1
|
Watt JA, Porter J, Tavilsup P, Chowdhury M, Hatch S, Ismail Z, Kumar S, Kirkham J, Goodarzi Z, Seitz D. Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review. J Am Med Dir Assoc 2024; 25:837-846.e21. [PMID: 38640961 DOI: 10.1016/j.jamda.2024.03.007] [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: 11/14/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs. DESIGN Systematic review. SETTING AND PARTICIPANTS Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management. METHODS We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4. RESULTS Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations. CONCLUSIONS AND IMPLICATIONS There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.
Collapse
Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Porter
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pattara Tavilsup
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mohammad Chowdhury
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Hatch
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kirkham
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas Seitz
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
2
|
Campbell M, Stewart T, Brunkert T, Campbell-Enns H, Gruneir A, Halas G, Hoben M, Scott E, Wagg A, Doupe M. Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders. PLoS One 2021; 16:e0259387. [PMID: 34752475 PMCID: PMC8577765 DOI: 10.1371/journal.pone.0259387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP. Methods An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 (“very important”), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one. Results Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one’s home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP. Conclusions Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness.
Collapse
Affiliation(s)
- Megan Campbell
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tara Stewart
- Department of Community Health Sciences, George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Thekla Brunkert
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | | | - Andrea Gruneir
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gayle Halas
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Erin Scott
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Malcolm Doupe
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- * E-mail:
| |
Collapse
|
3
|
Cianfrocca C, Caponnetto V, Donati D, Di Stasio E, Tartaglini D, Lancia L. The opinions and feelings about their educational needs and role of familial caregivers of Parkinson's Disease patients: a qualitative study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020002. [PMID: 33263347 PMCID: PMC8023112 DOI: 10.23750/abm.v91i12-s.10264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK In the advanced stages of Parkinson's Disease, patients need complex care and support, especially at home, where they often receive assistance by familial caregivers. However, caregivers may be or feel unable to cope with their role and, despite the needs of caregivers are often assessed in the literature, their opinions and feelings about these needs are not widely explored yet. This study aimed at exploring the opinions and feelings about their educational needs and role of familial caregivers of Parkinson's Disease patients. METHODS A qualitative study was conducted from October to December 2017 in a polyclinic of central Italy. Fourteen caregivers voluntarily participated in the study; semi-structured face-to-face interviews were conducted, and audio recorded until data saturation. Two investigators reviewed the transcribed notes, created Meaning Units, Sub-categories and finally the Categories with emerged themes. RESULTS The analysis of the 14 interviews generated three categories: supportiveness of healthcare educational programs; sense of inability to manage caregiver tasks; need for interaction with other familial caregivers. CONCLUSIONS The caregivers declared their belief that healthcare educational courses can be useful in helping them live and understand the caregiving tasks and expressed their need to share their experiences with other caregivers. In fact, they often they felt abandoned and poorly trained for the patient's management at the home. The clinical practice should allow healthcare professionals to meet the training and emotional needs of caregivers and create a trust relationship with them to make caregivers skilled in caring for patients.
Collapse
Affiliation(s)
- Claudia Cianfrocca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | | | - Daniele Donati
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of 'Sacro Cuore', Rome, Italy; Univeristy Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy.
| | | | - Loreto Lancia
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Edificio Rita Levi Montalcini - Via G. Petrini - 67100 L'Aquila, Italy.
| |
Collapse
|
4
|
Novais T, Mouchoux C, Kossovsky M, Winterstein L, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Neurocognitive disorders: what are the prioritized caregiver needs? A consensus obtained by the Delphi method. BMC Health Serv Res 2018; 18:1016. [PMID: 30594202 PMCID: PMC6311000 DOI: 10.1186/s12913-018-3826-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background The symptoms related to neurocognitive disorders (NCD) may lead to caregiver burden increase. Involving caregivers in research may be an effective way of improving the practicalities and relevance of interventions. The aim of this study was to gather opinion and gain consensus on the caregivers ‘priorities, using a Delphi method and including aspects of needs in pharmaceutical dimension. Methods Observational study using a modified Delphi method. This study was conducted in the Clinical and Research Memory Center of the University Hospital of Lyon (France), between September 2015 and January 2016. The expert panel was composed of 68 informal caregivers of people with subjective cognitive decline or NCD living at home. Results Caregivers assigned a very high importance to the dimension “information needs about their relative’s disease”, i.e. information on the disease, the treatment and the research; and to “coping skills”, i.e. skills related to emotional support, communication, relationship evolution with the relative and skills to cope with behavioural crisis, behavioural and cognitive disorders. The aspect “coping with behavioural disorders” received a high selection rate (83%). Conclusions The main needs selected can be used to design relevant interventions and give guidance to policy to support caregivers. To meet caregiver’s needs, interventions should focus on information about disease and treatment and psychoeducational interventions.
Collapse
Affiliation(s)
- Teddy Novais
- EA-7425 HESPER, Health Services and Performance Research, University Lyon, F-69003, Lyon, France. .,Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France. .,University Lyon 1, F-69000, Lyon, France.
| | - Christelle Mouchoux
- Pharmaceutical Unit, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France.,University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France
| | - Michel Kossovsky
- Department of Internal medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Lucie Winterstein
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - Pierre Krolak-Salmon
- University Lyon 1, F-69000, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000, Lyon, France.,Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| | - V Dauphinot
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, Hospices Civils de Lyon, F-69100, Lyon, France
| |
Collapse
|
5
|
Jorm AF, Ross AM. Guidelines for the public on how to provide mental health first aid: narrative review. BJPsych Open 2018; 4:427-440. [PMID: 30450221 PMCID: PMC6235998 DOI: 10.1192/bjo.2018.58] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/18/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Expert-consensus guidelines have been developed for how members of the public should assist a person with a mental health problem or in a mental health crisis. AIMS This review aimed to examine the range of guidelines that have been developed and how these have been implemented in practice. METHOD A narrative review was carried out based on a systematic search for literature on the development or implementation of the guidelines. RESULTS The Delphi method has been used to develop a wide range of guidelines for English-speaking countries, Asian countries and a number of other cultural groups. The primary implementation has been through informing the content of training courses. CONCLUSION Further work is needed on guidelines for low- and middle-income countries. DECLARATION OF INTEREST A.F.J. is an unpaid member of the Board of Mental Health First Aid International (trading as Mental Health First Aid Australia), which is a not-for-profit organisation.
Collapse
Affiliation(s)
- Anthony F Jorm
- Professorial Fellow, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anna M Ross
- Research Assistant, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| |
Collapse
|
6
|
Jennings AA, Guerin N, Foley T. Development of a tool for monitoring the prescribing of antipsychotic medications to people with dementia in general practice: a modified eDelphi consensus study. Clin Interv Aging 2018; 13:2107-2117. [PMID: 30425465 PMCID: PMC6203170 DOI: 10.2147/cia.s178216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite their adverse effects, antipsychotics are frequently used to manage behavioral and psychological symptoms of dementia. Regular monitoring of antipsychotic prescribing has been shown to improve the appropriateness of prescribing. However, there is currently no consensus on what the components of such a monitoring tool would be. Aim The aim of this study was to use an expert consensus process to identify the key components of an antipsychotic repeat prescribing tool for use with people with dementia in a general practice setting. Methods A modified eDelphi technique was employed. We invited multidisciplinary experts in antipsychotic prescribing to people with dementia to participate. These experts included general practitioners (GPs), geriatricians and old age psychiatrists. The list of statements for round 1 was developed through a review of existing monitoring tools and international best practice guidelines. In the second round of the Delphi, any statement that had not reached consensus in the first round was presented for re-rating, with personalized feedback on the group and the individual’s response to the specific statement. The final round consisted of a face-to-face expert meeting to resolve any uncertainties from round 2. Results A total of 23 items were rated over two eDelphi rounds and one face-to-face consensus meeting to yield a total of 18 endorsed items and five rejected items. The endorsed statements informed the development of a structured, repeat prescribing tool for monitoring antipsychotics in people with dementia in primary care. Conclusion The development of repeat prescribing tool provides GPs with practical advice that is lacking in current guidelines and will help to support GPs by providing a structured format to use when reviewing antipsychotic prescriptions for people with dementia, ultimately improving patient care. The feasibility and acceptability of the tool now need to be evaluated in clinical practice.
Collapse
Affiliation(s)
| | - Naoihse Guerin
- Department of General Practice, University College Cork, Cork, Ireland,
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland,
| |
Collapse
|
7
|
Maki Y, Endo H. The contribution of occupational therapy to building a dementia-positive community. Br J Occup Ther 2018. [DOI: 10.1177/0308022618774508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yohko Maki
- Chief, Education and Innovation Center, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidetoshi Endo
- Director, Education and Innovation Center, National Center for Geriatrics and Gerontology, Aichi, Japan
| |
Collapse
|
8
|
The Effect of Cognitive Intervention on Cognitive Improvement in Patients with Dementia. Dement Neurocogn Disord 2018; 17:23-31. [PMID: 30906388 PMCID: PMC6427996 DOI: 10.12779/dnd.2018.17.1.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose The effect of cognitive intervention in patients with dementia is inconsistent. This study sought to find out the effect of cognitive intervention by measuring interval change between before and after intervention. Methods We evaluated cognitive changes according to clinical diagnostic group across Gangwon province for 940 patients with dementia diagnosed at hospital clinics and 2,975 subjects without dementia. All subjects were treated with cognitive intervention. They underwent a cognitive and mood assessment before and after intervention. We used interval change of Mini-Mental State Examination (MMSE) scores as a primary measure of interventional outcome. Results Changes in mean MMSE score were significantly different between the non-dementia group and the dementia group (p=0.016), with changes of 0.7±2.4 and 1.0±3.7 points (±standard deviation), respectively. Cognitive improvement regarding completion of session was significantly higher in the dementia group (p=0.001), with changes of 0.41±4.51 for uncompleted group and 1.30±3.22 points for completed ones. Lower initial MMSE scores, lower age, and type of intervention were found to be independent predictive factors of subsequent cognitive changes as indicated by mean MMSE scores. Conclusions These findings suggest that cognitive intervention might be useful for patients with dementia. Their response to treatment might be related to the type of intervention.
Collapse
|
9
|
Jorm AF, Ross AM, Colucci E. Cross-cultural generalizability of suicide first aid actions: an analysis of agreement across expert consensus studies from a range of countries and cultures. BMC Psychiatry 2018; 18:58. [PMID: 29490626 PMCID: PMC5831714 DOI: 10.1186/s12888-018-1636-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A number of Delphi expert consensus studies have been carried out with different countries and cultural groups to develop guidelines on how a member of the public should provide assistance to a person who is suicidal. The present study aimed to determine whether cross-culturally generalizable suicide first aid actions are possible by comparing agreement across these Delphi studies. METHODS Data on endorsement rates for items were compared across six Delphi studies. These studies involved panels of professionals and consumer advocates from English-speaking countries, professionals from Sri Lanka, professionals from Japan, professionals from India, professionals from the Philippines, and professionals and consumer advocates in refugee and immigrant mental health. Correlations were calculated between item endorsement rates across panels. RESULTS There were 18 items that were highly endorsed across all eight of the Delphi panels and an additional 15 items highly endorsed across the panels from the three lower middle-income countries (India, Philippines and Sri Lanka). Correlations across panels in item endorsement rates were all 0.60 or above, but were higher between panels from countries that are socioeconomically similar. CONCLUSIONS There is broad agreement across the diverse expert panels about what are appropriate suicide first aid actions for members of the public, indicating that cross-cultural generalizability is possible. However, there is also some cultural specificity, indicating the need for local tailoring.
Collapse
Affiliation(s)
- Anthony F. Jorm
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC 3010 Australia
| | - Anna M. Ross
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC 3010 Australia
| | - Erminia Colucci
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC 3010 Australia ,0000 0001 0710 330Xgrid.15822.3cDepartment of Psychology, Middlesex University London, London, UK
| |
Collapse
|