Dementia Current Awareness Bulletin September 2021

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Journal articles:

Title: Influence of cognitive impairment and dementia on oral health and the utilization

of dental services: Findings of the Oral Health, Bite force and Dementia Study

(OrBiD).

Citation: BMC oral health; Aug 2021; vol. 21 (no. 1); p. 399

Author(s): Jockusch, Julia; Hopfenmüller, Werner; Nitschke, Ina

Objective: The aim of this study was to show the influence of cognitive impairment and

dementia on oral health and on the utilization of dental services.

Methods: A cross-sectional analyzation of data of the OrBiD (Oral Health, Bite Force and

Dementia) pilot study was conducted. 137 subjects were stratified into five dementia groups

on the basis of the Mini Mental State Examination (MMSE) (1-no dementia (MMSE 28-30),

2-mild cognitive impairment (MMSE 25-27), 3-mild dementia (MMSE 18-24), 4-moderate

dementia (MMSE 10-17), and 5-severe dementia (MMSE < 10)). Information on the

utilization of dental services and oral health parameters (DMFT index, degree of restoration,

Periodontal Screening Index, Bleeding on Probing, Oral Hygiene Index, Denture Hygiene

Index) were collected.

Results: An increase in dementia resulted in significant reduction in utilization. Moreover,

with increasing cognitive impairment/dementia there was a significant difference in the

number of teeth that were decayed, but not in the number of filled or missing teeth or the

DMF/T index itself. With increasing dementia, the degree of restoration decreased and

oral/denture hygiene deteriorated significantly. Nevertheless, periodontal therapy was

required for all subjects independent of their degree of dementia while bleeding on probing

was increasing with increasing dementia.

Conclusions: An influence of cognitive impairment and dementia on oral health and on the

utilization of dental services was shown. However, no conclusions about the influence of the

utilization behavior of people with dementia on oral health parameters can be drawn.

Title: Perspectives of people living with dementia and their care partners about the

impact on social health when participating in a co-designed Dementia café.

Citation: Health & social care in the community; Aug 2021

Author(s): Innes, Anthea; Chesterton, Lorna; Morris, Lydia; Smith, Sarah K; Bushell, Sophie

Abstract: Those diagnosed with dementia and those who provide care and support often

feel socially isolated with limited opportunities for social engagement, increasing the

potential for loneliness and further isolation that is detrimental to social health. This study

examined how a co-designed dementia café impacted on the self-reported social health of

community dwelling people with dementia and their care partners in the North-West of

England. Semi-structured interviews were conducted at two time periods (summer of 2019

and spring of 2020), with five people living with dementia and eight care partners. The key

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finding was that participating in the cafés led to a sense of belonging and purpose that was

beneficial to well-being and social health for all participants. Community-based initiatives

that provide opportunities for peer support for the person with the diagnosis and the care

partner are essential so that people living with dementia may rebuild their confidence as well

as retaining opportunities to socialise.

Title: Sustainable nurse-led care for people with dementia including mild cognitive

impairment and their family in an ambulatory care setting: A scoping review.

Citation: International journal of nursing practice; Aug 2021 ; p. e13008

Author(s): Yamakawa, Miyae; Kanamori, Takuya; Fukahori, Hiroki; Sakai, Ikuko

Objective: This review aimed to determine the characteristics of a nurse-led intervention for

people with dementia including mild cognitive impairment and their family in an ambulatory

care setting.

Background: Enhancing the role of nurses in a multidisciplinary team of ambulatory care

follow-up after a diagnosis of dementia is thought to lead to successful dementia care.

Design: This is a scoping review.

Data sources: MEDLINE, CINAHL, EMBASE, Cochrane, JBI, Japan Medical Abstracts

Society, PsycINFO and Web of Science were searched on 14 March 2019.

Review methods: This scoping review was conducted using the Joanna Briggs Institute

methodology, followed the PRISMA-ScR checklist and considered studies that included

interventions conducted by nurses and included outcomes regarding dementia symptoms or

family care burden.

Results: Eleven studies were included. Of these, all interventions were multifactorial and

reported effective results. Educational interventions were most common, and the content of

education included the characteristics of dementia and how to interact with patients with

dementia. The roles of nurses included caregiver education, assessment, care plan creation

for continuous monitoring and team building.

Conclusion: This scoping review suggested that effective nurse-led interventions in the

ambulatory care of people with dementia are continuous patient and family supports,

primarily caregiver education within multidisciplinary teams.

Title: Smart Home Sensing and Monitoring in Households With Dementia: User-

Centered Design Approach.

Citation: JMIR aging; Aug 2021; vol. 4 (no. 3); p. e27047

Author(s): Tiersen, Federico; Batey, Philippa; Harrison, Matthew J C; Naar, Lenny; Serban,

Alina-Irina; Daniels, Sarah J C; Calvo, Rafael A

Objective: As life expectancy grows, so do the challenges of caring for an aging population.

Older adults, including people with dementia, want to live independently and feel in control of

their lives for as long as possible. Assistive technologies powered by artificial intelligence

and internet of things devices are being proposed to provide living environments that support

the users' safety, psychological, and medical needs through remote monitoring and

interventions. This study investigates the functional, psychosocial, and environmental needs

of people living with dementia, their caregivers, clinicians, and health and social care service

providers toward the design and implementation of smart home systems.

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Methods: We used an iterative user-centered design approach comprising 9 substudies.

First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and

clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health

and social care clinicians) were conducted to define the needs of people with dementia,

home caregivers, and professional stakeholders in both daily activities and technology-

specific interactions. Then, the spectrum of needs identified was represented via patient-

caregiver personas and discussed with stakeholders in a workshop (14 occupational

therapists; 4 National Health Service pathway directors; and 6 researchers in occupational

therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care

services (n=8), eliciting opportunities for innovative care technologies and public health

strategies. Finally, these design opportunities were discussed in semistructured interviews

with participants of a smart home trial involving environmental sensors, physiological

measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment

puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors

that motivate household members to use these technologies.

Results: Outcomes of these activities include a qualitative and quantitative analysis of

patient, caregiver, and clinician needs and the identification of challenges and opportunities

for the design and implementation of remote monitoring systems in public health pathways.

Conclusions: Participatory design methods supported the triangulation of stakeholder

perspectives to aid the development of more patient-centered interventions and their

translation to clinical practice and public health strategy. We discuss the implications and

limitations of our findings, the value and the applicability of our methodology, and directions

for future research.

Title: The value of deprescribing in older adults with dementia: a narrative review.

Citation: Expert review of clinical pharmacology; Aug 2021 ; p. 1-16

Author(s): Sawan, Mouna J; Moga, Daniela C; Ma, Megan J; Ng, Joanna C; Johnell,

Kristina; Gnjidic, Danijela

Introduction: Mitigating the burden of unnecessary polypharmacy or multiple medication

use in people living with dementia has been recognized as a key priority internationally. One

approach to reducing inappropriate polypharmacy is through medication withdrawal or

deprescribing.

Area covered: Non-systematic searches of key databases including PubMed, Embase, and

Google Scholar were conducted from inception to 28 February 2021 for articles that

assessed the safety and/or efficacy of deprescribing in older adults living with dementia.

Personal reference libraries were also utilized. Information on current clinical trials was

found in clinicaltrial.gov.

Expert Opinion: There is limited direct evidence to inform deprescribing in older adults with

dementia specifically. This review identified nineteen studies that have assessed the impact

of deprescribing interventions to reduce inappropriate polypharmacy or direct deprescribing

of specific medications. However, the current evidence is limited in scope as most studies

focused on medication-related outcomes (e.g. discontinuation of high-risk medications)

rather than patient-centered outcomes in individuals living with dementia. Furthermore, most

studies focused on addressing inappropriate polypharmacy in older adults with dementia

living in long-term care facilities, and interventions did not involve the person and their carer.

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Further evidence on the impact of deprescribing in this population across clinical settings is

needed.

Title: Optimizing the diagnosis and management of dementia within primary care: a

systematic review of systematic reviews.

Citation: BMC family practice; Aug 2021; vol. 22 (no. 1); p. 166

Author(s): Fernandes, Brooklynn; Goodarzi, Zahra; Holroyd-Leduc, Jayna

Objective: To understand how best to approach dementia care within primary care and its

challenges, we examined the evidence related to diagnosing and managing dementia within

primary care.

Methods: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane

Database of Systematic Reviews from inception to 11 May 2020. English-language

systematic reviews, either quantitative or qualitative, were included if they described

interventions involving the diagnosis, treatment and/or management of dementia within

primary care/family medicine and outcome data was available. The risk of bias was

assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with

Open Science Framework.

Results: Twenty-one articles are included. The Mini-Cog and the MMSE were the most

widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS)

achieved high sensitivity (100 %, 95 % CI: 70-100 %) and specificity (82 %, 95 % CI: 72-

90 %) within the shortest amount of time (3.16 to 5 min) within primary care. Five of six

studies found that family physicians had an increased likelihood of suspecting dementia after

attending an educational seminar. Case management improved behavioural symptoms,

while decreasing hospitalization and emergency visits. The primary care educational

intervention, Enhancing Alzheimer's Caregiver Health (Department of Veterans Affairs), was

successful at increasing carer ability to manage problem behaviours and improving

outcomes for caregivers.

Conclusions: There are clear tools to help identify cognitive impairment in primary care, but

strategies for management require further research. The findings from this systematic review

will inform family physicians on how to improve dementia diagnosis and management within

their primary care practice.

Title: Implementing a Reablement Intervention, "Care of People With Dementia in

Their Environments (COPE)": A Hybrid Implementation-Effectiveness Study.

Citation: The Gerontologist; Aug 2021; vol. 61 (no. 6); p. 965-976

Author(s): Clemson, Lindy; Laver, Kate; Rahja, Miia; Culph, Jennifer; Scanlan, Justin N;

Day, Sally; Comans, Tracy; Jeon, Yun-Hee; Low, Lee-Fay; Crotty, Maria; Kurrle, Sue;

Cations, Monica; Piersol, Cathy V; Gitlin, Laura N

Objectives: The translation of reablement programs into practice is lagging despite strong

evidence for interventions that maintain function for the person living with dementia as well

as improve carer well-being. The aim was to evaluate the implementation of an evidence-

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based program, Care of People with Dementia in Their Environments (COPE), into health

services.

Research design and methods: An implementation-effectiveness hybrid design was used

to evaluate implementation outcomes while simultaneously involving a pragmatic pre-post

evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention,

outcomes for people living with dementia and carers, and beliefs and behaviors of

interventionists contributing to successful implementation.

Results: Seventeen organizations in Australia across 3 health contexts, 38 occupational

therapists, and 17 nurses participated in training and implementation. While there were

challenges and delays in implementation, most organizations were able to offer the program

and utilized different models of funding. Overall, we found there was moderate fidelity to

components of the program. Pre-post outcomes for carer well-being and coping (Perceived

Change Index, p < .001) and activity engagement of the person living with dementia (p =

.002) were significantly increased, replicating previous trial results. What contributed most to

therapists implementing the program (Determinants of Implementation Behaviour

Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a

sense of control in delivery (p = .004), and a belief the program was very useful to their

clients (p = .002).

Discussion and implications: This study demonstrated that implementation is possible in

multiple health systems and beneficial to individuals and their families.

Title: Enteral tube feeding for people with severe dementia.

Citation: The Cochrane database of systematic reviews; Aug 2021; vol. 8 ; p. CD013503

Author(s): Davies, Nathan; Barrado-Martín, Yolanda; Vickerstaff, Victoria; Rait, Greta;

Fukui, Akiko; Candy, Bridget; Smith, Christina H; Manthorpe, Jill; Moore, Kirsten J;

Sampson, Elizabeth L

Objectives: The balance of benefits and harms associated with enteral tube feeding for

people with severe dementia is not clear. An increasing number of guidelines highlight the

lack of evidenced benefit and potential risks of enteral tube feeding. In some areas of the

world, the use of enteral tube feeding is decreasing, and in other areas it is increasing. This

study aims to assess the effectiveness and safety of enteral tube feeding for people with

severe dementia who develop problems with eating and swallowing or who have reduced

food and fluid intake.

Search methods: We searched ALOIS, the Cochrane Dementia and Cognitive

Improvement Group's register, MEDLINE, Embase, four other databases and two trials

registers on 14 April 2021.

Selection criteria: We included randomised controlled trials (RCTs), or controlled non-

randomised studies. Our population of interest was adults of any age with a diagnosis of

primary degenerative dementia of any cause, with severe cognitive and functional

impairment, and poor nutritional intake. Eligible studies evaluated the effectiveness and

complications of enteral tube feeding via a nasogastric or gastrostomy tube, or via jejunal

post-pyloric feeding, in comparison with standard care or enhanced standard care, such as

an intervention to promote oral intake. Our primary outcomes were survival time, quality of

life, and pressure ulcers.

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Data collection and analysis: Three review authors screened citations and two review

authors assessed full texts of potentially eligible studies against inclusion criteria. One

review author extracted data, which were then checked independently by a second review

author. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I)

tool to assess the risk of bias in the included studies. Risk of confounding was assessed

against a pre-agreed list of key potential confounding variables. Our primary outcomes were

survival time, quality of life, and pressure ulcers. Results were not suitable for meta-analysis,

so we presented them narratively. We presented results separately for studies of

percutaneous endoscopic gastrostomy (PEG) feeding, nasogastric tube feeding and studies

using mixed or unspecified enteral tube feeding methods. We used GRADE methods to

assess the overall certainty of the evidence related to each outcome for each study.

Main results: We found no eligible RCTs. We included fourteen controlled, non-randomised

studies. All the included studies compared outcomes between groups of people who had

been assigned to enteral tube feeding or oral feeding by prior decision of a healthcare

professional. Some studies controlled for a range of confounding factors, but there were high

or very high risks of bias due to confounding in all studies, and high or critical risks of

selection bias in some studies. Four studies with 36,816 participants assessed the effect of

PEG feeding on survival time. None found any evidence of effects on survival time (low-

certainty evidence). Three of four studies using mixed or unspecified enteral tube feeding

methods in 310 participants (227 enteral tube feeding, 83 no enteral tube feeding) found

them to be associated with longer survival time. The fourth study (1386 participants: 135

enteral tube feeding, 1251 no enteral tube feeding) found no evidence of an effect. The

certainty of this body of evidence is very low. One study of PEG feeding (4421 participants:

1585 PEG, 2836 no enteral tube feeding) found PEG feeding increased the risk of pressure

ulcers (moderate-certainty evidence). Two of three studies reported an increase in the

number of pressure ulcers in those receiving mixed or unspecified enteral tube feeding (234

participants: 88 enteral tube feeding, 146 no enteral tube feeding). The third study found no

effect (very-low certainty evidence). Two studies of nasogastric tube feeding did not report

data on survival time or pressure ulcers. None of the included studies assessed quality of

life. Only one study, using mixed methods of enteral tube feeding, reported on pain and

comfort, finding no difference between groups. In the same study, a higher proportion of

carers reported very heavy burden in the enteral tube feeding group compared to no enteral

tube feeding. Two studies assessed the effect of nasogastric tube feeding on mortality (236

participants: 144 nasogastric group, 92 no enteral tube feeding). One study of 67

participants (14 nasogastric, 53 no enteral tube feeding) found nasogastric feeding was

associated with increased mortality risk. The second study found no difference in mortality

between groups. The certainty of this evidence is very low. Results on mortality for those

using PEG or mixed methods of enteral tube feeding were mixed and the certainty of

evidence was very low. There was some evidence from two studies for enteral tube feeding

improving nutritional parameters, but this was very low-certainty evidence. Five studies

reported a variety of harm-related outcomes with inconsistent results. The balance of

evidence suggested increased risk of pneumonia with enteral tube feeding. None of the

included studies assessed behavioural and psychological symptoms of dementia.

Authors' conclusions: We found no evidence that tube feeding improves survival;

improves quality of life; reduces pain; reduces mortality; decreases behavioural and

psychological symptoms of dementia; leads to better nourishment; improves family or carer

outcomes such as depression, anxiety, carer burden, or satisfaction with care; and no

indication of harm. We found some evidence that there is a clinically significant risk of

pressure ulcers from enteral tube feeding. Future research should focus on better reporting

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and matching of control and intervention groups, and clearly defined interventions,

measuring all the outcomes referred to here.

Title: Symptoms and Treatment Needs of People with Dementia-Related Psychosis: A

Mixed-Methods Study of the Patient Experience.

Citation: Clinical gerontologist; Aug 2021 ; p. 1-15

Author(s): Brandt, Teresa; Frangiosa, Theresa; Biggar, Virginia; Taylor, Angela; Valentine,

James; Keller, Bill; Price, Mark; DeMuro, Carla; Abler, Victor

Objectives: This study describes the person-centered experience and impact of symptoms

and the treatment needs of dementia-related psychosis (DRP) from a patient and care

partner perspective.

Methods: Qualitative interviews and a quantitative survey were used to collect patient

experience data from persons with DRP or their care partners.

Results: Sixteen participants (1 person with DRP, 15 care partners) completed the

qualitative interview; 212 participants (26 persons with DRP, 186 care partners) completed

the quantitative survey. The most commonly reported symptoms were visual hallucinations,

auditory hallucinations, persecutory delusions, and distortion of senses. The most common

impacts were difficulty differentiating what is real from what is not real, increased anxiety,

and effects on personal relationships. Current treatments were less than moderately helpful,

and the ability to distinguish what is real from what is not real and overall symptom

improvement were described as the most important benefits of an ideal treatment.

Conclusions: Patient experience data provide insights into urgent therapeutic needs of

patients by describing the nature, frequency, and severity of symptoms and the impacts they

have on individuals' lives.

Clinical implications: Patient experience data demonstrate an unmet need for treatments

to reduce the symptoms and impacts of DRP.

Title: Evaluation of a Workshop on Therapeutic Lying and Dementia Care for Long-

Term Care Staff Supporting Persons with Dementia.

Citation: Journal of continuing education in nursing; Sep 2021; vol. 52 (no. 9); p. 438-444

Author(s): Hartung, Benjamin; Freeman, Calen; Grosbein, Haddas; Santiago, Anna

Theresa; Gardner, Sandra; Turzanski, Melissa

Objective: Therapeutic lying is an intervention used by health care professionals (HCPs)

when a person with dementia is disoriented and distressed and when all other interventions

have not succeeded in deescalating the symptoms of dementia.The goal of this study was to

evaluate a workshop on therapeutic lying and dementia care for HCPs specializing in the

care of persons living with dementia with symptoms of dementia. Seventeen HPCs,

including nurses and personal support workers (PSWs), participated in the workshop and

evaluation survey.

Results: The workshop did not affect the attitudes of HCPs toward therapeutic lying and

dementia, their sense of competence in providing care to patients with dementia, or their

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rate of admitting to using therapeutic lying in dementia care settings. All of the PSWs and

50.0% of the nurses admitted to using therapeutic lying as an intervention.

Conclusion: Current nursing ethics standards and training practices may cause reluctance

among nurses to include therapeutic lying in care plans as a last resort and as a person- and

family-centered intervention to deescalate the symptoms of dementia.

Title: Outcomes of a financial incentive scheme for dementia care by dementia

specialist teams in acute-care hospitals: A difference-in-differences analysis of a

nationwide retrospective cohort study in Japan.

Citation: International journal of geriatric psychiatry; Sep 2021; vol. 36 (no. 9); p. 1386-1397

Author(s): Morita, Kojiro; Fukahori, Hiroki; Ogawara, Hirofumi; Iwagami, Masao; Matsui,

Hiroki; Okura, Toru; Itoh, Sakiko; Fushimi, Kiyohide; Yasunaga, Hideo

Objectives: The quality of care for dementia in acute-care settings has been criticised. In

2016, the Japanese universal health insurance system introduced a financial incentive

scheme for dementia care by dementia specialist teams in acute-care hospitals. This study

aimed to investigate the effectiveness of this financial incentive scheme on short-term

outcomes (in-hospital mortality and 30-day readmission).

Design and methods: Using a Japanese nationwide inpatient database, we identified older

adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure,

cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to

March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted

(n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We

then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we

restricted the postintervention group to patients who actually received dementia care.

Results: There was no association between a hospital's adoption of the incentive scheme

and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88-

1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95-1.14; p = 0.37). Only 29% of

patients in hospitals adopting the scheme actually received dementia care. The sensitivity

analysis showed that receiving dementia care was associated with decreased in-hospital

mortality.

Conclusions: The financial incentive scheme to enhance dementia care by dementia

specialist teams in Japan may not be working effectively, but the results do suggest that

individual dementia care was associated with decreased in-hospital mortality.

Title: The meaning and experience of gratitude for people living with dementia.

Citation: Dementia (London, England); Aug 2021 ; p. 14713012211040675

Author(s): Pearson, Martha; Clarke, Chris; Wolverson, Emma

Background: Supporting people to live well with dementia is an international government

priority. People living with dementia experience a range of positive emotions despite the

challenges associated with dementia. Further research is needed to explore how these

positive experiences can be fostered to support well-being. There is empirical evidence of

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the benefits of gratitude in other clinical groups, but no studies have explored how gratitude

is experienced by people living with dementia.

Methods: In this mixed-methods study, eight people living with dementia shared their

experiences of gratitude through interviews and gratitude diaries. Qualitative data were

analysed using interpretative phenomenological analysis. Quantitative data regarding diary

use were analysed using descriptive statistics.

Findings and conclusions: Gratitude holds interpersonal and transpersonal meanings for

people living with dementia, balanced with challenges of dementia and ageing. This study

offers insight into the existence and relevance of gratitude for people living with dementia,

highlighting the importance of using multiple methods in dementia research. Positive

psychology interventions informed by these findings may be effective in supporting well-

being for people with dementia.

Title: Systematic review of the current psychosocial interventions for people with

moderate to severe dementia.

Citation: International journal of geriatric psychiatry; Sep 2021; vol. 36 (no. 9); p. 1313-1329

Author(s): Hui, Esther K; Tischler, Victoria; Wong, Gloria H Y; Lau, W Y Tiffany; Spector,

Aimee

Objective: Dementia, a global epidemic, currently affects 50 million individuals worldwide.

There are currently limited effective treatments for moderate to severe dementia, and most

treatments focus on reducing symptoms rather than improving positive factors. It is unclear if

improvements are not possible due to disease severity. This review examines the efficacy of

the current psychosocial interventions for people with moderate to severe dementia,

focusing on improving cognition and quality of life (QoL) to evaluate what treatments are

working and whether improvements are possible.

Methods: A systematic search was conducted using six key databases to identify

psychosocial interventions for people with moderate to severe dementia, measuring

cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020.

Results: The search identified 4193 studies, and 74 articles were assessed for full-text

review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence

Database Scale. The included RCTs were moderate in quality.

Conclusions: Aromatherapy and reminiscence therapy showed the strongest evidence in

improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a

multicomponent study improved QoL. However, a quality assessment, using pre-specified

criteria, indicated many methodological weaknesses. While we found improvements in

cognition and QoL for moderate to severe dementia, results must be interpreted with

caution. Future interventions with rigorous study designs are a pressing need and required

before we can recommend specific interventions.

Title: Nursing students' knowledge about behavioral and biopsychosocial domains of

dementia: A cross-sectional survey study.

Citation: International journal of nursing knowledge; Aug 2021

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Author(s): Abu Khait, Abdallah; Menger, Austin; Hamaideh, Shaher H; Al-Modallal, Hanan;

Abdalrahim, Asem

Objective: The purpose of this study was to investigate nursing students' knowledge about

behavioral and biopsychosocial domains of dementia and the factors associated with nurses'

knowledge.

Methods: A cross-sectional, predictive study was conducted using a web-based survey. A

convenience sample of 356 nursing students from a large public university completed an

anonymous online survey comprising 25 Likert-scale items. Univariate analyses (two-sample

t tests and one-way ANOVA) were used for model selection at the cutoff level of 0.20 in

producing a multivariate linear regression model. Multiple linear regression analysis was

conducted to predict a given student's score using the demographic variables selected. The

regression model was used to infer pairwise demographic group comparisons while

controlling for other demographic variables.

Findings: The mean score of students' knowledge about dementia was 24.53 ± 7.81 out of

48 (52%). Students scored the lowest scores on knowledge about communication with and

behaviors of people with dementia and the risk factors and health promotion areas in

dementia care. Students' gender, current grade point average (GPA), family history with

dementia, and education level had statistically significant effects on the mean total dementia

knowledge score and respective subscales (p < 0.05). The model predicting the total

dementia knowledge score explained the most variation among all five models conducted

(29%).

Conclusions: The findings indicate that nursing curricula should introduce educational

programs related to all aspects of dementia knowledge earlier on.

Implications for nursing practice: The survey findings suggest raising standards of

dementia knowledge and implementing educational strategies in clinical settings that

adequately prepare nurses to interact with or care for people with dementia.

Title: Towards person-centred rehabilitation in dementia - a narrative synthesis.

Citation: Disability and rehabilitation; Sep 2021; vol. 43 (no. 18); p. 2673-2679

Author(s): Thuesen, Jette; Ravn, Maiken Bay; Petersen, Kirsten Schultz

Objective: The aim of this study was to identify and synthesize person-centred principles

and components as described in rehabilitation intervention studies which target home

dwelling people with mild to moderate dementia.

Materials and methods: A narrative synthesis was carried out which included 19

rehabilitation intervention studies targeting people with mild to moderate dementia. The

analysis was guided by an initial program theory about person-centredness in rehabilitation,

which was developed for this purpose.

Results: Person-centred principles and components were identified and synthesised.

Person-centred rehabilitation practice in dementia includes: (1) a focus on the needs,

preferences and cultural values of the individual and consideration of his/her life history and

biography; (2) the cooperation of professionals and people with dementia, including specific

tools and methods such as goal-setting, holistic assessment and methods to activate and

empower the individual, and building relationships; (3) organisation and structure.

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Conclusion: Compared to the principles of Kitwood, person-centredness in rehabilitation for

people living with dementia also includes goal-setting and empowering principles. There is a

need for developing the theoretical and philosophical foundation for person-centredness in

rehabilitation in relation to people with dementia.

Implication for rehabilitation: Person-centredness is a key feature in rehabilitation for

people living with dementia.In rehabilitation, person-centredness may entail other principles

and components than in dementia care in general.There is a need for developing person-

centredness in rehabilitation, both in theory and in practice.

Title: Transing dementia: Rethinking compulsory biographical continuity through the

theorization of cisism and cisnormativity.

Citation: Journal of aging studies; Sep 2021; vol. 58 ; p. 100956

Author(s): Silverman, Marjorie; Baril, Alexandre

Abstract: Using theoretical tools from trans studies and disability/crip studies, we

reconceptualize the self in the context of dementia. We illustrate that most dementia

discourse, scholarship and intervention emphasize a maintenance of the pre-dementia self.

We argue that the compulsory biographical continuity needed to maintain the pre-dementia

self is based on interlocking forms of ageism, ableism, and cogniticism, and interacts with

what we call cisism (the oppressive system that discriminates against people on the basis of

change) and its normative components, cisnormativity* and ciscognonormativity. After

providing a critical genealogy of the term cisnormativity*, we resignify and redeploy this

concept in the context of dementia, demonstrating how it is useful for critiquing compulsory

biographical continuity. Following the verbs queering and cripping, we propose a transing of

dementia that leads to a new conceptualization of the self that is fluid and changing, rather

than one anchored in multiple oppressions.

Title: The involvement of people with dementia in advocacy: a systematic narrative

review.

Citation: Aging & mental health; Sep 2021; vol. 25 (no. 9); p. 1595-1604

Author(s): Weetch, Jason; O'Dwyer, Siobhan; Clare, Linda

Methods: A systematic search and narrative synthesis of original research was conducted.

Searches in Pubmed, Web of Science, PsychINFO and CINAHL followed PRISMA

Guidelines. The review focused on people with dementia involved in advocacy. There were

no restrictions based on study design or date. Language was limited to English.

Results: Seven papers were identified, with predominantly qualitative methodologies. Four

overarching themes were identified: threats, fighting back, evolving identities and making a

difference. Threats ranged from those arising from dementia as an illness, to exposure to

stigma. Fighting back represented advocates' response to these threats, often described

using martial metaphors. Evolving identities captured advocates' journeys through diagnosis

to involvement in advocacy and subsequent impact upon identity. Making a difference

represented the impact of dementia advocacy at an individual, community and societal level.

13

Conclusions: This review confirms that the threats associated with dementia extend

beyond the symptoms of illness. Dementia advocacy offers potential improvements in well-

being for those involved, through the activity itself and via extended social networks. There

is little research on broader aspects of advocates' identity, including ethnicity, gender, and

age. There has been little attempt to quantify the impact of dementia advocacy.

Title: Associated factors of suicidal ideation among older persons with dementia

living at home in eight European countries.

Citation: Aging & mental health; Sep 2021; vol. 25 (no. 9); p. 1730-1739

Author(s): Holmstrand, Cecilia; Rahm Hallberg, Ingalill; Saks, Kai; Leino-Kilpi, Helena;

Renom Guiteras, Anna; Verbeek, Hilde; Zabalegui, Adelaida; Sutcliffe, Caroline; Lethin,

Connie

Objectives: This study aimed to investigate the occurrence of suicidal ideation and

associated factors in older persons with dementia living at home in eight European

countries, and its association with quality of life. Furthermore, changes in suicidal ideation

over time were investigated.

Methods: This cohort study (n = 1,223) was part of the European "RightTimePlaceCare"

project conducted in 2010-2013. Participating countries were Estonia, Finland, France,

Germany, the Netherlands, Spain, Sweden and the United Kingdom. Baseline and follow-up

data were analysed using bivariate and multivariate logistic regression.

Results: The occurrence of suicidal ideation in the participating countries varied between

6% and 24%. Factors significantly (p < 0.0018) associated with suicidal ideation using

bivariate analysis were: nationality, depressive symptoms, delusions, hallucinations,

agitation, anxiety, apathy, disinhibition, irritability, night-time behaviour disturbances,

anxiolytics and anti-dementia medication. In the multivariate regression analysis, country of

origin, moderate stage of the dementia, depressive and delusional symptoms, and anti-

dementia medication were significantly associated with suicidal ideation (p < 0.05). Over

time, suicidal ideation decreased from severe to mild or became absent in 54% of the

persons with dementia.

Conclusion: It is essential that professionals identify older persons with dementia and

suicidal ideation and depressive and other psychological symptoms in order to give them

appropriate treatment and provide relief for their informal caregivers. We emphasize the

importance of identifying suicidal ideation, irrespective of depressive symptoms, and

specifically of paying attention to persons with moderate dementia. Living with the informal

caregiver seems to be associated with staying stable without suicidal ideation.

Title: Function-Focused Goal Attainment and Discharge Outcomes in Hospitalized

Persons With Dementia.

Citation: Journal of gerontological nursing; Sep 2021; vol. 47 (no. 9); p. 13-20

Author(s): Boltz, Marie; Monturo, Cheryl; Brockway, Cindy; Kuzmik, Ashley; Jones, Joanne

Roman; Resnick, Barbara

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Abstract: Hospitalized persons with dementia are at higher risk for functional decline and

cognitive loss related to delirium. Family-centered, function-focused care (Fam-FFC)

engages the family care partner in education and active participation in function-focused

goal setting, implementation, and evaluation to support delirium prevention and abatement

and return to baseline physical function. The purpose of the current study was to examine

the association of function-focused goal attainment with two discharge outcomes, return to

baseline physical function and delirium severity at discharge, in hospitalized persons with

dementia. In the ongoing Fam-FFC clinical trial, the majority of goals (N = 433) developed by

134 care partner/patient dyads and nurses address mobility, cognitive stimulation, and self-

care. Regression techniques demonstrated that goal attainment was significantly associated

with return to baseline function (B = 0.826, Wald = 4.17 [1], p = 0.041) and lower delirium

severity at discharge (B = 0.175, t = 2.239, p = 0.027). Results support the contribution of

family engagement in promoting functional recovery of hospitalized persons with dementia.

Title: Effect of Dementia on Outcomes after Surgically Treated Hip Fracture in Older

Adults.

Citation: The Journal of arthroplasty; Sep 2021; vol. 36 (no. 9); p. 3181

Author(s): Jorissen, Robert N; Inacio, Maria C; Cations, Monica; Lang, Catherine; Caughey,

Gillian E; Crotty, Maria

Objective: Hip fractures are associated with increased mortality and functional limitations.

However, the effect that dementia has on these outcomes in individuals in aged care

settings after fracture is not well established. This study examined the association of

dementia with post-hip fracture mortality, permanent residential aged care entry, transition

care use, and change in activities of daily living (ADL) needs.

Methods: A retrospective cohort study using data from the Registry of Senior Australians

(2003-2015) was conducted. Individuals with a hip fracture while receiving aged care

services were included. Associations of dementia with mortality, risks of transition and

permanent care use, and ADL needs progression were estimated using multivariable Cox,

Fine-Gray, and logistic regression methods, respectively.

Results: Of 4771 individuals evaluated, 76% were women, the median age was 86 years

(IQR 82-90), and 71% already lived in permanent residential aged care at the time of

fracture. Within two years of their hip fracture, 50.4% (95% CI 48.9%-51.8%) of individuals

died, 16.2% (95% CI 14.2%-18.2%) entered a transition care program, 59.1% (95% CI

56.5%-61.7%) entered permanent residential aged care, and 32% had greater ADL needs.

Dementia was associated with higher risk of two-year mortality (HR = 1.19, 95% CI 1.09-

1.30), 90-day entry into permanent care (sHR = 1.96, 95% CI 1.60-2.38), and increased

likelihood of ADL limitations (OR = 1.36, 95% CI 1.00-1.85). Minor differences were seen in

transition care use by dementia status.

Conclusion: Dementia is a strong risk factor for mortality after hip fractures in individuals in

aged care settings and associated with a high risk of entry into permanent care.

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Title: Usefulness and acceptability of an animation to raise awareness to grief

experienced by carers of individuals with dementia.

Citation: Dementia (London, England); Aug 2021 ; p. 14713012211041259

Author(s): Scher, Clara; Crawley, Sophie; Cooper, Claudia; Sampson, Elizabeth L; Moore,

Kirsten J

Objective: Many carers of individuals with dementia experience high levels of grief before

and after the death of the person with dementia. This study aimed to determine the

usefulness, acceptability, and relevance of an animation developed to raise awareness to

grief experienced by carers of people with dementia.

Methods: This research had a cross-sectional survey design. We contacted carers of

people with dementia over the phone or email. Participants evaluated the animation through

an online or paper-based survey. We used descriptive statistics and analysed qualitative

data using thematic analysis. We required a sample of 40 carers to adequately power the

study with a target of 75% of carers finding the animation useful, acceptable, and relevant.

Results: 31/78 carers approached evaluated the animation. Ninety-four percent of

participants found the animation relevant to their situation, meeting our target. However, we

fell short of this target for usefulness (68%) and acceptability (73%). The qualitative

responses suggested that participants felt the animation could help improve the

understanding of grief among carers, family, friends, and healthcare professionals. Carers

also shared that the animation would be most useful for carers of newly diagnosed people

with dementia.

Conclusion: Most carers of people with dementia in this study reported that the animation

was useful, acceptable, and relevant. Dissemination of the resource may be useful for the

majority of carers, with the caveat that a few carers may find it distressing and need to be

referred for further support.

Title: Use of hypnosis in the field of dementia: A scoping review.

Citation: Archives of gerontology and geriatrics; 2021; vol. 96 ; p. 104453

Author(s): Wawrziczny, Emilie; Buquet, Amandine; Picard, Sandrine

Objective: Dementia has negative implications for the quality of life of person and lead to

situations of distress. Hypnosis is effective in several health domains but its use in people

with dementia is debated. The aim was to scope the research activity on the use of hypnosis

with persons with dementia to manage their distress, symptoms or daily life.

Method: We used five international databases: PubMed/Medline, the Cochrane Library,

ScienceDirect, PsycINFO, and Google Scholar.

Results: Only seven articles were listed and three articles described the same longitudinal

pilot study. Hypnosis was used either in one or several sessions, alone or as an adjunct and

reinforced with daily self-hypnosis with or without audio tapes in people with dementia. The

results show that they experienced moderate-to-high hypnotizability, but some adaptations

were needed given their attention disabilities. They showed benefit on

symptoms. Nevertheless, some methodological weaknesses such as small heterogeneous

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samples, the use of non-validated tools for hypnotizability or outcomes, or the insufficient

definition of the content of sessions limit the scope of the results.

Conclusion: Hypnosis seems feasible and acceptable for people with dementia and could

provide interesting clinical benefits, but a randomized controlled trial with a large

homogeneous sample would be highly informative.

Title: Daughters' experiences of shared caregiving to a parent with dementia.

Citation: Scandinavian journal of caring sciences; Sep 2021; vol. 35 (no. 3); p. 853-859

Author(s): Kokorelias, Kristina M; Nguyen, Lily; Elane, Genalyn; Wasilewski, Marina

Bastawrous; Rittenberg, Nira; Cameron, Jill I

Background: Siblings often share in the care of parents with dementia, but little is known

about how care is shared. Research suggests that in comparison with their brothers, sisters

provide the majority of care to a parent with dementia and this can contribute to the sisters

experiencing poorer health outcomes. There is limited knowledge about how to guide

siblings who share in the care of a parent with dementia.

Objective: Our qualitative descriptive study sought to explore the experiences of adult

daughters sharing care responsibilities with their siblings. The study protocol was approved

by institutional (University of Toronto and Baycrest Health Sciences) research ethics boards.

Materials & methods: Thirty-four daughters participated in an online qualitative survey.

Data were analysed using Braun and Clarke's (Qualitative Research in Psychology, 3, 2006,

77) 6-step process.

Results: In an overarching theme, daughters expected shared caregiving with their siblings.

They conceptualised this to be a practice of being equitable in dividing care responsibilities

and fulfilling a supportive role for a parent with dementia; however, this expectation was not

met by most daughters. Two subthemes were identified: (a) factors facilitating/constraining

shared caregiving and (b) consequences of sharing care. The findings highlight the

importance of understanding shared caregiving among siblings when caring for a parent with

dementia.

Discussion: Results from this study suggest that although shared caregiving is often the

goal, factors such as gender roles, geographical proximity, caregiver expertise/skill set and

work schedules affect caregivers' abilities to share caregiving. These factors affected

whether daughters viewed the caregiving situation as being shared equitably or inequitably,

and this led to feelings of acceptance or resentment of their sibling's contribution to the care

of their parent.

Conclusions: Healthcare providers can utilise these findings to better support adult-child

caregivers negotiating care with their siblings.

Title: Measuring Awareness in People with Dementia: Results of a Systematic

Scoping Review.

Citation: Journal of geriatric psychiatry and neurology; Sep 2021; vol. 34 (no. 5); p. 335-348

Author(s): Alexander, Catherine M; Martyr, Anthony; Savage, Sharon A; Morris, Robin G;

Clare, Linda

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Objective: Awareness of the diagnosis or related changes in functioning varies in people

with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring

awareness in a clinical setting could facilitate tailored support and optimize involvement in

personal health and care decisions. This scoping review aimed to identify validated methods

of assessing awareness in dementia and appraise their clinical utility.

Method: A systematic search was conducted of English-language publications that

measured awareness in PwD, in 6 electronic databases. Search terms included dement*,

Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial,

metacognit*, or discrepanc*.

Results: We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We

identified 76 measures, most commonly using a discrepancy questionnaire comparing

evaluations of function by PwD and an informant. There were 30 awareness measures

developed and validated for use in dementia populations but few designed for general

clinical use.

Conclusions: Although we found a range of clinical indications for measuring awareness,

there were few studies investigating clinical applications and few tools designed for clinical

purposes. Further investigation and development of a person-centered tool could facilitate

health and care choices in mild-to-moderate dementia.

Title: The effect of COVID-19 isolation measures on the cognition and mental health of

people living with dementia: A rapid systematic review of one year of quantitative

evidence.

Citation: EClinicalMedicine; Sep 2021; vol. 39 ; p. 101047

Author(s): Suárez-González, Aida; Rajagopalan, Jayeeta; Livingston, Gill; Alladi, Suvarna

Objective: COVID-19 prevention and control policies have entailed lockdowns and

confinement. This study aimed to summarize the global research evidence describing the

effect of COVID-19 isolation measures on the health of people living with dementia.

Methods: We searched Pubmed, PsycINFO and CINAHL up to 27th of February 2021 for

peer-reviewed quantitative studies about the effects of isolation during COVID-19 on the

cognitive, psychological and functional symptoms of people with dementia or mild cognitive

impairment. The Joanna Briggs Institute critical appraisal tool was used to conduct the

quality assessment.

Findings: 15 eligible papers were identified, examining a total of 6442 people with

dementia. 13/15 studies investigated people living in the community and 2 in care homes.

Out of 15 studies, 9 (60%) reported changes in cognition and 14 (93%) worsening or new

onset of behavioral and psychological symptoms. Six studies (46%) reported a functional

decline in daily activities in a variable proportion of the population

analyzed.InterpretationCOVID-19 isolation measures have damaged the cognitive and

mental health of people with dementia across the world. It is urgent to issue guidance that

balances infection control measures against the principles of non-maleficence to guarantee

fair and appropriate care during pandemic times for this population.

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Title: Current UK clinical practice in diagnosing dementia in younger adults:

compliance with quality indicators in electronic health records from mental health

trusts.

Citation: Aging & mental health; Sep 2021; p. 1-10

Author(s): O'Malley, Mary; Parkes, Jacqueline; Stamou, Vasileios; LaFontaine, Jenny;

Oyebode, Jan; Campbell, Jackie; Carter, Janet

Objectives: To examine current UK practice in diagnosis of patients under 65 with young

onset dementia, within 5 years of date of diagnosis, identified from electronic health records

of 8 NHS mental health trusts.

Methods: Patients diagnosed with young onset dementia were assembled from the UK-

Clinical Record Interactive System, (UK-CRIS) using diagnosis of dementia as the index

date. A pre-designed proforma, derived by international Delphi consensus from experts in

the field in previous work, was used to assess components of the diagnostic assessment in

402 electronic health records across 8 NHS sites. Information was extracted on key aspects

of clinical and physical examination according to both a minimum and gold standard.

Results: Percentage compliance rates analysed by NHS site and statement, including

compliance for site for minimum standard (11 statements), the additional 20 statements

required for Gold standard, and the complete Gold standard set (31 statements) show that

the additional 20 statements in the Gold standard had consistently higher compliance rates

for every site compared to the minimum set.

Conclusion: Findings confirmed variation in clinical practice and identified commonly

missed items in examination and enquiry compared to expert consensus. This suggests that

a template proforma, which contains the key indicators for comprehensive assessment of

dementia in young adults according to a quality standard could help support clinicians to

improve record keeping and reduce gaps in knowledge.

Title: Can music enhance awareness in unresponsive people with severe dementia?

An exploratory case series using behavioral, physiological and neurophysiological

measures.

Citation: Neurocase; Aug 2021; p. 1-12

Author(s): Sun, Yanan; Baird, Amee; Gelding, Rebecca; de Wit, Bianca; Thompson, William

Forde

Abstract: In five people with severe dementia, we measured their behavioral and

physiological responses to familiar/unfamiliar music and speech, and measured ERP

responses to subject's own name (SON) after exposure to familiar/unfamiliar music or noise.

We observed more frequent behavioral responses to personally-significant stimuli than non-

personally-significant stumuli, and higher skin temperatures for music than non-music

conditions. The control group showed typical ERPs to SON, regardless of auditory exposure.

ERP measures were unavailable for the dementia group given challenges of measuring

EEG in this population. The study highlights the potential for personally-significant auditory

stimuli in enhancing responsiveness of people with severe dementia.

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Title: Informal carers' support needs when caring for a person with dementia - A

scoping literature review.

Citation: Scandinavian journal of caring sciences; Sep 2021; vol. 35 (no. 3); p. 685-700

Author(s): Holt Clemmensen, Trine; Hein Lauridsen, Henrik; Andersen-Ranberg, Karen;

Kaae Kristensen, Hanne

Objective: Informal carers of people with dementia report having unmet needs for support

and few supportive interventions have been shown to be effective. There is a need to

develop needs assessment instruments and supportive interventions with a holistic and

person-centred approach to meet the various and complex needs of carers. The aim of this

study was to provide an overview of carers' support needs when caring for people with

dementia with the objectives to map and synthesise knowledge on key concepts of carers'

support needs.

Methods: A scoping review methodology was used. A literature search was conducted in

PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019.

Three authors independently selected articles meeting the inclusion criteria, and data were

extracted using a matrix developed for that purpose. Inductive content analysis was used to

synthesise key concepts of carers' support needs.

Results: The search identified 2748 articles after removing duplicates, and 122 articles were

included in the mapping of carers' support needs. Synthesising carers' support needs

indicated that the full extent of support needs emerges in the interaction between the carer

and the person cared for and that it is possible to categorise support needs into four key

concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care,

and 4) knowledge of dementia.

Conclusion: The findings of this study help to map a framework describing carers' support

needs that may guide the development of future needs assessment instruments and

supportive interventions.

Title: Detection of dementia on voice recordings using deep learning: a Framingham

Heart Study.

Citation: Alzheimer's research & therapy; Aug 2021; vol. 13 (no. 1); p. 146

Author(s): Xue, Chonghua; Karjadi, Cody; Paschalidis, Ioannis Ch; Au, Rhoda;

Kolachalama, Vijaya B

Background: Identification of reliable, affordable, and easy-to-use strategies for detection of

dementia is sorely needed. Digital technologies, such as individual voice recordings, offer an

attractive modality to assess cognition but methods that could automatically analyze such

data are not readily available.

Methods and findings: We used 1264 voice recordings of neuropsychological

examinations administered to participants from the Framingham Heart Study (FHS), a

community-based longitudinal observational study. The recordings were 73 min in duration,

on average, and contained at least two speakers (participant and examiner). Of the total

voice recordings, 483 were of participants with normal cognition (NC), 451 recordings were

of participants with mild cognitive impairment (MCI), and 330 were of participants with

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dementia (DE). We developed two deep learning models (a two-level long short-term

memory (LSTM) network and a convolutional neural network (CNN)), which used the audio

recordings to classify if the recording included a participant with only NC or only DE and to

differentiate between recordings corresponding to those that had DE from those who did not

have DE (i.e., NDE (NC+MCI)). Based on 5-fold cross-validation, the LSTM model achieved

a mean (±std) area under the receiver operating characteristic curve (AUC) of 0.740 ± 0.017,

mean balanced accuracy of 0.647 ± 0.027, and mean weighted F1 score of 0.596 ± 0.047 in

classifying cases with DE from those with NC. The CNN model achieved a mean AUC of

0.805 ± 0.027, mean balanced accuracy of 0.743 ± 0.015, and mean weighted F1 score of

0.742 ± 0.033 in classifying cases with DE from those with NC. For the task related to the

classification of participants with DE from NDE, the LSTM model achieved a mean AUC of

0.734 ± 0.014, mean balanced accuracy of 0.675 ± 0.013, and mean weighted F1 score of

0.671 ± 0.015. The CNN model achieved a mean AUC of 0.746 ± 0.021, mean balanced

accuracy of 0.652 ± 0.020, and mean weighted F1 score of 0.635 ± 0.031 in classifying

cases with DE from those who were NDE.

Conclusion: This proof-of-concept study demonstrates that automated deep learning-driven

processing of audio recordings of neuropsychological testing performed on individuals

recruited within a community cohort setting can facilitate dementia screening.

Title: Using video consultations to support family carers of people living with

dementia.

Citation: Nursing older people; Aug 2021

Author(s): Madden, Gayle; Rose, Tom; Crystal, Lucy

Abstract: Established in 2019, the Lincolnshire Admiral Nurse Service supports family

carers of people living with dementia through psychosocial interventions. Before the

coronavirus disease 2019 (COVID-19) pandemic, the team provided home visits as

standard, but the fact that Lincolnshire is a large rural county affected the team's ability to

provide timely support to all the carers who needed it. In 2019-20, a practice development

project underpinned by participatory action research was undertaken to trial the use of video

consultations with carers. However, carers' uptake of video consultations was low and the

project was affected by the COVID-19 pandemic. This article describes the project and

discusses the findings of its evaluation. The Admiral Nurse team had mixed experiences and

felt that, overall, its support was more effective when delivered face to face. The project

provides insights into the challenges and benefits of video consultations for delivering

psychosocial interventions to carers of people living with dementia.

Title: Comparative efficacy of non-pharmacological interventions on behavioural and

psychological symptoms in elders with dementia: A network meta-analysis.

Citation: Nursing open; Sep 2021

Author(s): Li, Wenjie; Xu, Xiaofeng; Wu, Fen; Ni, Yuanyuan; Lan, Jun; Hu, Xiuying

Objective: To explore the best non-pharmaceutical interventions for improving the

behavioural and psychological symptoms in elders with dementia.

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Design: Bayesian network meta-analysis.

Methods: A comprehensive electronic literature search was performed in five English

databases and four Chinese databases to identify relevant randomized controlled trials

(RCTs) that were published up to 31 October 2019.

Results: A total of 41 RCTs were included in this network meta-analysis involving 5 different

non-pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT),

behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of

network meta-analysis showed that individualized nursing was the best in improving

depression, cognitive function, and activities of daily living of behavioural and psychological

symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms.

Reminiscence therapy was the best in improving neuropsychiatric symptoms.

Title: Dementia stigma reduction (DESeRvE) through education and virtual contact in

the general public: A multi-arm factorial randomised controlled trial.

Citation: Dementia (14713012); Aug 2021; vol. 20 (no. 6); p. 2152-2169

Author(s): Kim ; Richardson, Alice; Werner, Perla; Anstey, Kaarin J

Objective: To examine the efficacy of the Dementia Stigma Reduction (DESeRvE)

programme, aimed at reducing the general public dementia-related stigma utilising

'education' and 'contact' approaches.

Methods: A total of 1024 Australians aged between 40 and 87 years (M = 60.8, SD = 10.1)

participated in a factorial randomised controlled trial. This trial examined four conditions:

online education programme (ED), contact through simulated contact with people with

dementia and carers (CT), education and contact (ED+CT) and active control. Cognitive,

emotional and behavioural aspects of dementia-related stigma were measured with a

modified Attribution Questionnaire, and dementia knowledge was measured with the

Dementia Knowledge Assessment Scale at the baseline, immediately and 12 weeks after

the completion of the intervention.

Results: All four groups improved (reduction in scores) significantly from baseline to week

12 in dementia-related stigma, and the effects were stronger for those with higher baseline

stigma scores. Intervention groups also improved significantly from baseline in dementia

knowledge. Especially, the ED (β =.85, SE =.07; p <.001) and ED+CT (β =.78, SE =.08; p

<.001) groups at immediate follow-up and CT (β =.21, SE =.09; p <.05) and ED+CT (β =.32,

SE =.09; p <.001) at 12-week follow-up showed significant effects.

Conclusions: Findings suggest that DESeRvE can be a valuable tool to enhance public's

dementia knowledge and reduce dementia-related stigma, especially for those with higher

levels of stigma. Reduction in stigma, however, may take a longer time to achieve, whereas

improvement in dementia knowledge is instant.

Title: Making clinical care decisions with people living with dementia in hospital: An

integrative literature review.

Citation: International journal of nursing studies; Aug 2021; vol. 120 ; p. 103979

Author(s): Todd, Jo-Anne; Lawson, Charles; Grealish, Laurie

22

Background: As our population ages, the percentage of hospitalised patients diagnosed

with dementia is expected to rise. However, there is emerging evidence that people living

with dementia may experience discrimination and exclusion from decisions about their

clinical care. Although dementia affects cognition, many patients living with dementia want to

participate in decision-making processes relating to their clinical care in hospital.

Objective: Identify the processes associated with making decisions about clinical care with

people living with dementia in hospital.

Design: An integrative literature review.

Data sources: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus,

EMBASE (Ovid), MEDLINE (PubMED), PsycINFO and HeinOnline.

Review method: One author conducted the initial screening of titles, and two authors

screened in subsequent rounds for abstracts and full text. The process of making clinical

decisions was the outcome of interest. Articles about people with cognitive impairment that

did not include dementia, or decisions such as discharge planning or end of life care were

excluded. An inductive synthesis of the findings was undertaken.

Results: Nine articles were identified for review and included expert opinion or hypothetical

discussion (n=5), cross-sectional survey research (n=3), and qualitative research (n=1).

Three themes were identified: capacity for decision-making is conceptualised as 'all or

nothing'; there are no universal principles for including people living with dementia in

decision-making in acute care settings; and autonomy is recognised but superseded by

beneficence.

Conclusions: Contemporary hospital practice is focused on determining capacity for

decisions, with an all or nothing attitude to capacity, effectively excluding many people living

with dementia from participation in decisions. While there is limited evidence to guide

clinicians in this complex and situated process of making clinical decisions, emerging

models of supported decision-making require further evaluation in the hospital setting.

Title: The Association between Vision Impairment and Incidence of Dementia and

Cognitive Impairment: A Systematic Review and Meta-analysis.

Citation: Ophthalmology; Aug 2021; vol. 128 (no. 8); p. 1135-1149

Author(s): Shang, Xianwen; Zhu, Zhuoting; Wang, Wei; Ha, Jason; He, Mingguang

Background: The magnitude and direction of the association between vision impairment

and incident dementia and cognitive impairment in prospective cohort studies was estimated

by systematic review and meta-analysis. The global burden of dementia associated with

vision impairment then was estimated.

Clinical relevance: Because a predominant proportion of vision impairment is preventable

or treatable, investigating its association with dementia may help to identify an important

modifiable factor for the prevention of dementia.

Methods: A literature search was conducted using PubMed, Embase, Web of Science, and

Google Scholar on September 15, 2020. Relative risks (RRs) were pooled using random-

effects models and stratified analyses for subgroups representing different study

characteristics. Publication bias was evaluated with funnel plots and the Egger test. The

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global burden of dementia associated with vision impairment was estimated based on the

Global Burden of Disease Study data on the prevalence of dementia and vision impairment.

Results: In the meta-analysis of 14 prospective cohort studies with 6 204 827 participants

and 171 888 dementia patients, the pooled RR associated with vision impairment was 1.47

(95% confidence interval [CI], 1.36-1.60). In the meta-analysis of 12 prospective cohort

studies with 45 313 participants and 13 350 patients with cognitive impairment, the pooled

RR was 1.35 (95% CI, 1.28-1.41). Stratified analyses showed that the associations of vision

impairment with incident dementia and cognitive impairment were similar across methods of

vision assessment, length of follow-up, and study quality. The global number of people with

dementia associated with moderate or severe vision impairment in 2016 was 2.1 million

(80% uncertainty interval, 1.0-3.3 million), which accounted for 4.7% (95% CI, 2.3%-7.5%) of

the global burden of dementia. Economic inequality was significant for the burden of

dementia associated with vision impairment.

Discussion: The overall quality of the body evidence was low because of the observational

design of the studies included in the analysis. Vision impairment is associated with an

increased risk of both dementia and cognitive impairment in older adults. Screening and

treating vision impairment, especially in low- and middle-income countries, may help to

alleviate the global burden of dementia.

Title: Decreasing trend in the incidence and prevalence of dementia: a systematic

review.

Citation: Minerva medica; Aug 2021; vol. 112 (no. 4); p. 430-440

Author(s): Mayer, Flavia; Remoli, Giulia; Bacigalupo, Ilaria; Palazzesi, Ilaria; Piscopo,

Paola; Bellomo, Guido; Canevelli, Marco; Corbo, Massimo; Vanacore, Nicola; Lacorte,

Eleonora

Introduction: The progressive ageing of the population is one of the main socio-

demographic phenomena, taking place at a global level. Several recent population-based

studies conducted worldwide suggest that the age-specific risk of dementia may be

changing in some countries and areas.

Evidence acquisition: This systematic review was performed using the methodology

proposed by the Cochrane handbook for systematic reviews and reported following the

PRISMA statement. A structured bibliographic search was performed on the databases

PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews. All

included studies were qualitatively assessed using the Methodological Evaluation of

Observational REsearch (MORE).

Evidence synthesis: The bibliographic search yielded 2394 records. Three more articles

were retrieved from other sources. A total of ten studies were included, five reported data on

a possible reduction in the prevalence of dementia, and five reported data on a possible

reduction in its incidence.

Conclusions: The present systematic review focused on the recent observations of a

possible decrease in the frequency of dementia and cognitive impairment in some Western

countries (USA, UK, Sweden, the Netherlands, France, Iceland) between 1977 and 2014.

The included studies have a high heterogeneity in terms of the clinical criteria used to

diagnose dementia, and of the criteria used to define the clinical condition preceding

dementia, such as isolated cognitive impairment. Moreover, the methodological quality with

24

which they were conducted was also heterogeneous, with scores ranging from 1 to 7 using

the MORE tool.

Title: What are the perceptions of people living with dementia, family carers,

professionals and other potential stakeholders to the use of global positioning

systems to promote safer outdoor walking?: a qualitative literature review.

Citation: Disability and rehabilitation. Assistive technology; Aug 2021; vol. 16 (no. 6); p.

614-623

Author(s): Cooper, Janet; Burrow, Simon; Pusey, Helen

Objective: Walking outdoors has many benefits which can improve quality of life for people

living with dementia. However, due to the risk of getting lost, many people with dementia are

denied the opportunity to be outdoors. There has been increased interest in using global

positioning systems (GPS) to facilitate independent outdoor mobility for people with

dementia, but this interest has been accompanied by ethical debate focussing on the rights

of an individual with dementia to maintain privacy and autonomy. The objective was to

establish what people, those with dementia, those who provide support for people with

dementia and wider society perceive to be the issues around GPS use.

Method: An adapted qualitative systematic review was conducted between November 2018

and December 2018. Medical, social and technological databases were searched for papers

with no date restriction. Initial search terms displayed nine hundred and sixty citations. Titles

and if necessary abstracts were read to determine which studies might be potentially

relevant. Forty papers were identified as potentially relevant and their abstracts and

references examined. This produced a further four potential studies. Following application of

the exclusion criteria thirty papers were eliminated. Fourteen were accepted, appraised and

thematically analyzed.

Results: The ethical debate was reflected in the opinions of the study respondents. There

was a willingness to relinquish some privacy for safety but people with dementia were not

prepared to sacrifice their autonomy-believing they alone should decide whether GPS was

appropriate.

Conclusion: GPS was felt to have the potential to facilitate independent outdoor walking,

but systems need to be tailored to the individual. There is also a need to contradict negative

societal perceptions of the ability of people with dementia to live a fulfilled life which is in

danger of diminishing GPS's potential to improve quality of life for people with dementia.

Implications for rehabilitation: Whilst dementia is a disabling and incurable disease,

taking advantage of technological developments such as GPS can diminish its negative

impact. Appropriate development and use of GPSs offers the potential to enable people with

dementia to explore the outdoors independently with subsequent improvement in self-

confidence, independence and autonomy. Professionals working with people with dementia

need to be aware of the GPS technology available and the ethical issues involved to support

the use of GPS.

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Title: Adverse Events, Functional Decline, and Access to Allied Health Therapies for

Patients with Dementia During Acute Hospitalization.

Citation: Journal of applied gerontology : the official journal of the Southern Gerontological

Society; Aug 2021; vol. 40 (no. 8); p. 847-855

Author(s): Fox, Amanda; MacAndrew, Margaret; Wyles, Katy; Yelland, Catherine; Beattie,

Elizabeth

Abstract: The number of patients attending acute care hospitals with a diagnosis of

dementia is increasing. The impact of hospitalization on function and adverse events is

perceived to be greater for patients with dementia than those without. This study compared

adverse events (falls, wounds, delirium, medication errors, infections, and incontinence),

functional decline, and allied health therapy for patients with and without dementia (n = 240).

Patients with dementia experienced significantly more adverse events and constant

observation by staff, were more dependent with mobility, hygiene and feeding, more often nil

by mouth, confused, and incontinent. Patients with dementia were significantly more likely to

receive speech and physiotherapy, although they did not significantly improve in function

during their hospital stay. Conversely, patients without dementia significantly improved in

mobility and continence. The unique health care needs of patients with dementia need to

inform models of care, policy, and practice to support safe health care delivery in this

vulnerable population.

Title: Effects on staff outcomes and process evaluation of the educating nursing staff

effectively (TENSE) program for managing challenging behavior in nursing home

residents with dementia: A cluster-randomized controlled trial.

Citation: International journal of nursing studies; Aug 2021; vol. 120 ; p. 103982

Author(s): Bielderman, Annemiek; Nieuwenhuis, Aniek; Hazelhof, Theo J G M; van Gaal,

Betsie G I; Schoonhoven, Lisette; Akkermans, Reinier P; Spijker, Anouk; Koopmans,

Raymond T C M; Gerritsen, Debby L

Objective: Challenging behavior is prevalent in people with dementia residing in nursing

homes and places a high burden on the nursing staff of dementia special care units. This

study evaluates an educational program for nursing staff for managing challenging behavior:

The Educating Nursing Staff Effectively (TENSE) program. This program can be tailored to

care organizations' wishes and needs and combines various learning styles. The aim of this

cluster-randomized controlled trial was to examine the short-term (3 months) and long-term

(9 months) effects of the TENSE training program on experienced stress, work contentment,

and stress reactions at work in nursing staff working in dementia special care units.

Design: Cluster-randomized controlled trial.

Methods: Nursing staff members of 18 dementia special care units within nine nursing

homes from different Netherlands regions were randomized into an intervention (n = 168) or

control (n = 129) group. The TENSE program consisted of a three-day training course and

two follow-up sessions after three and six months, respectively. The primary outcome was

stress experienced by nursing staff measured with the Utrecht Burnout Scale - C. Secondary

outcomes were work contentment and stress reactions at work. Furthermore, process

26

evaluation data on the reach of and compliance with the program and the program's

feasibility and relevance were collected. Data were collected between November 2012 and

November 2014.

Results: In general, the participants appreciated the quality and relevance of the TENSE

training and evaluated the content of the training as beneficial. The TENSE training had no

effect on the components of experienced stress, i.e., emotional exhaustion (p = 0.751),

depersonalization (p = 0.701), and personal accomplishment (p = 0.182). Furthermore, no

statistically significant effects of the intervention on work contentment and stress reactions at

work were found.

Conclusions: The TENSE training program did not have an effect on experienced stress,

work contentment, nor stress reactions at work of nursing staff working in dementia special

care units. In future studies, more focus on practicing new skills seems needed.

Title: Implementing post diagnostic dementia care in primary care: a mixed-methods

systematic review.

Citation: Aging & mental health; Aug 2021; vol. 25 (no. 8); p. 1381-1394

Author(s): Frost, Rachael; Rait, Greta; Aw, Su; Brunskill, Greta; Wilcock, Jane; Robinson,

Louise; Knapp, Martin; Hogan, Nicole; Harrison Dening, Karen; Allan, Louise; Manthorpe,

Jill; Walters, Kate; PriDem team

Objectives: Concentrating post-diagnostic dementia care in primary care may lead to better

and more cost-effective care closer to home. We aimed to assess which intervention

components and contextual factors may contribute to the successful delivery and

implementation of primary care-led post-diagnostic dementia care.

Methods: Mixed-methods systematic review. We searched five databases (inception-March

2019) with reference list screening and citation tracking. We included studies evaluating

post-diagnostic dementia care interventions where primary care had a significant role in

dementia care, which assessed one or more implementation elements (acceptability,

feasibility, adoption, sustainability, reach, costs, appropriateness or fidelity). Two authors

independently critically appraised studies.

Results: Out of 4528 unique references, we screened 380 full texts and included 49

evaluations of services collecting implementation process data. Most services had high

acceptability ratings. The most acceptable components were information provision, social

and emotional support and links to community organisations. Feasibility was chiefly

influenced by provider engagement and leadership, building dementia care capacity,

sufficient resources/funding and collaboration. Care quality was maximised through adding

capacity from a dementia-specific health professional. On the basis of limited data, costs for

various primary care-led models did not substantially differ from each other.

Conclusion: A range of primary care-led dementia care models appear feasible and

acceptable. Future services should: add dementia-focussed health professionals into

primary care, develop primary care leadership and provide sufficient funding and

collaboration opportunities. Information, community service links and social and ongoing

support should be part of services. Further exploration of service reach and formalised

fidelity assessment are needed.

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Title: Goal setting for people with mild cognitive impairment or dementia in

rehabilitation: A scoping review.

Citation: Australian occupational therapy journal; Aug 2021

Author(s): Jogie, Praneeta; Rahja, Miia; van den Berg, Maayken; Cations, Monica; Brown,

Sarah; Laver, Kate

Objective: Goal setting is an integral part of the rehabilitation process and assists

occupational therapists to target therapy towards achieving meaningful outcomes. People

with mild cognitive impairment or dementia may experience barriers participating in goal

setting due to preconceptions that the person cannot participate owing to changes in both

cognitive and communicative abilities. The aim of this review was to identify goal setting

approaches, common goals identified, and enablers and barriers to goal setting for people

with mild cognitive impairment or dementia participating in specific rehabilitation

programmes.

Methods: Four electronic databases were searched in April 2020 for English language

articles that described goal setting processes during a rehabilitation programme for people

with mild cognitive impairment or dementia. Studies of all designs were included. Two

authors screened citations and full text articles. Data were extracted, synthesised, and

presented narratively.

Results: Twenty-seven studies met the eligibility criteria. Both structured and nonstructured

goal setting methods were used with common tools including the Canadian Occupational

Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The

nature of goals tended to depend on the scope of the rehabilitation programme in which the

person was involved. Goal setting was more difficult for people with more advanced

symptoms of dementia and when staff lacked skills and experience working with people with

dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport,

individualisation of goals, and family involvement were reported to be beneficial.

Conclusion: Collaborative goal setting is a foundation of rehabilitation for people with

dementia and should not be avoided due to preconceptions that the person cannot

participate. Results suggests that occupational therapists can use a number of strategies to

maximise participation and engagement and play a pivotal role in upskilling staff to enable

effective goal setting for people with mild cognitive impairment or dementia.

Title: Resilience and supporting people living with dementia during the time of

COVID-19; A qualitative study.

Citation: Dementia (London, England); Aug 2021 ; p. 14713012211036601

Author(s): Hanna, Kerry; Giebel, Clarissa; Butchard, Sarah; Tetlow, Hilary; Ward, Kym;

Shenton, Justine; Cannon, Jacqueline; Komuravelli, Aravind; Gaughan, Anna; Eley, Ruth;

Rogers, Carol; Rajagopal, Manoj; Limbert, Stan; Callaghan, Steve; Whittington, Rosie;

Shaw, Lisa; Donnellan, Warren; Gabbay, Mark

Objectives: To explore the different factors of resilience for people living with dementia and

unpaid carers, in response to sudden changes in care and lifestyle during the COVID-19

pandemic.

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Methods: Unpaid carers and people living with dementia were offered telephone interviews

in April 2020 to discuss their experiences since the COVID-19 pandemic. Participants were

asked about the benefits and challenges of accessing dementia support, as well as coping,

symptoms, strategies and impacts. Each transcript was analysed using inductive and

deductive thematic analysis by two researchers.

Findings: Semi-structured interviews from 50 participants (n = 42 unpaid carers and n = 8

people living with dementia) reported protective and risk factors of resilience concerning (1)

communication, (2) adaptations, (3) support networks and (4) lifestyle factors and coping

mechanisms.

Conclusions: Resilience factors considered both organisational factors for external support,

along with individual coping mechanisms. Organisations and social support services should

consider resilience factors in future service planning, to better support people living with

dementia, or caring someone living with dementia, during times of great stress. The

ecological model of resilience established from this research refers to resilience during times

of unexpected change in the COVID-19 pandemic; however, it could be considered relevant

in other periods of high stress within this cohort.

Title: Exploring the Role of Web-Based Interventions in the Self-management of

Dementia: Systematic Review and Narrative Synthesis.

Citation: Journal of medical Internet research; Jul 2021; vol. 23 (no. 7); p. e26551

Author(s): Lee, Abigail Rebecca; Gerritzen, Esther Vera; McDermott, Orii; Orrell, Martin

Background: The increasing prevalence of dementia has promoted a move toward

equipping people with the skills required for greater self-management of the condition to

enable a better quality of life. Self-management encompasses numerous skills, such as goal

setting and decision making, which aim to improve an individual's physical and mental well-

being when they live with long-term health conditions. Effective self-management may lead

to increased well-being and quality of life. Reviews of web-based and app-based

interventions have suggested that they have the potential to provide self-management

support for people living with a range of conditions, including dementia.

Objective: The aim of this review is to explore the existing use of web-based or app-based

interventions that facilitate or support self-management in dementia and discuss their

effectiveness in promoting self-management and independence.

Methods: A total of 5 electronic databases were systematically searched for relevant

articles published between January 2010 and March 2020. Included studies were appraised

using the Downs and Black checklist and the Critical Appraisal Skills Program qualitative

research checklist. A narrative synthesis framework was applied using tables and

conceptual mapping to explore the relationships within and among studies.

Results: A total of 2561 articles were identified from the initial search, of which 11 (0.43%)

met the inclusion criteria for the final analysis. These included 5 quantitative, 4 mixed

methods, and 2 qualitative studies. All the included articles were of fair to high quality across

the two appraisal measures. Interventions were delivered through a range of web-based and

app-based technologies and targeted several self-management concepts. However, there

was inconsistency regarding the domains, often affected by dementia, that were targeted by

the interventions reviewed.

Conclusions: Web-based and app-based interventions for dementia can be delivered

through a range of means and can target different aspects of self-management. The small

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number of studies included in this review report positive outcomes that seem to support the

use of these interventions for people living with dementia. However, there is a clear need for

more high-quality research into this type of intervention delivery and for studies that use a

much larger number of participants across the dementia spectrum. Future research should

consider the barriers to and facilitators of intervention adoption highlighted in this review and

whether interventions can encompass the physical, social, cognitive, and emotional domains

affected by dementia.

Title: Avoiding repair, maintaining face: Responding to hard-to-interpret talk from

people living with dementia in the acute hospital.

Citation: Social science & medicine (1982); Aug 2021; vol. 282 ; p. 114156

Author(s): Pilnick, Alison; O'Brien, Rebecca; Beeke, Suzanne; Goldberg, Sarah; Harwood,

Rowan

Abstract: People living with dementia (PLWD) are almost always admitted to the acute

hospital for reasons unrelated to their dementia, finding themselves in the unfamiliar

environment of a Health Care of Older Persons acute ward. The effect of this environment

creates a challenge not just for a PLWD themselves, but also for the staff who care for them.

Concerns have been raised by both policy makers and staff about the quality of

communication between hospital staff and PLWD. Using conversation analysis, we

examined 41 video recordings of healthcare professional (HCP)/PLWD interactions collected

across three acute inpatient wards in a large teaching hospital in the UK. In this paper, we

focus our analysis on hard-to-interpret talk (talk where there are problems in hearing,

speaking and/or understanding), and the ways in which healthcare professionals respond to

this. Repair of hard- to- interpret talk is common in ordinary interaction, but we find that

HCPs in this setting use a range of approaches to avoid direct repair. These approaches

are: the use of non-committal responses and continuers such as 'yeah' or nods; the use of

repetitions or partial repetitions; responding to the emotional tone displayed in the PLWD's

utterance; closing the current topic and shifting to the next; and treating the PLWD's talk as

related to the task at hand. We suggest that the use of these approaches may be one way in

which HCPs manage respecting the personhood of the PLWD, by preserving face and

enabling a continuation of an interaction in which the PLWD can take an active part. Our

paper provides an empirical demonstration of the high level of interactional skill involved in

dementia care work. It also illustrates how these skills can be described and specified, and

hence incorporated into the recommendations and tips that are produced for communication

with PLWD.

Title: Essential oil therapy for the short-term treatment of behavioral and

psychological symptoms of dementia: a monocentric randomized pilot study.

Citation: Aging clinical and experimental research; Aug 2021; vol. 33 (no. 8); p. 2251-2259

Author(s): Mascherona, Ilenia; Ferretti, Michele; Soldini, Emiliano; Biggiogero, Maira;

Maggioli, Caterina; Fontana, Pio Eugenio

Objective: The behavioral and psychological symptoms of dementia (BPSD) can be

severely distressing for both patients and caregivers. This study assessed the efficacy of

30

environmental diffusion essential oil therapy (EOT) combined with psychotropic drug therapy

(group A) in BPSD management, compared with psychotropic drug therapy alone (group B).

The stress responses of attending caregivers were also assessed.

Methods: Thirty-two patients with dementia and BPSD were enrolled. The presence and

severity of BPSD were assessed using the Italian version of the NPI-NH scale, which also

measures the stress felt by professional caregivers. Global geriatric evaluations were

performed to rule out acute diseases that could contribute to delirium and worsen patients'

mental status.

Results: Following treatment, the average NPI-NH value was significantly reduced in group

A compared with group B (p < 0.001). Caregiver distress was also significantly reduced in

group A (p < 0.01).

Discussion: This pilot study showed that BPSD were better treated using EOT combined

with standard pharmacological treatment, compared with standard pharmacological

treatment alone. No adverse effects of EOT were observed. Reductions in caregiver distress

could be due either to reductions in BPSD severity and frequency resulting in decreased

caregiver burden, and/or the emotional benefit for caregivers of exposure to essential oils.

Conclusions: This study supports the combined use of EOT and psychotropic drugs in the

treatment of BPSD. Essential oils may improve the wellbeing of both patients and

caregivers, without adverse effects. Additionally, EOT is easy to administer by environmental

diffusion.

Title: Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses

Working in a Specialized Dementia Unit.

Citation: Dementia and geriatric cognitive disorders; Aug 2021 ; p. 1-8

Author(s): Cheon, Chin Yee; Tay, Felicia Hui En; Choo, Juliet; Yap, Philip Lin Kiat

Objective: Person-centred care (PCC) is synonymous with best practice in the care of

persons with dementia. However, the research focus has been in long-term care settings

with less attention in acute hospitals. We aimed to study the perspectives and experiences

of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally

Infirm Elders [CAMIE]).

Method: This was an exploratory qualitative study involving individual, face-to-face, semi-

structured in-depth interviews. A purposive sample of 10 nurses participated in the interview.

We employed an inductive thematic analysis approach to analyse the qualitative data.

Results: The findings highlighted the positive experiences, for example, meaningful

connection with patients and the challenges, for example, managing challenging behaviour

in providing PCC. The initial challenges were due to a lack of prior knowledge and

experience. Through formal and informal learning, the nurses built confidence and

competence, and also provided support to one other. They emphasized the importance of

teamwork and camaraderie in the CAMIE team but raised concerns about the negative

perceptions of non-CAMIE nurses on the value of their work.

Conclusion: Despite the challenges, adequate knowledge and robust organizational level

support are the key support for nurses to embrace PCC as their care ethos in the acute care

setting.

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Title: Effectiveness of robot therapy in the management of behavioural and

psychological symptoms for individuals with dementia: A systematic review and

meta-analysis.

Citation: Journal of psychiatric research; Aug 2021; vol. 140 ; p. 381-394

Author(s): Ong, Yoke Chin; Tang, Arthur; Tam, Wilson

Abstract: Robot therapy presents a promising alternative in dementia care. However, its

effectiveness has not been verified comprehensively. This systematic review and meta-

analysis aim at evaluating the effectiveness of robot therapy in the management of

behavioural and psychological symptoms for individuals with dementia. Studies assessing

the effectiveness of robot therapy were identified using 10 academic research databases:

CENTRAL, CINAHL, CNKI, The Cochrane Library, Embase, IEEE Xplore, MEDLINE,

PubMed, Scopus, and ProQuest Dissertations & Theses. Additional references were

identified from the reference lists of included studies and relevant reviews. Data extraction

and risk of bias assessment were conducted independently by two review authors. Meta-

analyses and subgroup analyses were performed and the heterogeneity of studies was

examined. 18 published articles from 14 studies involving a total of 1256 participants were

included. Participants with robot therapy had a significant decrease in agitation (SMD -0.38,

95% CI -0.66, -0.09; p = 0.01) and a significant increase in social interaction (SMD 0.49,

95% CI 0.01, 0.97; p = 0.04) while effects for depression, anxiety, cognitive status, and

quality of life were not statistically significant. Results from this review show that robot

therapy can effectively reduce agitation and increase social interactions for individuals with

dementia. Future clinical practice should consider the potential of robot therapy as an option

to be implemented into current dementia programmes. Further large-scale trials are required

for the thorough investigation of different intervention formats and robot types, while

considering potential confounding factors.

Title: The Effects of Individualized Music Listening on Affective, Behavioral,

Cognitive, and Sundowning Symptoms of Dementia in Long-Term Care Residents.

Citation: Journal of aging and health; Aug 2021; p. 8982643211033407

Author(s): Lineweaver, Tara T; Bergeson, Tonya R; Ladd, Kendall; Johnson, Heather;

Braid, Donald; Ott, Monica; Hay, Donald P; Plewes, John; Hinds, Mary; LaPradd, Michelle L;

Bolander, Hannah; Vitelli, Sarah; Lain, Mikala; Brimmer, Tim

Objectives: This study aimed to replicate music's positive effects on dementia-related

symptoms, determine whether a 6-month intervention would lead to greater positive

outcomes than typical 3- to 4-month interventions, and examine changes in sundowning

symptoms after music listening.

Methods: 282 nursing home residents with dementia listened to personalized music

playlists 1-3 times weekly for 30 minutes across 6 months. Standardized assessments of

affect, behavior, and cognition and direct observations of sundowning symptoms comprised

the outcomes.

Results: Results documented significant improvements in residents' general

neuropsychiatric symptoms, agitation, and depression across the first 3 months, but no

additional improvements across the subsequent 3 months. Seven sundowning symptoms

32

significantly improved following music listening, with some (e.g., disengagement) being more

amenable to music than others (e.g., aggression).

Discussion: Results support short-term individualized music listening as an effective non-

pharmacological approach for improving dementia-related symptoms in nursing home

residents and suggest new applications of music-related interventions

Sources Used:

The following databases are used in the creation of this bulletin: Amed, British Nursing

Index, Cinahl & Medline.

Disclaimer

The results of your literature search are based on the request that you made, and consist of

a list of references, some with abstracts. Royal United Hospital Bath Healthcare Library will

endeavour to use the best, most appropriate and most recent sources available to it, but

accepts no liability for the information retrieved, which is subject to the content and accuracy

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the interpretation or application of these results, which are not intended to provide advice or

recommendations on patient care.