Improving Nutritional Status of Older Persons with Dementia Using a National Preventive Care Program

OBJECTIVE

The aim of the study was to investigate the outcome of change in body weight associated with use of a structured preventive care process among persons with dementia assessed as at risk of malnutrition or malnourished. The preventive care process is a pedagogical model used in the Senior Alert (SA) quality register, where nutrition is one of the prioritized areas and includes four steps: assessment, analysis of underlying causes, actions performed and outcome.

DESIGN

An analysis of data from SA with a pre-post design was performed.

SETTING

The participants were living in ordinary housing or special housing in Sweden.

PARTICIPANTS

1912 persons, 65 years and older, registered in both SA and the dementia quality register Svedem were included.

INTERVENTION

A national preventive care program including individualized actions.

MEASUREMENTS

The Mini Nutritional Assessment-Short Form was used to assess nutritional status at baseline. Body weight was measured during baseline and follow-up (7-106 days after baseline).

RESULTS

74.3% persons were malnourished or at risk of malnutrition. Those at risk of malnutrition or malnourished who were registered in all four steps of the preventive care process, increased in body weight from baseline (Md 60.0 kg) to follow-up (Md 62.0 kg) (p=0.013). In those with incomplete registration no increase in body weight was found.

CONCLUSION

Using all steps in the structured preventive care process seems to improve nutritional status of persons with dementia assessed as at risk of malnutrition or malnourished. This study contributes to the development of evidence-based practice regarding malnutrition and persons with dementia.

Students' learning as the focus for shared involvement between universities and clinical practice: a didactic model for postgraduate degree projects

In an academic programme, completion of a postgraduate degree project could be a significant means of promoting student learning in evidence- and experience-based practice. In specialist nursing education, which through the European Bologna process would be raised to the master's level, there is no tradition of including a postgraduate degree project. The aim was to develop a didactic model for specialist nursing students' postgraduate degree projects within the second cycle of higher education (master's level) and with a specific focus on nurturing shared involvement between universities and healthcare settings. This study embodies a participatory action research and theory-generating design founded on empirically practical try-outs. The 3-year project included five Swedish universities and related healthcare settings. A series of activities was performed and a number of data sources secured. Constant comparative analysis was applied. A didactic model is proposed for postgraduate degree projects in specialist nursing education aimed at nurturing shared involvement between universities and healthcare settings. The focus of the model is student learning in order to prepare the students for participation as specialist nurses in clinical knowledge development. The model is developed for the specialist nursing education, but it is general and could be applicable to various education programmes.

High frequency of cognitive dysfunction before stroke among older people

OBJECTIVES

We examined cognitive functions before and in acute phase of stroke studying frequency and profile of cognitive impairment and relationships between cognitive status.

METHODS

Seventy-four patients with early phase after stroke and 49 healthy controls were included and examined using the Mini-Mental State Examination (MMSE) and a battery of neuropsychological tests. Cognitive status before stroke-onset was investigated using Cognitive Impairment Questionnaire.

RESULTS

Cognitive impairments were present in 96% of patients after stroke onset using the battery of neuropsychological tests and in 39% of patients using the MMSE, but in only 9% of controls. Seventy-six percent exhibited reduced executive function and 75% reduced psychomotor tempo. Cognitive dysfunction was present in 52% before stroke onset without any impact on the frequency of impairment in the various cognitive areas in early phase after stroke.

CONCLUSIONS

Cognitive impairment is frequent before the onset of stroke among older people and may partially explain the very high frequency of cognitive impairment observed after stroke onset.

Outcomes of an educational intervention for the family of a person with bipolar disorder: a 2-year follow-up study

This study aimed to analyse the outcomes of an educational intervention for family members living with a person with bipolar disorder. A longitudinal study was conducted comprising a 10-session educational intervention designed for families with members in outpatient mental health care. Thirty-four family members agreed to participate. Data were collected on five occasions, at baseline and during a 2-year follow-up through self-assessment instruments: the Carers of Older People in Europe Index, the Jalowiec Coping Scale-40, the Sense of Coherence questionnaire and the Social Adaptation Self-evaluation Scale. The results showed that the condition had a considerable negative impact on the family members as carers, but the educational intervention increased their understanding, which facilitated the management of their lives. A significant improvement in stress management was seen over time and social functioning was retained. The study showed that families living with one member with bipolar disorder benefited from the educational intervention in terms of increasing understanding of the condition and reducing stress. Mental health care needs to develop educational interventions further and offer the families support to strengthen their ability to manage with the situation.

The life circumstances of persons with a psychiatric disability: a survey in a region in southern Sweden

This article describes the life circumstances of persons with a psychiatric disability living in one urban and six rural areas in a single region in Sweden. Furthermore, the life circumstances of persons with a psychiatric disability are discussed in relation to the aims of social policies in Sweden. Data were collected by means of a survey study exploring the formal support provided by local authorities to its citizens and the informal support given by family members and volunteers. The results reveal how the respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. The results indicate that persons with a psychiatric disability, regardless of where they live, need both formal and informal support in order to cope with their everyday lives. The family plays an important role in this, and it is essential for the formal and informal support systems to cooperate with each other. The lack of activities and opportunities for work experienced by persons with a psychiatric disability indicates that the sociopolitical goal of fostering access to employment and work and to earning a living for this group is far from having been attained.

Family and friends provide most social support for the bereaved

Social support is important in the bereavement period. In this study, the respondents were family members and friends to a patient who had died at a palliative care unit. The aim was to explore wishes and needs for, access to and effects of social support in the bereaved. We found that the grieving person's wishes for social support from their network and the network also provided most social support. The network consisted of the close family, the origin family, relatives and friend. Support from the professional staff was required when the network was dysfunctional or when the grieving person did not want to burden members of his/her own network. The need for social support from professional staff was most needed close to the death and some time after.

Color and form as support for picture recognition in old age

This study examined the effect of color and form as support for picture recognition measured immediately and after a period of 20 minutes in two groups: a random sample of 80-year-old men and women, with a Mini-Mental-State-Examination (MMSE) score of >26 points (N=142), and individuals with confirmed diagnosis of Alzheimer's disease (AD) with a MMSE score ranging from 7-26 points (N=50). The result showed that individuals with AD could make use of spatial support for recognition at a significantly lower level than among the cognitively intact 80-year olds, but most interestingly with a similar pattern. Chromatic pictures had an advantage over achromatic ones on immediate recognition measured as less time consumption and a higher number of correct answers in both groups. However, after 20 minutes' retention time, achromatic pictures were better recognized than chromatic ones by both the 80-year olds and the individuals with AD. It is suggested that immediate recognition had most support from self-generated cues concerning color, in contrast to retained recognition where instead cues concerning form had the strongest impact. Gender and age had no influence on recognition. Visual function and abstract vs concrete objects showed a slight impact on the result. Factors of intelligence and memory in the group of 80-year olds only had a minor influence on recognition, contrary to dementia which had a profound impact. It is concluded that spatial support as to color and form could be used for recognition in old age groups. The result will encourage further experimental research in using coding and cueing strategies for future implications in clinical practice.

Colour discrimination, colour naming and colour preferences among individuals with Alzheimer's disease

OBJECTIVE

To study the ability of colour naming, colour discrimination and colour preference in Alzheimer's disease (AD).

DESIGN

Descriptive, consecutive sample.

PARTICIPANTS

Fifty subjects >65 years with AD.

INTERVENTIONS

Testing colour discrimination, colour naming and colour preferences.

MAIN OUTCOME MEASURES

Ability to detect colour differences in the yellow, red, blue and green areas, ability to assign a name to 22 colour samples, ability to rank seven colours in order of preference.

MAIN RESULTS

Discrimination ability was significantly better in the yellow and red area and for lightness variations. Cognitive decline had a significant impact on naming mixed colours and using elaborate colour names. Severity of dementia did not affect the preference rank order of colours.

CONCLUSIONS

Ability to discriminate is affected in AD, with most errors in the blue and green area. Naming colours shows a cognitive decline. Preferences for colour are stable despite the disease.

Color discrimination, color naming and color preferences in 80-year olds

The aim of the present study was to investigate color discrimination, color naming and color preference in a random sample of 80-year-old men and women. Knowledge of color perception in old age can be of value when using color contrast, cues and codes in the environment to promote orientation and function. The color naming test indicated that the colors white, black, yellow, red, blue and green promoted recognition to the highest degree among all subjects. A gender-related difference, in favor of women, occurred in naming five of the mixed colors. Women also used more varied color names than men. Color discrimination was easier in the red and yellow area than in the blue and green area. This result correlates positively with visual function on far sight, and negatively with diagnosis of a cataract. The preference order for seven colors put blue, green and red at the top, and brown at the bottom, hence agreeing with earlier studies, and indicating that the preference order for colors remains relatively stable also in old age. This result should be considered when designing environments for old people.

Some aspects of colour perception among patients with Alzheimer's disease

The proportion of elderly people in western societies is on the increase. At the same time, demands are being heard for improvements in the quality of health care, including the design of the physical environment. The aim of this study was to call attention to some aspects of colour and the possibilities of using it as an orientational aid for institutionalized demented patients and thereby enhance the quality of their care. A pilot study was carried out to establish whether patients with Alzheimer's disease are different from non-demented patients regarding certain aspects of colour perception. Twelve hospitalized patients with Alzheimer's disease were compared with a matched control group of non-demented patients regarding colour naming, colour discrimination and colour preference. No significant differences were found between the groups. In an additional experiment to test short-term memory it was found that the patients with Alzheimer's disease gained substantial help from colour cues. It is concluded that colour should be taken into account in the designing of the health care environment, particularly geriatric wards.