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Dementia Current Awareness Bulletin September 2021
A number of other bulletins are also available – please contact the Academy
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Playlist for Life is a UK-based personal music and dementia charity They offer free resources for
family members and a free introductory webinar for health professionals interested in finding out
more about the power of personal playlists for dementia. Find out more about Playlist for Life.
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
9
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
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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
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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
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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.
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