Dementia

Background: Falls in people with dementia often result in physical and psychological impacts, reducing independence and increasing healthcare costs. Falls place a significant economic burden on the healthcare system. Although individuals with dementia face a heightened risk of falling, there is limited evidence supporting effective home-based interventions for this population. Methods: A mixed-methods process evaluation was embedded within a pilot cluster randomised controlled trial, guided by a realist framework. The evaluation was conducted across six UK sites (three intervention, three control). It included fidelity checks of routine data collection, observation of intervention sessions, multidisciplinary team (MDT) meetings, and therapist supervision. Semi-structured interviews were conducted with people with dementia, caregivers, and therapists. Results: High fidelity was achieved in home assessments and intervention delivery, with participants completing an average of 15 out of 22 planned sessions. Regular home visits enhanced engagement and motivation, while MDT support boosted therapist confidence in managing complex cases. Most participants met their functional goals and reported improved confidence. However, challenges included geographical and capacity variability in service delivery and inconsistent referral pathways. Therapists’ attitudes toward advanced dementia influenced intervention delivery. The dyadic approach supported activity engagement but occasionally increased caregiver responsibilities. Conclusions: The Maintain intervention was feasible and acceptable, with preliminary evidence of improved daily living activities and quality of life. A future trial should focus on standardising MDT support, addressing falls-related anxiety, and developing sustainable post-intervention strategies. Protocol adaptations, such as video consultations, demonstrated potential to mitigate workforce challenges.

Introduction: Dementia-friendly hospitals (DFH) are mentioned as one of several key initiatives in national dementia strategies. In our previous integrative review, we identified 17 descriptions of DFHs and analysed six characteristics of DFH: continuity, person-centredness, consideration of phenomena within dementia, environment, valuing relatives and knowledge and expertise within the hospital (Manietta et al., BMC Geriatrics, 2022, 22, 468, 1-16). We also learned that the term DFH is based more on healthcare practice than research. To address this research gap, one step of our DEMfriendlyHospital study is to examine the perspectives of professional dementia experts working in hospitals in Germany.

Method: We used a qualitative design and conducted 14 semi-structured interviews with professional dementia experts from various healthcare professions (12 nurses, two physicians, and one physiotherapist). Data were collected between November 2021 and March 2022. Using an inductive content analysis, we furthermore analysed the interviews in a participatory way involving a group of research associates and professional dementia experts.

Results: From the professional dementia experts’ perspectives, a dementia-friendly hospital needs to focus on the people with dementia, their relatives and also on the staff who care for them. A DFH is characterised by specific hospital processes, structures and environment which consider the needs of people with dementia, dementia-specific knowledge and the skills of hospital staff, their awareness and attitude towards people with dementia. A DFH needs the social inclusion of patients with dementia and their perception as a person as well as the involvement of relatives, who are an important support for the patients and their care.

Conclusion: There are links between our results from interviews with professional dementia experts and our integrative review. At the same time, the perspectives of patients with dementia and their relatives are underrepresented. To fill this gap, our next step is to interview people with dementia who are hospitalised and their relatives, aiming to enhance the description of a DFH and its characteristics.

Background: Clinical pharmacists are increasingly working as part of primary care teams in UK. Many people living with dementia live at home with the support of primary care. Given the complexity of their health problems and their use of several medications, clinical pharmacists may potentially play a crucial role in their support Aims: To explore clinical pharmacists’ experiences of working in primary care with people living with dementia and identify any specific training needs to provide effective support for this patient group.

Methods: An online survey sent via email in 2023 through professional organisations, social media, and utilising research team contacts. The survey covered topics including clinical pharmacists’ background, experience of working with people with dementia, and training needs.

Results: 57 clinical pharmacists responded to the survey; the meantime working as a clinical pharmacist was 9.6 years (standard deviation 8.6) and within a primary care setting was 6.1 years (standard deviation 6.1). Just over three-quarters of respondents (n=31, 77%) work with people living with dementia. While almost two thirds (n=35, 61%) had undertaken training for dementia care, such training often lasted a few hours (less than a day) (n=17, 49%). Most respondents (n=39, 89%) wanted further information or training; including non-pharmacological interventions to improve quality of life in dementia and how to support carers and relatives. Practice challenges reported included a lack of face-to-face consultations and getting assurance that the patient could safely take medications.

Conclusions: These findings indicate an interest in dementia care, a willingness to undertake further training but practice uncertainties that suggest a system approach might be beneficial.

Objectives: The objective of this study was to examine participant’s experience with remote delivery during SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681), a home-based, double-blind, randomized controlled trial targeting older adults at risk for dementia. Metrics included study adherence, adverse events (AEs), participant’s attitudes towards technology, and protocol deviations (PDs) due to technological difficulties. Methods: Participants underwent 16 weeks of physical and cognitive interventions (three sessions/week) remotely administered in their homes via Zoom for Healthcare^TM. Participants used a laptop, webcam, and required email and internet access. Throughout the trial, adherence, AEs, and PDs were recorded. Post- intervention, survey questions about satisfaction with technology were administered and semi-structured interviews were conducted which underwent thematic analysis. Results: Sixty participants, mean age 68.9 and 76.7% female, were randomized to one of four intervention arms, with 52 completing the 16-week intervention. Adherence rate was 87.5% with no significant difference between treatment arms (p=0.656). There were 88 AEs reported in 42 participants. The majority (71.6%) of AEs were unrelated to the intervention, and 69.3% were classified as mild. There was one serious AE, unrelated to the intervention. Most (74.9%) participants reported overall satisfaction with technology, with Zoom being both enjoyable (81.0%) and easy to use (96%). Most enjoyed using the computer (87%), and the majority (87.0%) encountered few difficulties with connectivity. Of the 2496 intervention sessions, 14 (0.56%) were missed due to technical difficulties. Technical difficulties requiring modification to the intervention, such as an unstable internet connection, were reported on 79 occasions (3.0%). Themes from the interviews were: participants built rapport with the research assistants; felt better participating; had fun; and technology helped overcome barriers to participation. Conclusions: Using technology to deliver dementia prevention interventions remotely was well received by participants Participation occurred safely from the comfort of their own home with few technical difficulties.

Introduction: The incidence of dementia among patients in perioperative settings is on the rise, presenting significant challenges for healthcare professionals in delivering adequate and appropriate care to this patient population. In order to gain a deeper understanding of the perioperative care needs of patients with dementia, thirty healthcare professionals were interviewed. The focus was on their experiences and perspectives regarding the fulfilment of these needs. Key factors influencing perioperative care were identified and categorized into three main themes: patient-related factors, healthcare professional-related factors, and healthcare environment-related factors. Methods: Thirty interviews were conducted with a diverse group of healthcare professionals, including anaesthetists, surgeons, nurses, and other perioperative staff. Thematic analysis was employed to process and interpret the data, identifying recurring themes and sub-themes that reflect the complexities of perioperative care for patients with dementia. Results: The analysis revealed three primary themes: 1) Factors related to the patient with dementia: Cognitive impairment and comorbidities uniquely challenge perioperative care. The unfamiliar hospital environment often exacerbates cognitive symptoms, and adherence to postoperative protocols can be problematic. Family involvement is crucial in supporting these patients. 2) Healthcare Professional Factors: Perceptions of dementia, communication issues, pain assessment, and the need for personalized care were highlighted. Training and education deficits among healthcare professionals were evident, impacting the quality of care. 3) Institutional Factors: Organisational policies and resource allocation significantly affect the provision of dementia care. Support for healthcare professionals through ongoing education and the development of dementia-specific guidelines were identified as essential needs. Conclusion: Effective perioperative care for patients with dementia requires addressing multifaceted challenges. Improving communication, enhancing education and training for healthcare professionals, involving family members, and ensuring institutional support are critical steps. A comprehensive, empathetic approach can lead to better outcomes and experiences for patients with dementia in the perioperative setting.

Background: Informal caregivers play a critical role in providing continuous, unpaid care to individuals with dementia, helping to improve their quality of life and reduce the demand on formal care services. The caregiving relationship is a complex, dyadic process that can have profound effects on both the caregiver and the care recipient, underscoring the need to alleviate caregiver burden and support their well-being. Understanding the motivations behind why individuals take on caregiving roles is essential, as it can predict their experiences, perceptions, and the overall impact of caregiving on their lives. A systematic review by Greenwood and Smith identified key motivators for informal caregivers. Additionally, there is substantial evidence that cultural perspectives and social values significantly influence caregiver experiences and motivations.

Methods: This systematic review aimed to update the findings of Greenwood and Smith by examining recent research on the motivations behind caregiving across different demographics, ethnicities, and cultures. Six electronic databases were searched from August 2018 to January 2024. Titles and abstracts were screened using machine learning methods (ASReview), and a subset of full texts underwent duplicate screening. Eligible studies were appraised using the Mixed Methods Appraisal Tool (MMAT), and data were extracted and organized into thematic categories.

Results: The initial search yielded 1,843 articles, of which 37 studies met the inclusion criteria after deduplication and screening. Cultural explanations for caregiving motivations included themes such as familism, ethnic identity, cultural values and beliefs, a sense of obligation, and personal fulfillment.

Discussion: Cultural perceptions and social values play a significant role in shaping caregivers' experiences and perceptions, which in turn influence families’ engagement with and acceptance of formal care and support services. These findings highlight the need for further research to guide the development of culturally sensitive psychosocial support interventions tailored for diverse caregiving populations. Such personalized approaches are essential for reducing caregiver burden and fostering an inclusive caregiving environment that respects the unique motivations and values of caregivers from various cultural backgrounds.

Introduction: Research suggests that physical and cognitive exercise can have a positive effective on those with dementia, but less is known about such interventions in those at risk for dementia. Understanding the feasibility of administering clinical assessments remotely using Zoom for Healthcare^TM in the context of a dementia prevention trial for at risk older adults is not well understood.

Methods: SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681) is a home-based, remotely delivered clinical trial targeting older adults at risk for dementia. Participants underwent a screening/baseline assessment and were randomized to one of four physical and cognitive exercise intervention arms for 16 weeks (3 times per week). They were reassessed immediately post-intervention and 6-months later. The standardized assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life were done at all three points. A research coordinator completed the assessments on a one-on-one basis via Zoom for Healthcare^TM. The quality of life questionnaire was mailed to the participant.

Results: Forty-eight of 60 participants (80%) (mean age 68.7 ± 5.7 years, 81.3% female) completed the study. Most participants (75.0%) were cognitively intact with at least 2 dementia risk factors. No participants withdrew from the trial because of difficulty with the remote delivery of the assessments. There were no statistically significant changes in any of the assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, or quality of life throughout the study.

Conclusion: This study demonstrates it is possible to administer standardized clinical assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life remotely in the context of a clinical trial. The study was not powered to detect meaningful differences in these assessments. Nevertheless, this confirms the feasibility of remotely administering clinical assessments to older adults at risk for dementia

Background

Dementia is a prevalent condition in an ageing population. Persons with dementia and their caregivers are often uncertain about what to expect after an initial diagnosis. Previous studies conducted on the experiences of informal caregivers show a clear demand to address these: providing adequate information, psychosocial support and access to services.

Introduction

The diagnosis of dementia is usually made by specialists in the tertiary hospital. However, resources in acute tertiary hospitals are expensive and valuable. To better allocate resources and improve the manpower situation, we have collaborated with our community partner to provide post diagnosis support (PDS) to patients newly diagnosed with dementia.

Methods

A PDS team consisting of an allied health professional and a caregiver peer is established by our community partner. They conduct home visits to provide psychoeducation to help persons with dementia and their caregivers understand more about dementia, develop personalised care plans, and coordinate support services to provide psychoemotional support.

Close communication is maintained between the PDS team and the acute hospital referral team. Multidisciplinary team meetings involving the geriatricians, nurses, case managers and community partners are also held quarterly to provide regular updates about the progress of the patients and facilitate learning.

Results

A total of 95 persons who were newly diagnosed with dementia in the previous 1.5 years were referred. 53 patients were eventually enrolled under the PDS programme, and received psychoeducation and personalised care plans. 72% were given caregiver support and 66% were linked up to community services. The average duration between date of referral to date of first home visit is 13 days.

Conclusions

In an ageing population where there is high healthcare utilisation, it is efficient to utilise existing services instead of duplicating them. By collaborating with community partners, we are empowering them to play a better role in supporting persons with dementia.

Introduction:

With population aging comes challenges like dementia, prompting the urgent identification of risk factors and its associations with other psychiatric disorders. This review aims to explore the connection between depression and the onset of mild cognitive impairment (MCI) or dementia through recent literature analysis.

Methods:

Systematic review and meta-analysis, following PRISMA recommendations, with studies from 2013 onwards. The search strategy “Depression” AND “Dementia” AND “Aged” was employed in the Cochrane, Embase, LILACS, PubMed, Scopus, and Scielo databases. Cohort studies in Portuguese, English, or Spanish were included, while reviews or clinical trials were excluded.The meta-analysis was conducted using RevMan software, employing unadjusted OR effect measures for exposure in the Forest Plot graph. Study heterogeneity was calculated using the I² statistic, with a cutoff point of >75% indicating high heterogeneity.

Results:

The search strategy identified 3,394 articles, screened by title and abstract. Of these, 187 were fully read, and 26 were included in the review. The most used tool for assessing depressive symptoms was the Geriatric Depression Scale (38.4%), while the Mini-Mental State Examination was the most frequently used tool for assessing symptoms of MCI and dementia (26.9%). The quantitative analysis included 14 studies evaluating dementia and 8 studies evaluating MCI. The likelihood of older adults with depression developing dementia was 1.75 times higher than in the non-depressed population (OR = 1.75; 95% CI 1.46 - 2.11). Additionally, a twofold increase in the likelihood of developing MCI was found in depressed older adults (OR = 2.03; 95% CI 1.44 - 2.88). All analyses revealed high heterogeneity.

Conclusion:

Depression was found to be associated with higher likelihood of developing MCI or dementia in older adults. Understanding this complex relationship with new studies and reviews is crucial for developing targeted interventions and improving the prognosis for individuals affected by both conditions.

Introduction:

Navigating dementia care is challenging, but patient navigation (PN) offers valuable support for this population. The "Navigating Dementia NB / Naviguer la démence NB" program piloted a PN program in New Brunswick, Canada, targeting people living with dementia (PLWD) and their carers. The program aimed to assist participants in navigating health and social care systems, matching their needs with available services.

Methods:

Navigating Dementia NB was co-developed by researchers, patient partners, and clinicians. This pilot program embedded six PNs in primary care clinics/centers across the province between July 2022 and July 2023.  Using a mixed methods approach, participant surveys and interviews were used to explore program benefits and recommendations for improvement. Focus groups were used to explore facilitators and barriers to program development and implementation.

Results:

There were 150 participants (PLWD and carer dyads) enrolled in the PN program who provided informed consent. Interviews were conducted with 36 PLWD and their carers. Focus groups were conducted with nine members of the research team and five patient navigators.  Program benefits included: emotional support from navigators, provision of relevant information, and facilitating connections to appropriate services. Recommendations for improvement included: the need for PLWD and their carers to have access earlier in the patient journey and the need to reassess provincial policies related to home care support. Facilitators for implementing a PN program included: providing appropriate staff training and leveraging established connections within the health and social systems.  Barriers included a compressed timeline and existing systemic issues to service access.

Conclusions:

The findings suggest that embedding PN for PLWD in community based primary care can be done.  The program was beneficial for PWLD and their carers. Future plans involve partnering with government to support the implementation and evaluation of a province-wide scale-up of the PN program for this population.