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McCartney A, Crosswell J, Rafnsson SB, Hoe J. The effectiveness of structured physical activity on agitation in people with dementia: a rapid review. Aging Ment Health 2024:1-11. [PMID: 38683159 DOI: 10.1080/13607863.2024.2345129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Managing agitation and other behaviours that challenge is a significant dementia care challenge. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects. This review evaluates the effectiveness of structured physical activity on agitation in dementia. METHOD Our rapid review searched four electronic databases, Cochrane CENTRAL, MEDLINE, CINAHL and Embase, for interventional studies using a structured physical activity programme in people with dementia and studied the effect of this activity on behaviours that challenge. Study quality was assessed using CASP criteria and data was narratively synthesised. RESULTS We included 13 studies in this review (four rated as high quality), involving a total of 1546 participants. Results were analysed according to exercise type, frequency and intensity of the intervention. Exercise is effective in reducing agitation and studies with higher adherence to exercise demonstrated more positive effects on agitation and behaviours that challenge. CONCLUSION Physical activity can be effective in reducing agitation in older adults with dementia. Further research is needed to clarify the type of intervention that is most beneficial. Strategies to make physical activity more acceptable and available to people with dementia need to be established.
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Affiliation(s)
- A McCartney
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - J Crosswell
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - S B Rafnsson
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
| | - J Hoe
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
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Wiese LK, Pratt BA, Heinze K, Besser L, Ifill A(A, Williams CL. Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults. CURRENT GERIATRICS REPORTS 2023; 12:205-219. [PMID: 38223294 PMCID: PMC10783445 DOI: 10.1007/s13670-023-00400-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 01/16/2024]
Abstract
Purpose of Review The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered. Recent Findings More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health. Summary Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Beth A. Pratt
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Katherine Heinze
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
| | - Lilah Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - Antoinita (Annie) Ifill
- Palm Health Foundation/Community Partners of South Florida, 491 E. Main Street Suite 5A, Pahokee FL 33476, USA
| | - Christine L. Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton FL 33431, USA
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Wang YY, Wang XX, Chen L, Liu Y, Li YR. A systematic review and network meta-analysis comparing various non-pharmacological treatments for older people with mild cognitive impairment. Asian J Psychiatr 2023; 86:103635. [PMID: 37270875 DOI: 10.1016/j.ajp.2023.103635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-pharmacological therapy appeared to alleviate Mild Cognitive Impairment (MCI) symptoms and signs, according to systematic studies. This network meta-analysis aimed to assess the impact of non-pharmacological therapies on improving cognition in individuals with MCI and identified the most effective intervention. METHODS We reviewed six databases in search of potentially relevant studies of non-pharmacological therapies such as Physical exercise (PE), Multidisciplinary intervention (MI), Musical therapy (MT), Cognitive training (CT), Cognitive stimulation (CS), Cognitive rehabilitation (CR),Art therapy (AT), general psychotherapy or interpersonal therapy (IPT), and Traditional Chinese Medicine (TCM) (such as acupuncture therapy, massage, auricular-plaster and other related systems) and others. Excluded the literature such as missing full text, missing search results, or no reporting specific values and combined with the inclusion criteria and exclusion criteria in this article, the literature ultimately included in the analysis addressed the following seven non-drug therapies PE, MI, MT, CT, CS, CR, AT. Mini-mental state evaluation paired meta-analyses were undertaken by taking weighted average mean differences with confidence intervals (CI) of 95%. The network meta-analysis was conducted to compare various therapies. RESULTS A total of 39 randomized controlled trials, including two three-arm studies, with 3157 participants were included. PE was most likely to be the most effective intervention to slow down the cognitive ability of patients (SMD = 1.34, 95%CI: 0.80, 1.89). CS and CR had no significant effect on cognitive ability. CONCLUSIONS The non-pharmacological therapy had the potential to greatly promote the cognitive ability of the adult population with MCI. PE had the best chance of being the best non-pharmacological therapy. Due to the limited sample size, substantial variability among different study designs, and the potential for bias, the results should be regarded with caution. Our findings should be confirmed by future multi-center randomized controlled, high-quality large-scale studies.
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Affiliation(s)
- Yuan-Yuan Wang
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China.
| | - Xiao-Xian Wang
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Lei Chen
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Yan Liu
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Ya-Ru Li
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
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Bennett J, Wolverson E, Price E. Me, myself, and nature: living with dementia and connecting with the natural world - more than a breath of fresh air? A literature review. DEMENTIA 2022; 21:2351-2376. [PMID: 35939420 DOI: 10.1177/14713012221117896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Despite growing awareness of the importance of engagement with the natural world for people living with dementia, little is known about the impact specifically for people living independently in their own home. This review identifies, analyses and synthesises existing research, incorporating first-person narrative accounts of the benefits and potential challenges experienced in forging meaningful connections with the natural world. METHODS Six databases were searched from February 2000 to February 2021. Relevant organisations and authors were contacted, and a hand search of included study reference lists was conducted. The findings of included studies were synthesised using a thematic analysis approach. FINDINGS Sixteen studies were included: 13 qualitative and three mixed methods. Eight themes and three sub-themes were identified, revealing how contact with the natural world held a significance for people living with dementia, associated with a sense of pleasure, comfort, stimulation, freedom and meaning. Support and the use of adaptive strategies afforded opportunities for continued engagement with meaningful outdoor activities and the promotion of identity, independence, social interaction, enhanced wellbeing and quality of life for people living independently with dementia. CONCLUSION Meaningful connections with the natural world offer far more than a 'breath of fresh air'. When support mechanisms are in place, engaging with the natural world can be a valuable arena for enablement and continuity, providing a sense of connectedness to self, place and others.
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Affiliation(s)
| | - Emma Wolverson
- University of Hull and Humber Teaching NHS Foundation Trust, Hull, UK
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Warren A. Behavioral and Psychological Symptoms of Dementia as a Means of Communication: Considerations for Reducing Stigma and Promoting Person-Centered Care. Front Psychol 2022; 13:875246. [PMID: 35422728 PMCID: PMC9002111 DOI: 10.3389/fpsyg.2022.875246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia has rapidly become a major global health crisis. As the aging population continues to increase, the burden increases commensurately on both individual and societal levels. The behavioral and psychological symptoms of dementia (BPSD) are a prominent clinical feature of Alzheimer’s disease and related dementias (ADRD). BPSD represent a myriad of manifestations that can create significant challenges for persons living with dementia and their care providers. As such, BPSD can result in detriments to social interaction with others, resulting in harm to the psychosocial health of the person with dementia. While brain deterioration can contribute to BPSD as the disease progresses, it may be confounded by language and communication difficulties associated with ADRD. Indeed, when a person with dementia cannot effectively communicate their needs, including basic needs such as hunger or toileting, nor symptoms of pain or discomfort, it may manifest as BPSD. In this way, a person with dementia may be attempting to communicate with what little resources are available to them in the form of emotional expression. Failing to recognize unmet needs compromises care and can reduce quality of life. Moreover, failing to fulfill said needs can also deteriorate communication and social bonds with loved ones and caregivers. The aim of this review is to bring the differential of unmet needs to the forefront of BPSD interpretation for both formal and informal caregivers. The overarching goal is to provide evidence to reframe the approach with which caregivers view the manifestations of BPSD to ensure quality of care for persons with dementia. Understanding that BPSD may, in fact, be attempts to communicate unmet needs in persons with dementia may facilitate clinical care decisions, promote quality of life, reduce stigma, and foster positive communications.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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The COVID-19 pandemic as experienced by the spouses of home-dwelling people with dementia - a qualitative study. BMC Geriatr 2021; 21:583. [PMID: 34670496 PMCID: PMC8527970 DOI: 10.1186/s12877-021-02551-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Worldwide, restrictive measures have been taken to manage the spread of the COVID-19 pandemic. Social distancing and self-isolation have considerably affected the lives of people with dementia and their informal caregivers. The purpose of the study was to explore the consequences of the COVID-19 pandemic as experienced by the spouses of home-dwelling people with dementia in Norway. METHODS The study had a qualitative descriptive design using individual telephone interviews for data collection. A total sample of 17 spouses of people with dementia were included, 14 women and three men ages 52 to 82 years. A qualitative content analysis following six steps inspired by Graneheim and Lundman was used to identify the categories presented. RESULTS The participants emphasized four main perspectives: 1) Radical changes in available services, 2) Restrictions changed everyday life, 3) Impacts on health and well-being, and 4) Actions that made life easier. The participants also described how positive activities and easily accessible services helped them in this situation. CONCLUSIONS The governmental restrictions of the COVID-19 pandemic resulted in radical changes in available services with severe consequences for the lives and well-being of home-dwelling people with dementia and their spouses. Examples of coping strategies and possible psychosocial interventions compatible with virus precautions were identified. The potential of such interventions should be further explored to meet the needs of vulnerable groups in situations like a pandemic.
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Müller B, Kropp P, Cardona MI, Michalowsky B, van den Berg N, Teipel S, Hoffmann W, Thyrian JR. Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia. BMC Geriatr 2021; 21:270. [PMID: 33892624 PMCID: PMC8063325 DOI: 10.1186/s12877-021-02201-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA. Methods Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes. Results Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ2(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02). Conclusions Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia. Trial registration ClinicalTrial.gov Identifier NCT01401582. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02201-1.
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Affiliation(s)
- Britta Müller
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany.
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Gehlsheimer Str. 20 Rostock, 18147, Rostock, Germany
| | | | | | - Nanja van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic and Psychotherapeutic Medicine, University Medicine Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Casey D, Gallagher N, Devane D, Woods B, Murphy K, Smyth S, Newell J, Murphy AW, Clarke C, Foley T, Timmons F, Dröes RM, O’Halloran M, Windle G, Irving Lupton K, Domegan C, O’Shea E, Dolan P, Doyle P. The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study. Pilot Feasibility Stud 2020; 6:177. [PMID: 33292667 PMCID: PMC7667740 DOI: 10.1186/s40814-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community. METHODS This is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery. CONCLUSION This feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility. TRIAL REGISTRATION ISRCTN25294519 Retrospectively registered 07.10.2019.
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Affiliation(s)
- Dympna Casey
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Niamh Gallagher
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, Wales
| | - Kathy Murphy
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Siobhán Smyth
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Fergus Timmons
- The Alzheimer Society of Ireland, Temple Road, Blackrock, Co. Dublin Ireland
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Center, A.J. Ernststraat 1187 (kamer D0.03), Amsterdam, The Netherlands
| | - Martin O’Halloran
- College of Engineering & Informatics, National University of Ireland Galway, Galway, Ireland
| | - Gill Windle
- School of Health Sciences, Bangor University, Bangor, Wales
| | - Kate Irving Lupton
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Christine Domegan
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Eamon O’Shea
- Centre for Economic & Social Research on Dementia, ILAS Building, National University of Ireland, Galway, Ireland
| | - Pat Dolan
- UNESCO Child and Family Research Centre, School of Political Science and Sociology, National University of Ireland, Galway, Ireland
| | - Priscilla Doyle
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
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Ibsen TL, Eriksen S. The experience of attending a farm-based day care service from the perspective of people with dementia: A qualitative study. DEMENTIA 2020; 20:1356-1374. [PMID: 32722922 DOI: 10.1177/1471301220940107] [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] [Indexed: 12/21/2022]
Abstract
People with dementia have different needs, and it is important to have variation in the services that are offered for this population. Farm-based day care aims to meet this diversity in need, but research on such services is lacking. The present study provides knowledge about how people with dementia experience attending farm-based day care services in Norway. Ten semi-structured interviews were conducted for five different services, while the participants were at the farm. The interviews were analysed in accordance with the content analysis of Graneheim, U., & Lundman, B. (2004) [Nurse Education Today, 24(2), 105-112] and revealed three main categories that included (1) social relations, (2) being occupied at the farm, and (3) individually tailored service. The findings were summarised in the overall theme that attending day care at a farm makes me feel like a real participant. Our findings indicate that the farm-based day cares in the present study provide person-centred care. The farm setting facilitates services that are tailored to the individual, where the participants get to use their remaining resources and spend time outdoors. Further, farm-based day care was described as being suitable for people with or without farm experience and must be seen as an important supplement to regular day care for those who could benefit from a more active service.
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Affiliation(s)
- Tanja L Ibsen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), 60512Vestfold Hospital Trust, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), 60512Vestfold Hospital Trust, Norway; Lovisenberg Diaconal University College, Norway
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