Dementia (London, England)最新文献

The pathway to a diagnosis of dementia and post-diagnostic support can be complicated for people living with dementia and their support networks, leading to delays in care. This paper describes the development and subsequent pilot of a specialist dementia nurse role named the Dementia Liaison Officer (DEMLO) within a tertiary Victorian hospital. The aim of the DEMLO was to identify and address gaps in dementia care. This pilot is based on the principles of the National Comprehensive Dementia Centre framework. Mapping of current outpatient diagnostic and post-diagnostic services for people with suspected cognitive impairment was conducted to identify gaps in care. Interviews with 25 hospital staff were also conducted to gain further perspectives on barriers to diagnostic and post-diagnostic care and inform the development of the DEMLO role. Several challenges to diagnostic/post-diagnostic support were identified, including the perception that waitlists were long, confusing referral criteria, and complex referral processes. The DEMLO was subsequently developed and trialled within the Geriatric Evaluation and Management (GEM) outpatient service. Three key functions were implemented: reviews of eligibility criteria for patients with cognitive impairment on the GEM clinic waitlist, introduction of a pre-clinic comprehensive geriatric assessment for GEM clinic patients and the introduction of a dementia post-diagnostic support service for all patients across the hospital. Challenges to developing and sustaining the pilot included limited timeframe, difficulty with integration and limited funding. Despite this, the pilot was well received, with 141 patients referred. The introduction of a nurse-led dementia intervention has resulted in increased person-centred care that encompasses pre-diagnostic and post-diagnostic support for people living with dementia. Evaluation of the pilot is ongoing.

In the Netherlands, where this study was conducted, there are around 800,000 family carers of people with dementia. Research into the needs and priorities of people with dementia and their family carers is crucial for developing tailored care and meaningful support. However, current research lacks attention to the everyday life experiences of caring for someone with dementia at home. Therefore, the research question this study aimed to address was: how do family carers of people with dementia living at home approach and experience their everyday life in a caring context? The study used a qualitative design, underpinned by a phenomenological approach. 15 family carers (10 partners and five adult children) participated in open interviews. Thematic analysis was used to document and structure the data. A member check was performed on the emergent findings through a focus group with six family carers (all care partners). This process resulted in four discrete but interlinked themes that reflected how family carers approach and experience caring at home for a person with dementia, namely: (1) Finding and keeping routines that work; (2) Focussing on small moments; (3) Rebalancing connections; and (4) Thinking ahead. These themes also emphasise the unfolding nature of everyday life that is constantly changing for family carers.

Background: The study compares the health impacts of various nonpharmacologic interventions on cognitive function, daily functioning, depression, and quality of life among people living with dementia. Methods: A comprehensive search was conducted across three databases-PubMed, Airiti Library, and Scopus-to identify eligible randomized controlled trials published in English or Chinese within the past decade, up to December 2023. This study included a systematic review and a network meta-analysis focusing on various health outcomes. Results: Analysis encompassed 26 studies with a total of 3,403 people living with dementia. Interventions that significantly influencing cognitive function included aerobic exercise combined with resistance exercise (SMD = 1.53, 95% CI: 1.13-1.93), resistance exercise alone (SMD = 1.53, 95% CI: 1.12-1.93), and reminiscence therapy (SMD = 1.25, 95% CI: 0.70-1.80). Resistance exercise had the greatest impact on daily functioning (SMD = 0.95, 95% CI: 0.57-1.33), while reminiscence therapy (SMD = 0.65, 95% CI: 0.20-1.10) and music therapy (SMD = 0.56, 95% CI: 0.31 - 0.81) had the most significant effect on depression. A significant effect on quality of life was not found in this study. Conclusions: Resistance exercise, multicomponent exercise incorporating resistance training, and reminiscence therapy as well as music therapy were found to positively impact the health of people living with dementia. These findings suggest that integrating nonpharmacologic practices could enhance dementia care.

Objectives: Behavioural and psychological symptoms of dementia (BPSD) are prevalent in residential aged care (RAC) settings, negatively impacting residents' quality of life and increasing carer burden. This study investigated current practices and experiences of RAC staff in managing BPSD, including collaborative behaviour support planning with family members. Methods: A cross-sectional survey was conducted with 43 RAC staff supporting residents with dementia. Data was collected about demographics, resident characteristics, and current behaviour support practices and support needs. Quantitative and qualitative data were analysed using descriptive statistics and thematic analysis respectively. Results: Despite the prevalence of written behaviour support plans, their perceived usefulness and staff involvement in their development were inconsistent. Collaboration with family members is valued but often limited by factors such as time constraints and communication difficulties. Staff identified a need for increased training and additional resources to provide effective behaviour support. Conclusion: This study highlights the need for improved training and support for RAC staff in managing BPSD, and a practice framework that clarifies roles and responsibilities across behaviour support service systems. Further research is needed to inform evidence-based behavioural interventions in RAC settings, with emphasis on collaborative practices that support best outcomes for residents with dementia.

This study compared the impact of an immersive virtual reality (VR)-based reminiscence therapy program with a similar non-immersive intervention on neuropsychiatric symptoms and quality of life of people with dementia. A pilot randomized controlled trial was conducted with 14 individuals with mild to moderately severe dementia, who participated in eight biweekly individual reminiscence sessions conducted by trained researchers, in which 360° videos of locations with personal relevance were displayed. Participants were randomly divided in two groups: one receiving therapy using VR headsets to promote an immersive experience while the other watched the videos on a monitor (non-immersive approach). Assessment was conducted pre- and post-intervention using the Quality of Life in Alzheimer's Disease Scale to measure quality of life and the Geriatric Depression Scale, Generalized Anxiety Disorder Scale and Neuropsychiatric Inventory to evaluate neuropsychiatric symptoms. Adverse simulation-related symptoms were also assessed with the Simulator Sickness Questionnaire. There were no statistically significant differences between groups at baseline, regarding sociodemographic variables and level of dementia progression. The results indicated significant improvements post-intervention in quality of life from caregivers' perspectives in the non-immersive group (p < .05) but not in the VR group. Differences in overall neuropsychiatric symptoms, depressive symptoms and anxiety symptoms between assessments were non-significant. However, slight improvements were visible, particularly regarding anxiety. Only a few instances of mild cybersickness symptoms were reported in both groups. In this study, pre- and post-intervention comparisons do not support the added value of using immersive VR in reminiscence therapy for people living with dementia. This raises questions about whether VR is worthwhile compared to traditional approaches, and how to better capture potential benefits of immersion with VR, which may be more evident considering in-session engagement and well-being or longer intervention programs.

Optimising antipsychotic prescribing in people living with dementia is important to manage symptoms and avoid adverse events. Clinical decision support tools that predict therapeutic response based on individual patient characteristics can help personalise prescribing and complement decision-making by prescribers. The aim of this study is to investigate the views of Australian prescribers on the development and use of a digital antipsychotic prescribing support tool in dementia. Thematic analysis was used to analyse the perspectives of Australian prescribers on using a digital prescribing support tool in dementia. Semi-structured, individual interviews were conducted with a sample of 14 clinicians. Themes were organised according to topic areas about the development and use of the tool. Clinicians expressed that the tool could assist in identifying risk, allowing prescribers to be more cautious with antipsychotic prescribing. The tool could promote informed decision-making by assisting prescribers to consider more factors prior to prescribing whilst serving as an educational tool to aid shared decision-making with patients and carers. Though there were benefits, clinicians raised that there are complexities of antipsychotic prescribing, as the tool may not account for situational need, where benefits may outweigh risks. Some clinicians expressed potential concerns with technology-based tools, where some prescribers may void their clinical judgement and over-rely on the tool. Some clinicians highlighted younger practitioners, general practitioners, nurses and pharmacists as potential users who could benefit from its use. Clinicians posed suggestions for development, including accessibility through an app, updating data as evidence and guidelines change, and prompts to aid decision-making. This study identified several considerations on the implementation of the tool in clinical practice. Perspectives raised by clinicians should be considered in the tool's future development.

There is considerable variation in the provision of support and services for people living with young onset dementia in the UK. This study aimed to elicit the views of people living with young onset dementia and their families on what they want in the community, and identify gaps in support. The Photovoice approach was used to collect views from four groups of participants, over three sessions of each group. A total of four people living with young onset dementia and eight carers took part. People living with young onset dementia want to do a variety of activities, and these need to be age appropriate and "normal" things that they would have done prior to their diagnosis. Activities need to be flexible and fitted to the person rather than the person being fitted to the activity. A number of facilitators and barriers were identified. Carers' lives are now very different to what they had planned or envisaged for the future, and they value peer support. They need support to help understand information and navigate paperwork, systems and processes. The study provided insights based on lived experience into what people living with young onset dementia and their families want from support and services in the community.

Playwork is a profession that focuses on enabling and enriching children's play experiences, creating a space for spontaneous, self-directed play. The application of playwork principles to dementia care holds promise and resonates with a relational approach to care. However, this area of practice has not yet been explored. This study aimed to explore if and how playwork approaches could be applied with people living with dementia and their impact on residents and those delivering the programme. A five-week playwork programme, delivered by undergraduate playwork students and lecturers, was piloted in a care home, with residents living with dementia. Interviews were conducted with care home staff, students, and playwork lecturers, and reflective diaries of the playwork sessions were maintained by students and lecturers. The findings indicate that playworkers can feasibly adapt their approaches so they are appropriate for older adults living with dementia. Playworkers can encourage agency and support free expression and exploration for residents. The sessions were perceived as having a positive impact on residents' emotional wellbeing, sense of recognition, social interaction, and engagement, as well as on some staff members' assessments of residents' abilities. The study also highlights the crucial role of care staff expertise during the sessions, particularly in addressing the medical and physiological needs of residents. However, engaging care staff proved challenging, resulting in a lack of continuity after the project concluded.

Introduction: The aim of this study was to examine the association of sex/gender and other factors with the perceived helpfulness of the diagnostic process and post-diagnostic services by persons with dementia and care partners.Methods: We conducted secondary cross-sectional analysis of surveys from the 'Cognisance' project. Sex/gender and other factors (e.g., demographic variables, help seeking behaviours, healthcare professional consulted) of persons with dementia and care partners from four countries were considered. Main outcomes were perceived helpfulness of diagnostic process and post-diagnostic services. We conducted descriptive and multivariate analyses.Results: Compared to men, more women with dementia perceived post-diagnostic services as helpful though not statistically significant. Sex/gender was not associated with perceived helpfulness of diagnostic process and post-diagnostic services among care partners. Satisfaction with and awareness of services were associated with perceived helpfulness among care partners.Discussion: These findings underscore the necessity for sex/gender-based research to enhance dementia care and for tailored interventions.

ObjectiveThe study's aim was to better understand how persons, diagnosed with dementia while still working, strived to make sense of and come to terms with their changing everyday lives during the process of exiting work life.MethodsThe study has an explorative, longitudinal design, following five persons who developed dementia while still working, with repeated, qualitative, in-depth interviews. Comparative analyses were combined with an interpretative approach, using the concepts doing, being, becoming and belonging.ResultsThree overarching themes were created: i/Finding out an orientation to continued activity engagement, ii/ Relating to the diagnosis and available dementia specific activities, and iii/ Managing wellbeing and information related to health care. Findings illuminate how participants sought avenues for continued activity engagement in everyday life, based on their perceptions of what they were able to do, who they wanted to be and become, and where they felt they belonged.ConclusionThe participants' agency came through strongly in their efforts to come to terms with changes in everyday life in their work and private lives, as well as with health care and dementia associations, underscoring that agency is vital and possible to support in persons with early-stage dementia.