
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Affiliation(s)
- Catherine Quinn
- Centre of Applied Dementia Studies, University of Bradford, Bradford, UK.,REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
| | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, Exeter, UK
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Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. Am J Occup Ther 2020; 74:7412410010p1-7412410010p87. [DOI: 10.5014/ajot.2020.74s2001] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The fourth edition of the Occupational Therapy Practice Framework: Domain and Process (hereinafter referred to as the OTPF–4), is an official document of the American Occupational Therapy Association (AOTA). Intended for occupational therapy practitioners and students, other health care professionals, educators, researchers, payers, policymakers, and consumers, the OTPF–4 presents a summary of interrelated constructs that describe occupational therapy practice.
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Rathnayake S, Moyle W, Jones C, Calleja P. Co-design of an mHealth application for family caregivers of people with dementia to address functional disability care needs. Inform Health Soc Care 2020; 46:1-17. [DOI: 10.1080/17538157.2020.1793347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarath Rathnayake
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Nursing, University of Peradeniya, Kandy, Sri Lanka
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Pauline Calleja
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Rathnayake S, Moyle W, Jones C, Calleja P. Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vollmer Dahlke D, Ory MG. Emerging Issues of Intelligent Assistive Technology Use Among People With Dementia and Their Caregivers: A U.S. Perspective. Front Public Health 2020; 8:191. [PMID: 32528920 PMCID: PMC7254691 DOI: 10.3389/fpubh.2020.00191] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
The increasing number of older adults with cognitive deficits, including dementia, poses a major challenge for public health in the United States. At the same time, the limited number of informal and professional caregivers available to support this rapidly growing population is of mounting concern. Not only does population aging limit the number of potential caregivers, but extant caregivers often lack skills to provide quality care. The integration of intelligent assistive technologies (IAT), including devices, robotics and sensors in many forms, into eldercare, may offer opportunities to reduce caregiver burden and enhance healthcare services while improving the quality of life among older adults with mild to severe cognitive deficits. However, many caregivers and their care recipients lack access to these technologies. The reasons for this reduced access are multifactorial, including the digital divide, sociocultural factors, and technological literacy. This mini review investigates the emerging use of IAT available to caregivers and older adults with cognitive deficits and explores the challenges in socioeconomic status and technological literacy as well as ethical and legal implications that should be considered in the design and development of IAT for older adults with cognitive deficits. Drawing from existing literature, it will suggest frameworks for design and adoption aimed at increased and equitable access for this vulnerable population.
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Affiliation(s)
- Deborah Vollmer Dahlke
- DVD Associates LLC, Austin, TX, United States.,TX A&M Center for Population Health and Aging, College Station, TX, United States
| | - Marcia G Ory
- TX A&M Center for Population Health and Aging, College Station, TX, United States
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Keglovits M, Stark S. Home Modifications to Improve Function and Safety in the United States. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1743510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Aplin T, Hoyle M, Fiechtner E, Bailey A, Ainsworth E. Home Modification Service Delivery in Australia. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1743512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tammy Aplin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Melanie Hoyle
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Emma Fiechtner
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Adelle Bailey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Behavioral Interventions for Alzheimer’s Management Using Technology: Home-Based Monitoring. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00312-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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44
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Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:764-785. [PMID: 32096857 DOI: 10.1001/jama.2019.22258] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. STUDY SELECTION Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. MAIN OUTCOMES AND MEASURES Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. RESULTS The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. CONCLUSIONS AND RELEVANCE Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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45
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Raj S, Stanley M, Mackintosh S, Fryer C. Scope of occupational therapy practice for adults with both Down syndrome and dementia: A cross-sectional survey. Aust Occup Ther J 2020; 67:218-228. [PMID: 31984512 DOI: 10.1111/1440-1630.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Dementia in adults with Down syndrome causes a progressive decline in daily occupations impacting both persons with Down syndrome and their informal caregivers. This study aimed to explore the scope of occupational therapy practice for adults with both Down syndrome and dementia and their informal caregivers living in their homes. METHODS A survey was conducted with occupational therapists having clinical experience in providing interventions for adults with Down syndrome. A web-based survey was developed to explore occupational therapy practice for this group of people with Down syndrome and their informal caregivers. Responses to closed-ended questions were analysed descriptively, and inductive content analysis was used for open-ended questions. RESULTS Forty-three occupational therapists from Australia, Canada, United Kingdom and the United States of America participated in the survey. Two-thirds were from the United Kingdom, most of whom were employed in the public sector and had at least 10 years of clinical experience. Over 90% of respondents received one or more referrals in a typical month for adults with Down syndrome having dementia, 68% of which were for a decline in activities of daily living. Home environment and activities of daily living were frequently assessed areas, and the commonest interventions were compensatory strategies and environmental modifications. Only half the respondents provided interventions for informal caregivers. Risk and safety and manual handling were frequently addressed domains for informal caregivers. Collaboration and developing clinical expertise were the two key perceived enablers for providing effective occupational therapy services. Fragmentation of services and a lack of client-centred care were the common perceived barriers. CONCLUSION Occupational therapists often address decline in activities of daily living for individuals with both Down syndrome and dementia. To support participation in meaningful occupations for these people and support the needs of their informal caregivers, it is essential that services are offered in a collaborative approach.
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Affiliation(s)
- Sujatha Raj
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Mandy Stanley
- Occupational Therapy, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Shylie Mackintosh
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Caroline Fryer
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
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46
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Fu H, Xu Z, Zhang XL, Zheng GQ. Kaixinsan, a Well-Known Chinese Herbal Prescription, for Alzheimer's Disease and Depression: A Preclinical Systematic Review. Front Neurosci 2020; 13:1421. [PMID: 32009890 PMCID: PMC6971218 DOI: 10.3389/fnins.2019.01421] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/16/2019] [Indexed: 01/30/2023] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia, is highly prevalent worldwide with no modifying therapy. Behavioral and psychological symptoms of dementia (BPSD) occur in most patients with AD, and depression is one of the most common AD-related BPSD. Kaixinsan (KXS) is an ancient Chinese herbal prescription widely used to treat dementia and forgetfulness. In this systematic review, we conducted a meta-analysis to assess preclinical evidence for the effects of KXS on cognitive impairment and depression. Thirty-eight articles involving 1,050 animals were included after searching from six databases from the inception up to June 2019. The primary outcome measures were behavioral outcome. Indicators of cognitive function in AD included escape latency, time spent on the target quadrant, and the number of target platform crossings in the Morris water maze (MWM) test. Indicators of depression included number of rearing events and total distance in the open-field test, duration of immobility in the forced swim test, and sucrose consumption or sucrose preference index in the sucrose preference test. The secondary outcomes were mechanisms of KXS for treatment of AD and depression. The results showed that KXS significantly reduced escape latency (P < 0.01), increased time spent in the target quadrant (P < 0.01), and increased the number of target platform crossings (P < 0.01) in the MWM test in AD models compared with control. The possible mechanisms for KXS-mediated improvements in cognitive function were antioxidant activity, anti-inflammatory activity, antiapoptotic activity, neuroprotection, and synapse protection. In addition, the results demonstrated that KXS significantly increased the number of rearing instances (P < 0.01) in the open-field test, decreased the duration of immobility (P < 0.01) in forced swim test, and increased sucrose consumption or sucrose preference index (P < 0.01) in the sucrose preference test in depression models compared with control. The mechanisms of KXS-mediated anti-depressive effects were HPA axis regulation, antioxidant activity, anti-inflammatory activity, synapse protection, and neuroprotection. The results of this study suggested that KXS can be used to effectively treat AD and depression through multiple mechanisms, extrapolating the therapeutic potential of KXS for treating AD-related BPSD.
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Affiliation(s)
| | | | | | - Guo-qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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47
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Simonetti A, Pais C, Jones M, Cipriani MC, Janiri D, Monti L, Landi F, Bernabei R, Liperoti R, Sani G. Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions. Front Psychiatry 2020; 11:579842. [PMID: 33132939 PMCID: PMC7550649 DOI: 10.3389/fpsyt.2020.579842] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) of dementia, such as anxiety, depression, agitation, and apathy, are complex, stressful, and costly aspects of care, and are associated to poor health outcomes and caregiver burden. A steep worsening of such symptoms has been reported during Coronavirus Disease 2019 (COVID-19) pandemic. However, their causes, their impact on everyday life, and treatment strategies have not been systematically assessed. Therefore, the aim of this review is to provide a detailed description of behavioral and psychopathological alterations in subjects with dementia during COVID-19 pandemic and the associated management challenges. METHODS A PubMed search was performed focusing on studies reporting alterations in behavior and mood and treatment strategies for elderly patients with dementia, in accordance with PRISMA guidelines. The following search strategy was utilized: (COVID* OR coronavirus OR "corona vir*" OR SARS-CoV-2) AND (dementia OR demented OR dement* OR alzheimer* OR "pick's disease" OR "lewy body" OR "mild cognitive" OR mild cognitive impairment OR MCI). RESULTS Apathy, anxiety and agitation are the most frequently NPS during the COVID-19 pandemic and are mainly triggered by protracted isolation. Most treatment strategies rely on pharmacotherapy; technology is increasingly utilized with mixed results. CONCLUSIONS NPS of dementia during COVID-19 appear to arise from social restrictions occurring as a consequence of the pandemic. Implementation of caregiver support and the presence of skilled nursing home staff are required to restore social interaction and adjust technological support to the patients' needs.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Cristina Pais
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Melissa Jones
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Delfina Janiri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy.,Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Laura Monti
- Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Rosa Liperoti
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriele Sani
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Neuroscience, Section of Psychiatry, Catholic University of Sacred Heart, Rome, Italy
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48
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de Wit J, Beelen A, van den Heerik MS, van den Berg LH, Visser-Meily JMA, Schröder CD. Psychological distress in partners of patients with amyotrophic lateral sclerosis and progressive muscular atrophy: what's the role of care demands and perceived control? PSYCHOL HEALTH MED 2019; 25:319-330. [PMID: 31747791 DOI: 10.1080/13548506.2019.1686646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Caregivers of Amyotrophic Lateral Sclerosis (ALS) and Progressive Muscular Atrophy (PMA) patients often experience psychological distress. Yet, it is unclear which factors explain the variance in psychological distress. This study seeks to evaluate how care demands and perceived control over caregiving influence psychological distress using moderation and mediation analysis. Data were collected as part of a RCT and 148 partners of patients with ALS or PMA were included. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Care demands were operationalized as physical functioning (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised) and behavioural changes of the patient (Amyotrophic Lateral Sclerosis-Frontotemporal Dementia-Questionnaire). Perceived control over caregiving was assessed using items adapted from the Job Content Questionnaire. Results showed that more behavioural changes and lower perceived control over caregiving were associated with higher levels of psychological distress in caregivers. Patients' physical functioning was not significantly related to caregivers' psychological distress. No moderation or mediation effects were found of perceived control over caregiving on the relationship between demand and psychological distress. Monitoring, psychoeducation and caregiver support with regard to behavioural changes in patients, seem to be important for the wellbeing of caregivers. Caregivers' perceived control might be a target for future interventions.
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Affiliation(s)
- Jessica de Wit
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Anita Beelen
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Marc S van den Heerik
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carin D Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Bennett S, Laver K, Voigt-Radloff S, Letts L, Clemson L, Graff M, Wiseman J, Gitlin L. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open 2019; 9:e026308. [PMID: 31719067 PMCID: PMC6858232 DOI: 10.1136/bmjopen-2018-026308] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL. DESIGN Systematic review and meta-analysis. METHODS Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data. RESULTS Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD -0.32, 95% CI -0.57 to -0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD -0.33, 95% CI -0.58 to -0.07); had less distress with behaviours (SMD -0.23, 95% CI -0.42 to -0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality. CONCLUSIONS Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy. PROSPERO REGISTRATION NUMBER CRD42011001166.
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Affiliation(s)
- Sally Bennett
- School of Health and Rehabilitation Sciences, The University Queensland, Brisbane, Queensland, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Center for Geriatric Medicine and Gerontology, University of Freiburg, Germany
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lindy Clemson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maud Graff
- IQ Healthcare & Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
| | - Jodie Wiseman
- Centre for Children's Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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50
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Trivedi DP, Braun A, Dickinson A, Gage H, Hamilton L, Goodman C, Ashaye K, Iliffe S, Manthorpe J. Managing behavioural and psychological symptoms in community dwelling older people with dementia: 1. A systematic review of the effectiveness of interventions. DEMENTIA 2019; 18:2925-2949. [PMID: 29557183 DOI: 10.1177/1471301218762851] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Kunle Ashaye
- Hertfordshire Partnership University NHS Foundation Trust, UK
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