Dementia

The introduction of an additional meal in nursing homes may be associated with a positive impact on the BMI of residents with dementia.

Abstract

Background

Since 2010, many nursing homes in Norway have introduced an extra meal daily, with a hot lunch, and pushing dinner to later in the day. This initiative aims to reduce the long time interval between breakfast and supper.

Aim

This study examines how an extra meal affects the residents' body mass index (BMI) at nursing homes in Norway. Research questions include how an extra meal affects BMI among residents in the dementia unit.

Methods

We used a cross-sectional design to analyze data from residents over 65 years old in dementia care units. Both parametric and non-parametric statistical tests were used to evaluate changes in BMI.

Results

Our study identified a modest increase in BMI among residents in the dementia care unit after introducing an additional meal. The results imply that incorporating an extra meal to meet residents' needs could support the maintenance of a healthy BMI.

Discussion

Our study reveals that the introduction of an extra meal resulted in a slight increase in BMI among the residents with dementia, which does not correspond with previous studies indicating malnutrition among these residents. The dementia disease reduces functional abilities, and challenges related to mealtime behavior, restlessness, and depression can lead to weight loss. The fact that our results show a slight increase in BMI at the dementia units may be related to these residents often being troubled with restlessness and not finding the peace to consume a full meal. By introducing an extra meal, the total food intake increases since residents still eat a little at each meal, and focusing more on accommodating each resident might have influenced the increase in BMI values.

Conclusion

The study indicates that the introduction of an extra meal has a positive effect on the BMI value of residents with dementia in nursing homes.

Introduction

Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition.

Methods

A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function.

Results

Results show that 70% of the sample had a gait speed deterioration (i.e., lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed < 0.8 m/s and an abnormal EEG frequency composition.

Conclusions

Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.

• Collaboration between a nursing home and an ambulatory geriatric-psychiatric team to patients with Behavioral and Psychological Symptoms of Dementia (BPSD)

Introduction

Healthcare professionals in nursing homes collaborate with specialized healthcare services to manage and support patients with BPSD. Geriatric- psychiatric ambulatory teams from the specialist health service provide professional assistance to healthcare professionals and family members for patients with geriatric psychiatric disorders and BPSD. This outreach- service is not very developed and could be further expanded. The study aimed to elucidate the collaboration between municipal health services and ambulatory geriatric-psychiatric teams within the specialist healthcare service.

Method

In this qualitative study we conducted individual interviews with six healthcare professionals representing four different nursing homes. The analysis is inspired by systematic text condensation. The research project has been submitted to the Norwegian Centre for Research Data.

Results

The informants expressed the importance of enhanced interaction with the specialist healthcare service in general and to patients with BPSD in spesific. When the informants receiving support from the team, the interaction is deemed more valuable and constructive. They find a shared meeting point with opportunity for sharing knowledge and engaging in dialogue.

Conclusion

The study indicates that health professionals see the importance of improved collaboration with specialized health services for patients with BPDS. When ambulatory teams engage actively, they experience collaboration characterized by closeness and shared understanding. The ambulatory-geriatric psychiatric team may become more well-known and the method of requesting professional help from the team can be made more transparent and clearer. It is also important that healthcare personnel proactively request professional assistance for patients with BPSD. With the increasing prevalence of patients with dementia, there is a need for further research to address the challenges in this area. Ambulatory geriatric-psychiatry teams are a service that should be explored further.

Background: ‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators.

Introduction: IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes.

Method: MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: raising awareness at daily MDT meetings; focussed education by presenting observational data to catering team; involvement of volunteers; the introduction of IN REACH champions; and prompting by signage, both physical and digital. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach.

Results: Baseline data showed out of 319 inpatients, only 33% had both food and drink within reach. 67% had cognitive impairment and only 27% were able to reach food and drink. Following 4 initial PDSA cycles 58% of patients had food and drink within reach.

Conclusions: Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.

 Introduction: The COVID-19 pandemic has raised concerns about its long-term effects, leading to conditions such as "Long COVID." Neurological manifestations, including "Brain Fog" with impaired cognitive function, have been reported, but their relationship with age and memory decline remains unclear. Method: This study aimed to investigate the effects of COVID-19 infection on memory function and explore the relationship between age and memory scores. The research utilized data from the 'COVID-19 Online Rapid Objective Neuro-memory Assessment' (CORONA) study, employing an online survey with a memory task. Ethical approval was obtained, and participants aged 18 and older were recruited globally, with 5,308 participants included in the analysis. Memory scores were obtained through a task featuring four categories. Statistical analysis, including T-tests and linear regression, was employed to evaluate the data. Results: Participants testing positive for COVID-19 (n = 678) exhibited lower mean total memory scores than those testing negative (n = 4,630), with a statistically significant difference (P < 0.05). Hospitalized COVID-19 patients (n = 37) had significantly lower memory scores compared to non-hospitalized patients (n = 641), suggesting a greater impact of hospitalization on memory function. Age was associated with declining memory scores, with an overall trend of decreasing scores as age increased. Three age groups exhibited significant differences in memory scores between COVID-19 positive and negative participants. Conclusion This study provides evidence that COVID-19 infection may be associated with worsened memory outcomes and cognitive function. Hospitalization due to COVID-19 appears to have a more substantial impact on memory than the infection alone. A steeper decline in memory scores with age was observed among COVID-19-positive participants, suggesting potential age-related vulnerability to memory decline associated with COVID-19. However, discrepancies in results may be attributed to sample size limitations, emphasizing the need for larger cohorts in future research.

Introduction:

Symptom heterogenicity in dementia subtypes can pose diagnostic challenges, leading to potential misdiagnoses and significant implications on patient management. The NICE Guidelines for Dementia 2018 [NG97] recommend FDG-PET where diagnostic uncertainty remains after initial assessment. From 2021, a national and collaborative initiative supported using FDG-PET brain imaging for dementia in Wales to facilitate more accurate and timely diagnoses with higher degrees of confidence. This project aimed to evaluate the temporal aspects and diagnostic accuracy of FDG-PET utilization in Cardiff and Vale University Health Board.

Methods:

A retrospective review of 25 patients’ medical records who underwent FDG-PET between 2019 – 2023 was completed. Demographics, diagnostic journey details, and durations between steps were recorded. A comparison of diagnoses made at Memory Clinic (MC) and post-FDG-PET was performed. Results: The average age of patients referred for FDG-PET was 63.3 years (sd=7.69); 60% were under the age of 65 (n=15). The mean time taken from GP referral to MC review was 108.7 days (sd= 44.9). The mean duration from MC review to FDG-PET was 201.7 days (influenced by one outlier with complex presentations). The median time from MC review to FDG-PET was 71 days. The most common final diagnosis was Alzheimer’s disease, both typical and atypical subtypes. 16% (n= 4) of final diagnoses differed from initial clinical suspicion but imaging was supportive in guiding onward management. Patient outcomes depended on final diagnoses.

Conclusion:

Overall, FDG-PET supported the team in establishing a diagnosis with greater confidence, where 84% of FDG-PET outcomes were consistent with the initial working diagnosis. The recorded durations between initial review in MC and FDG-PET imaging varied considerably between individuals, however, the impression was that access to FDG-PET in Wales has supported earlier confirmation of diagnosis compared with prior practice and plays a particular role in earlier diagnosis of younger individuals.

Introduction: Neuroimaging plays an important role in assessing patients referred to a memory assessment service. CT scans are a cost-effective option and are useful to identify other causes of cognitive impairment and provide valuable information regarding the subtype of dementia. In our trust, there is no standardised request proforma for CT head scans and not all relevant criteria have been included that are in line with the guidance from the British Society of Neuroradiologists (BSNR) proposed structure dementia template for routine clinical practice. This audit aims to assess CT head scan reports of patients with cognitive impairment referred for a memory assessment to determine whether information from the request has been addressed in the report.

Methods: Retrospective review of CT head scan reports from an outpatient memory assessment clinic between July and September 2022. Data was collected from Cito, Rio. 58 scans were reviewed against CT request proforma which requested to comment on evidence of different atrophy in medial temporal lobe, hippocampus, amygdala; evidence of ischaemia, infarction, and small cerebral vessel disease; rule out Space Occupying Lesion (SOL).

Results: CT scans were reviewed against the CT request. 67% commented on the medial temporal lobe, 31% on the hippocampus, and 0% on the amygdala. 21 out of 58 reports commented on the Medial Temporal Atrophy score. In terms of ischaemia/infarcts all 58 reports mentioned this, while 78% commented on evidence of small vessel disease and 95% on SOL.

Conclusion: Reviewing the criteria against each CT report, not all information was commented on by the radiologists. The CT request proforma overlaps with some of the proposed BSNR guidelines; however, it could be improved to include relevant information that will aid the referrer with the diagnosis. Action plan: discuss with local old age psychiatry to refine the CT request proforma.

Background Alzheimer’s disease-modifying drugs (DMDs) are in routine use in other countries. They will likely be available in the UK within the next year. It is not yet clear how many patients will be eligible for them or what resources are required to establish this eligibility. Methods Patients attending the out-patient memory clinic of a single geriatrician between 01/02/2022 and 12/01/2023 were identified. Information required to judge eligibility according to the lecanemab appropriate use recommendations (Cummings et al 2023) was extracted between 08/08/23 – 13/09/2023. Relevant data included: diagnosis, that is dementia or mild cognitive impairment (MCI), cognitive symptoms due to a non-dementia causing disease pathology or diagnosis unclear; Addenbrooke’s Cognitive Examination III (ACE-III) and Mini-Mental State Examination (MMSE) scores; brain MRI reports; CSF analysis results; anticoagulant/antiplatelet drug history. Results In total, 328 records for n=214 patients were identified during the audit period. Of these 214 patients, 4 were <50 years and 9 were >90 years. Of the remaining 201 patients, 122 were diagnosed with dementia, 31 with MCI due to an underlying dementia-causing disease, 45 with symptoms due to non-dementia-causing pathology and 3 had an unclear diagnosis. Of the 153 patients with dementia/MCI, 105 had an ACE ≥60 or an MMSE ≥22. Of these, 32 were on anticoagulants. Of the 73 patients therefore potentially eligible for DMDs, 26 had MRI imaging and 2 CSF analysis. With the information available at the time of audit, one patient would have fulfilled the lecanemab appropriate use recommendations. Conclusion A large proportion of patients attending a geriatrician-led memory clinic during this audit period were ineligible for DMDs at first pass assessment, mostly on the basis of diagnosis and cognitive scores. Adequate investigation of potentially eligible patients will require significant increases in MRI and CSF analysis capabilities. Of note, this audit did not consider likely aetiological diagnosis.

Background: Managing agitation and other behavioural and psychological symptoms of dementia (BPSD) is a significant challenge and impacts on quality of life for people living with dementia. The priority is to find effective non pharmacological interventions as drug treatments can have significant side effects.

Objectives: This review evaluates the effectiveness of structured physical activity on agitation in people living with dementia Methods A rapid review of the literature was carried out following PRISMA guidelines. Four electronic databases were searched (Cochrane CENTRAL, MEDLINE, CINAHL and Embase) looking for interventional studies that used a structured physical activity programme in people with a diagnosis of dementia, studied the effects of this activity on BPSD and compared this with a control group that did not follow an exercise programme.

Results: From 112 identified articles, 13 were included in this review, involving a total of 1546 participants. The results were analysed and synthesised according to the type of exercise intervention (aerobic, multicomponent or strength training) and by the frequency and intensity of the intervention. Quality assessment using CAPS guidelines indicated four studies as higher quality with seven being of moderate quality. The results showed that aerobic exercise in particular appears to be effective in reducing agitation and those studies with higher adherence to exercise tended to demonstrate more positive effects on agitation and BPSD.

Conclusions: There is evidence that physical activity can be effective in the reduction of agitation in older adults with a dementia diagnosis. Further research is needed to clarify the type of intervention that is most beneficial and strategies to make physical activity more acceptable and available to older people with dementia need to be established

Introduction

by 2025 over 1 million people will be diagnosed with dementia in the UK. Person-centred care is the best practice for looking after patients with dementia, but this is often not managed well within acute hospital settings. This can result in poor hospital experience and longer than necessary stay. A snapshot of data was taken retrospectively from May 2023 within the ED & AMU at an acute hospital. This showed an average length of stay (LOS) of 5.25 days. A study in 2013, which implemented This Is Me (TIM) documents in hospital saw a reduction in inpatient falls, improved patient experience and in turn LOS reduced.  

Aim: To reduce LOS and improve the patient experience for people with dementia presenting to the hospital following a fall. 

Method

A two-week pilot was implemented in ED & AMU 7 days a week, 8-6pm. Patients were identified through the ED therapy screening process. Paper copies of the TIM were filled in for patients meeting the criteria. Inclusion criteria were admission with a fall and had a dementia diagnosis. LOS data was collected and follow-up data was collected.

Results

Twenty-five patients met the inclusion criteria. Every patient had a TIM document completed within 48 hours. The average LOS was 1.87 days. All patients/relatives reported the TIM was important, and that it improved information transfer. There were several limiting factors including the time involved to complete the TIM, reduced weekend staffing and limited awareness from the multidisciplinary team of the TIM document. 

Conclusion

To conclude, using the TIM Document facilitates a reduction in LOS and an improvement in patient experience. Further recommendations such as launching this project for a longer time frame, using an electronic version of TIM and MDT teaching.