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Preoperative comprehensive geriatric assessment and multidisciplinary team input in older people undergoing elective orthopaedic surgery: A feasibility trial 对接受择期骨科手术的老年人进行术前老年病综合评估和多学科团队参与:可行性试验。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-03-18 DOI: 10.1111/ajag.13302
Anna Mearns, Amanda Tsan Yue Siu, Melisa Birdling, Thomas Geddes, Helen Kenealy

Objective

To determine the feasibility of preoperative comprehensive geriatric assessment (CGA) and multidisciplinary team (MDT) input for older people undergoing elective orthopaedic surgery in a tertiary New Zealand setting.

Methods

This single-centre retrospective study included elective orthopaedic patients older than 65 years (and Māori/Pasifika aged greater than 55 years) with hyperpolypharmacy, frailty, neurocognitive disorders and poor functional status. Patients attended a preoperative clinic where they had a geriatrician-led CGA along with MDT input. The feasibility of this preoperative model was assessed using outcomes of acceptability, accessibility and adherence. A qualitative description of patient demographics along with clinic assessment and interventions further describes this pilot experience.

Results

Sixty patients met inclusion criteria. This group were vulnerable older people (median age 77 years), with a high incidence of hyperpolypharmacy (85%), frailty (80%) and neurocognitive disorders (30%). Acceptability was high (97%), along with CGA accessibility (100%); however, MDT accessibility varied (53–90%). Adherence to MDT intervention was low; with only 26% of patients completing physiotherapy sessions and only 29% adhering to dietary advice. Accurate recall was a significant factor contributing to poor adherence. Comprehensive geriatric assessment was demonstrated to be a broad and flexible intervention.

Conclusions

CGA with MDT input is an acceptable and accessible intervention to be utilised as part of improved preoperative care for the older person undergoing elective orthopaedic surgery. Further consideration around methods to increase adherence in this patient group should be explored. Future research should focus on refining the intervention, and quantifying impact on patient outcomes.

目的确定在新西兰一家三级医院接受择期骨科手术的老年人术前综合老年评估(CGA)和多学科团队(MDT)投入的可行性:这项单中心回顾性研究纳入了65岁以上(毛利人/帕西菲卡人55岁以上)、患有多药、虚弱、神经认知障碍和功能状况不佳的择期骨科患者。患者在术前门诊接受由老年病学专家主导的 CGA 治疗,并由医疗小组提供意见。这种术前模式的可行性通过可接受性、可及性和依从性等结果进行评估。对患者人口统计学、诊所评估和干预措施的定性描述进一步说明了这一试点经验:结果:60 名患者符合纳入标准。这些患者都是易受伤害的老年人(中位年龄 77 岁),多药(85%)、虚弱(80%)和神经认知障碍(30%)的发病率很高。他们对 CGA 的可接受性(97%)和可及性(100%)都很高;但对 MDT 的可及性却不尽相同(53%-90%)。坚持接受 MDT 干预的比例较低;只有 26% 的患者完成了物理治疗疗程,只有 29% 的患者坚持接受饮食建议。准确回忆是导致坚持率低的一个重要因素。综合老年评估被证明是一种广泛而灵活的干预措施:有多学科小组参与的 CGA 是一种可接受、可利用的干预措施,可作为改善接受择期骨科手术的老年人术前护理的一部分。应进一步考虑如何提高该患者群体的依从性。未来的研究应侧重于完善干预措施,并量化对患者预后的影响。
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引用次数: 0
Chinese-Australian carers' perceived needs and preferences in planning to embed an iSupport for Dementia program in aged care services 华裔澳大利亚照护者在计划将痴呆症 iSupport 项目嵌入老年照护服务中的感知需求和偏好。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-28 DOI: 10.1111/ajag.13287
Ying Yu, Lily Xiao, Ada Cheng, Ivan Wang, Kam Chiu, Eliza Chan, Candy Xie, Yunrui Zhou, Zoey Zhuang, Jing Wang

Objective

To assess Chinese-Australian carers' needs and preferences through co-design strategies with stakeholders to embed an evidence-based iSupport for Dementia program into routine community aged care services in Chinese ethno-specific aged care organisations.

Methods

A cross-sectional survey was conducted from July to August 2022 in three Chinese ethno-specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services.

Results

A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web-based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences.

Conclusions

Chinese-Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno-specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia.

目标:通过与利益相关者共同设计策略,评估澳大利亚华裔照护者的需求和偏好,以便将基于证据的痴呆症iSupport项目纳入华裔养老机构的常规社区养老服务:2022年7月至8月,我们在澳大利亚的三家华裔养老机构开展了一项横断面调查。我们采用单变量分析来检验在将痴呆症iSupport项目纳入社区养老服务常规实践时,与照护者需求和偏好相关的变量:共有 101 名照护者完成了调查。在我们的研究中,大多数照护者都希望 iSupport 程序能以他们的母语提供,有一名程序主持人来引导程序,并希望在程序中与同伴互动。大多数照护者表示,他们愿意用分配给家庭护理计划的预算来支付 iSupport 计划的费用。与 65 岁以上的照护者相比,年轻的照护者(65 岁以下)和成年子女的照护者更有可能使用基于网络的 iSupport 手册并邀请其家庭成员参加该计划。其他人口特征与他们的需求和偏好没有明显关联:在这项研究中,华裔澳大利亚人照顾者所感知到的需求和偏好将为实施文化定制的 iSupport 计划提供参考,该计划将被纳入由华裔特定养老机构提供的社区养老服务中。研究结果还将为澳大利亚其他不同文化和语言社区的照护者提供在文化和语言上一致的 iSupport 计划。
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引用次数: 0
Face and content validity of a mobile delirium screening tool adapted for use in the medical setting (eDIS-MED): Welcome to the machine 适用于医疗环境的移动谵妄筛查工具(eDIS-MED)的面效和内容效度:欢迎使用机器。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-28 DOI: 10.1111/ajag.13288
Eamonn Eeles, Oystein Tronstad, Andrew Teodorczuk, Dylan Flaws, John F Fraser, Nadeeka Dissanayaka

Objectives

Following a user-centred redesign and refinement process of an electronic delirium screening tool (eDIS-MED), further accuracy assessment was performed prior to anticipated testing in the clinical setting.

Methods

Content validity of each of the existing questions was evaluated by an expert group in the domains of clarity, relevance and importance. Questions with a Content Validity Index (CVI) <0.80 were reviewed by the development group for potential revision. Items with CVI <0.70 were discarded. Next, face validity of the entirety of the tests was conducted and readability measured.

Results

A panel of five clinical experts evaluated the test battery comprising eDIS-MED. The content validity process endorsed 61 items. The overall scale CVI was 0.92. Eighty-eight per cent of the responses with regard to question relevancy, usefulness and appropriateness were positive. The questions were deemed fifth grade level and very easy to read.

Conclusions

A revised electronic screening tool was shown to be accurate according to an expert group. A clinical validation study is planned.

目的对电子谵妄筛查工具(eDIS-MED)进行以用户为中心的重新设计和改进后,在临床环境中进行预期测试之前,对其准确性进行了进一步评估:方法:专家组从清晰度、相关性和重要性三个方面对每个现有问题的内容有效性进行了评估。内容有效性指数(CVI)结果:由五位临床专家组成的专家小组评估了 eDIS-MED 测试系统。内容效度程序认可了 61 个项目。总体量表 CVI 为 0.92。在问题的相关性、有用性和适当性方面,88%的回答是肯定的。问题被认为具有五年级水平,非常容易阅读:专家组认为,经修订的电子筛查工具是准确的。计划进行临床验证研究。
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引用次数: 0
Dementia in Australia: Clinical recommendations post-diagnosis 澳大利亚的痴呆症:诊断后的临床建议
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-26 DOI: 10.1111/ajag.13291
David Foxe, Mirelle D'Mello, Sau Chi Cheung, Julane Bowen, Olivier Piguet, Yun Tae Hwang

The delivery of a dementia diagnosis, the information provided, and the practical advice and support arranged can have a long-lasting impact on patients and their families and deserves attention equal to that given to the assessment and investigation process. Patients and their families need a constructive yet sensitive conversation about the nature and cause of their difficulties, communicated in plain language, and tailored to their main concerns and needs. This conversation should lead to the provision of high-quality, easily accessible information. Following this, clinicians may wish to consider broaching the following dementia topics: (1) pharmacological and non-pharmacological interventions, (2) connection and integration with relevant organisations, (3, 4) application for formal support services and engagement with support teams, (5) safety in the home, (6, 7) financial planning, guardianship and legal matters, (8) driving eligibility, (9) support and education resources to family carers and (10) research initiatives and genetic information. Addressing these topics will contribute to improved disease management, which is likely to improve the dementia journey for the patient, their carer(s), and family.

对痴呆症的诊断、所提供的信息以及所安排的实际建议和支持,会对患者及其家属产生长期的影响,值得与评估和调查过程同等重视。患者及其家属需要就其困难的性质和原因进行建设性而又敏感的对话,以通俗易懂的语言进行交流,并针对其主要关切和需求进行调整。这种对话应导致提供高质量、易于获取的信息。在此之后,临床医生不妨考虑探讨以下痴呆症话题:(1) 药物和非药物干预;(2) 与相关组织的联系和整合;(3, 4) 申请正式支持服务并与支持团队接触;(5) 居家安全;(6, 7) 财务规划、监护和法律事务;(8) 驾驶资格;(9) 为家庭照护者提供支持和教育资源;(10) 研究计划和遗传信息。解决这些问题将有助于改善疾病管理,从而有可能改善患者、其照护者和家人的痴呆症生活。
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引用次数: 0
Evaluating a virtual reality dementia training experience using psychophysiological methods: A randomised controlled study 使用心理生理学方法评估虚拟现实痴呆症培训体验:随机对照研究
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-26 DOI: 10.1111/ajag.13294
Andrew Stafford, Stuart Bender, Kiran Parsons, Billy Sung

Objectives

Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training.

Methods

Twenty-two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self-reported scales.

Results

Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean .012 mV vs. video .005 mV, F[1, 20] = 8.70, p = .01; negative emotion fEMG: VR mean .018 mV vs. video .008 mV, F[1, 20] = 18.40, p < .001). Self-ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR .1 t = .07, df = 9, p = .95 vs. video −2.3 t = −2.265, df = 11, p = .045).

Conclusions

Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia.

虚拟现实(VR)越来越多地被用于痴呆症护理人员的培训。在改善执业护士对痴呆症的护理方面,虚拟现实技术是否优于传统的培训技术,目前还不得而知。本研究比较了 VR 应用程序与基于视频的非沉浸式培训对护士对痴呆症患者的知识和态度的影响。
{"title":"Evaluating a virtual reality dementia training experience using psychophysiological methods: A randomised controlled study","authors":"Andrew Stafford,&nbsp;Stuart Bender,&nbsp;Kiran Parsons,&nbsp;Billy Sung","doi":"10.1111/ajag.13294","DOIUrl":"10.1111/ajag.13294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self-reported scales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean .012 mV vs. video .005 mV, <i>F</i>[1, 20] = 8.70, <i>p</i> = .01; negative emotion fEMG: VR mean .018 mV vs. video .008 mV, <i>F</i>[1, 20] = 18.40, <i>p</i> &lt; .001). Self-ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR .1 <i>t</i> = .07, df = 9, <i>p</i> = .95 vs. video −2.3 <i>t</i> = −2.265, df = 11, <i>p</i> = .045).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"43 3","pages":"523-532"},"PeriodicalIF":1.4,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajag.13294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139969091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A randomised controlled pilot study of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls 针对有跌倒史的社区老年人开展的任天堂 Ring Fit Adventure™ 平衡与强化锻炼项目随机对照试验研究
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-26 DOI: 10.1111/ajag.13297
Wayne Lap Sun Chan, Cody Wing Lam Chan, Howard Ho Wing Chan, Kelvin Chi Kin Chan, Jerry Sai Kit Chan, Oscar Lok Wang Chan

Objectives

This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™-based balance and muscle strengthening exercise program in community-dwelling older adults with a history of falls.

Methods

Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self-perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini-BESTest), lower limb muscle strength (Five-Time Sit-to-Stand test), mobility (Timed-Up and Go test), dual-task ability (Timed-Up and Go test—Dual Task), fear of falling (Icon-FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks.

Results

Thirty-one participants (74%) finished the 8-week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p < .031). The mean scores of the self-perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ± .53, 3.08 ± .59, and 3.47 ± .57 respectively. A significant improvement in the anticipatory subscore of the Mini-BESTest was found in the experimental group compared to the control group (p = .02; Partial eta squared = .14).

Conclusions

The Nintendo Ring Fit Adventure™-based exercise program was feasible, acceptable, and potentially effective in community-dwelling older adults with a history of falls.

这项试点研究考察了基于任天堂 Ring Fit Adventure™ 的平衡和肌肉强化锻炼计划的可行性、可接受性和效果,该计划适用于有跌倒史的社区老年人。
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引用次数: 0
Implicit attitudes towards dementia after education: Preliminary trial results from Japan 教育后对痴呆症的内隐态度:日本的初步试验结果。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-15 DOI: 10.1111/ajag.13284
Hiroshige Matsumoto, Haruno Suzuki, Haruna Kugai, Manami Takaoka, Mariko Sakka, Kenichiro Ito, Noriko Yamamoto-Mitani, Ayumi Igarashi

Objective

This study aimed to investigate the feasibility and validity of measuring implicit attitudes towards dementia in adults and older adults and evaluate the impact of dementia-friendly education using virtual reality (VR) on implicit attitudes.

Methods

This study was a secondary analysis of data from a randomised controlled trial. Community members in Tokyo aged 20–90 years participated in dementia-friendly education with or without VR. At the end of the dementia-friendly education programs, implicit attitudes towards dementia were measured using the Implicit Relational Assessment Procedure (IRAP).

Results

Of the 145 participants, 89 (61%) started the IRAP, and 21 (15%) completed it. Lower age was significantly associated with the start/completion of the IRAP, and the age thresholds at which 50% of participants would not start/complete it were estimated to be 72.3/44.8 years, respectively. Those who had experience interacting with people with dementia other than family members had lower IRAP scores than those who had no such experience. The intervention group participating in the VR program had lower IRAP scores than the control group (p = .09).

Conclusions

Although measuring implicit attitudes using IRAP is deemed not feasible for people in their 70s and older, the differences in interaction experience would be evidence supporting the validity of the measurements of implicit attitudes towards dementia. The results suggest that dementia-friendly education, using VR, improves implicit attitudes towards dementia.

研究目的本研究旨在调查测量成年人和老年人对痴呆症的内隐态度的可行性和有效性,并评估使用虚拟现实(VR)开展痴呆症友好教育对内隐态度的影响:本研究是对一项随机对照试验数据的二次分析。年龄在 20-90 岁之间的东京社区成员参加了使用或不使用虚拟现实技术的痴呆症友好教育。在痴呆症友善教育项目结束时,使用内隐关系评估程序(IRAP)测量了参与者对痴呆症的内隐态度:在 145 名参与者中,89 人(61%)开始了 IRAP,21 人(15%)完成了 IRAP。年龄越小,开始/完成 IRAP 的可能性越大,据估计,50% 的参与者不会开始/完成 IRAP 的年龄阈值分别为 72.3/44.8 岁。与痴呆症患者(家庭成员除外)有过互动经验的参与者的 IRAP 分数低于没有此类经验的参与者。参加虚拟现实项目的干预组的 IRAP 分数低于对照组(P = .09):尽管使用 IRAP 对 70 岁及以上的老人进行内隐态度测量被认为是不可行的,但互动经验的差异将成为支持痴呆症内隐态度测量有效性的证据。研究结果表明,使用虚拟现实技术开展痴呆症友好教育可改善人们对痴呆症的内隐态度。
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引用次数: 0
My Hakka grandmother 我的客家祖母
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-15 DOI: 10.1111/ajag.13286
Susan Ogle, Eileen Chong
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引用次数: 0
Australian medical practitioners' perspectives about current practice relating to fitness to drive assessment for older people with dementia and mild cognitive impairment: A qualitative study 澳大利亚执业医师对当前痴呆症和轻度认知障碍老年人驾驶能力评估实践的看法:定性研究。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-11 DOI: 10.1111/ajag.13281
Claire Spargo, Kate Laver, Angela Berndt, Zoe Adey-Wakeling, Stacey George

Objectives

To describe the perspectives of Australian medical practitioners about current practice, and the potential benefit of tools and resources to support fitness to drive assessment for older people with dementia and mild cognitive impairment (MCI).

Methods

Semi-structured interviews with 22 medical practitioners from cognitive/memory clinics, hospitals, general practice and driving fitness assessment services in Australia. Reflexive thematic analysis was conducted.

Results

Two overarching themes were generated: (1) Uncomfortable decisions, describing feelings of discomfort expressed by practitioners about making fitness to drive recommendations, with two subthemes: (a) ‘Feeling uncertain’ and (b) ‘Sticking your neck on the line’; and (2) Easing the discomfort, describing participants' desire for tools/resources to support practitioners to increase comfort with fitness to drive recommendations, with two subthemes: (a) ‘Seeking certainty’ and (b) ‘Focusing on the process’ conveying two different perspectives about how this may be achieved. There was a desire for a new in-office assessment tool capable of accurately predicting fitness to drive outcomes and views that an evidence-based clinical pathway could improve practitioners' confidence in decision-making.

Conclusions

Perceptions of discomfort relating to fitness to drive assessment of older people with dementia and MCI exist amongst medical practitioners from health-care settings across Australia. In the absence of a well-validated in-office assessment tool, practitioners may benefit from an evidence-based clinical pathway to guide driving recommendations.

目的描述澳大利亚医疗从业人员对当前实践的看法,以及支持痴呆症和轻度认知障碍(MCI)老年人驾驶能力评估的工具和资源的潜在益处:对来自澳大利亚认知/记忆诊所、医院、全科诊所和驾驶能力评估服务机构的 22 名医疗从业人员进行了半结构式访谈。对访谈结果进行了反思性主题分析:结果:产生了两个首要主题:(1) 不舒服的决定,描述了从业人员在提出驾驶能力建议时所表达的不舒服的感觉,其中有两个次主题:(a) "感觉不确定";(b) "不舒服":(2)缓解不适感,描述了参与者对工具/资源的渴望,以支持从业人员提高驾驶适宜性建议的舒适度,有两个次主题:(a) "寻求确定性 "和(b) "关注过程",传达了关于如何实现这一目标的两种不同观点。人们希望有一种新的诊室评估工具,能够准确预测 "适合驾驶 "的结果,并认为以证据为基础的临床路径可以提高从业人员对决策的信心:结论:澳大利亚各地医疗机构的执业医师在对老年痴呆症和 MCI 患者进行驾驶能力评估时存在不适感。由于缺乏经过充分验证的诊室评估工具,从业人员可能会受益于循证临床路径,以指导驾驶建议。
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引用次数: 0
Effect of cognitive training on cognitive function in community-dwelling older people with mild-to-moderate dementia: A single-blind randomised controlled trial 认知训练对轻度至中度痴呆症社区居住老年人认知功能的影响:单盲随机对照试验
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-02-11 DOI: 10.1111/ajag.13283
Thanwarat Chantanachai, Daina L. Sturnieks, Stephen R. Lord, Jacqueline C. T. Close, Susan E. Kurrle, Kim Delbaere, Narelle Payne, Roslyn Savage, Morag E. Taylor

Objectives

The purpose of this assessor-blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild-to-moderate dementia.

Methods

The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6-month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370).

Results

Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6- or 12-months (between-group differences [95% CI] for primary outcomes at 6-months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT-A 2.7 s [−14.1, 19.5]; TMT-B −17.1 s [−79.3, 45.2]). At the 12-month follow-up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver-rated participant quality of life and higher caregiver quality of life compared to control.

Conclusions

This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia.

试验目的这项评估者盲法随机对照试验旨在确定计算机化认知训练(CT)对61名轻度至中度痴呆症患者的执行功能、处理速度和工作记忆的影响:主要结果是在完成为期 6 个月的干预后,进行前向数字跨度和寻迹测试 (TMT)。次要结果包括认知和体能表现、跌倒率、参与者和照顾者的生活质量以及 CT 程序的可用性和坚持性。该研究已在澳大利亚和新西兰临床试验注册中心注册(ACTRN12617000364370):结果:干预组(n = 31)参与者平均每周做 CT 81 分钟,系统可用性评分尚可(参与者:68.8 ± 22.1;护理者:79.4 ± 23.5)。在 6 个月或 12 个月时,干预组和对照组在认知或体能表现结果上没有明显的统计学差异(6 个月时主要结果的组间差异 [95% CI]:前向数字跨度 -0.3 [-0.8, 0.3];TMT-A 2.7 s [-14.1, 19.5];TMT-B -17.1 s [-79.3, 45.2])。与对照组相比,干预组在 12 个月的随访再评估中报告的抑郁症状明显增多,护理人员评定的参与者生活质量较低,而护理人员的生活质量较高:本研究表明,CT 项目对工作记忆、处理速度和执行功能没有益处。今后的研究需要更好地了解如何利用 CT 改善患有轻度-中度痴呆症的老年人的认知和身体功能。
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Australasian Journal on Ageing
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