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Background: Rural-urban differences in health service use among persons with prevalent dementia are known. However, the extent of geographic differences in health service use over a long observation period, and prior to diagnosis, have not been sufficiently examined. The purpose of this study was to examine yearly rural-urban differences in the proportion of patients using health services, and the mean number of services, in the 5-year period before and 5-year period after a first diagnosis of dementia. Methods: This population-based retrospective cohort study used linked administrative health data from the Canadian province of Saskatchewan to investigate the use of five health services [family physician (FP), specialist physician, hospital admission, all-type prescription drug dispensations, and short-term institutional care admission] each year from April 2008 to March 2019. Persons with dementia included 2,024 adults aged 65 years and older diagnosed from 1 April 2013 to 31 March 2014 (617 rural; 1,407 urban). Matching was performed 1:1 to persons without dementia on age group, sex, rural versus urban residence, geographic region, and comorbidity. Differences between rural and urban persons within the dementia and control cohorts were separately identified using the Z-score test for proportions (p < 0.05) and independent samples t-test for means (p < 0.05). Results: Rural compared to urban persons with dementia had a lower average number of FP visits during 1-year and 2-year preindex and between 2-year and 4-year postindex (p < 0.05), a lower likelihood of at least one specialist visit and a lower average number of specialist visits during each year (p < 0.05), and a lower average number of all-type prescription drug dispensations for most of the 10-year study period (p < 0.05). Rural-urban differences were not observed in admission to hospital or short-term institutional care (p > 0.05 each year). Conclusions: This study identified important geographic differences in physician services and all-type prescription drugs before and after dementia diagnosis. Health system planners and educators must determine how to use existing resources and technological advances to support care for rural persons living with dementia. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine housing need for older people and people with dementia, with reference to Scotland. This paper also examines policy responses and tensions arising from such need and looks critically at the evidence of care needs and what older people want in relation to later life conditions, including dementia. Design/methodology/approach: Taking the Being Home: Housing and Dementia in Scotland report (2017) as a baseline descriptor, the authors have collated evidence from a range of sources to help them examine what has changed in terms of policy, practice and population ageing. Set against this backdrop, using desk-based analytical methods, the authors interrogate existing planning processes and systems in Scotland. Findings: Scottish Spatial Planning has a policy blindness on the overwhelming evidence of the housing needs derived from an ageing population. Policy focus is geared towards the amount of housing supplied, rather than appropriate types of housing, leaving older people with little choice of suitable accommodation. A key area to improve is in establishing greater co-operation and policy synthesis between health, social, housing and planning functions. Broad policy ambition must be transferred into detailed reality for older people and people with dementia to benefit. Originality/value: The integrated approach and in-depth analysis, linked to planning policy and housing need, is highly original and much needed. [ABSTRACT FROM AUTHOR]

Limited research has explored the relationship between falls, cognitive decline, and dementia onset in older adults with aging. Therefore, this study aimed to investigate the impact of cognitive function on the development of dementia and explore the association between falls and dementia among older adults. This study utilized data from the Korean Longitudinal Study of Aging, which tracked a sample group at 2-year intervals from the initial wave in 2006 to the eighth wave in 2020. Among the older adults (≥60 years) surveyed, 2829 were included in the analysis, and cognitive function and number of falls per year were recorded. We hypothesized that these variables were associated with dementia and tested the variables using dementia diagnosis data. The participants were assigned to either a dementia group (dementia diagnosis) or a control group (no dementia diagnosis). Analyses were performed to enhance generalizability of the hypothesis to all participants (≥45 years, n = 7130). Cognitive decline and dementia incidence increased with aging among older adults. The dementia group had a significantly higher rate of cognitive decline than the control group, as well as a higher number of falls and magnitude of annual changes in falls. The changes in falls were irregular regardless of cognitive function. Furthermore, falls were associated only with the development of dementia, not cognitive function. Similar trends were observed across the total participant group. Our findings highlight the importance of monitoring cognitive function and falls as potential markers for predicting dementia onset in older adults. • We studied the association between falls and dementia in older adults. • Older adults with dementia showed a rapid increase in cognitive decline. • Significant correlation was found between cognitive decline, falls, and dementia. • Cognitive function and falls in older adults are markers of dementia. • Multifaceted approaches are needed to prevent dementia in older adults. [ABSTRACT FROM AUTHOR]

We envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disease. In this article, we review key potentially modifiable risk factors and genetic risk factors and discuss assessment of risk factors as well as additional fluid and imaging biomarkers that may enhance risk profiling. We then outline multidomain measures and risk profiling and provide practical guidelines for Brain Health Services, with consideration of outstanding uncertainties and challenges. Users of Brain Health Services should undergo risk profiling tailored to their age, level of risk, and availability of local resources. Initial risk assessment should incorporate a multidomain risk profiling measure. For users aged 39–64, we recommend the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) Dementia Risk Score, whereas for users aged 65 and older, we recommend the Brief Dementia Screening Indicator (BDSI) and the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI). The initial assessment should also include potentially modifiable risk factors including sociodemographic, lifestyle, and health factors. If resources allow, apolipoprotein E ɛ4 status testing and structural magnetic resonance imaging should be conducted. If this initial assessment indicates a low dementia risk, then low intensity interventions can be implemented. If the user has a high dementia risk, additional investigations should be considered if local resources allow. Common variant polygenic risk of late-onset AD can be tested in middle-aged or older adults. Rare variants should only be investigated in users with a family history of early-onset dementia in a first degree relative. Advanced imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET) or amyloid PET may be informative in high risk users to clarify the nature and burden of their underlying pathologies. Cerebrospinal fluid biomarkers are not recommended for this setting, and blood-based biomarkers need further validation before clinical use. As new technologies become available, advances in artificial intelligence are likely to improve our ability to combine diverse data to further enhance risk profiling. Ultimately, Brain Health Services have the potential to reduce the future burden of dementia through risk profiling, risk communication, personalized risk reduction, and cognitive enhancement interventions. [ABSTRACT FROM AUTHOR]

Obtaining consent for medical treatment in older adults raises a number of complex challenges. Despite being required by ethics and the law, consent for medical treatment is not always validly sought in this population. The dynamic nature of capacity, particularly in individuals who have dementia or other cognitive impairments, adds complexity to obtaining consent. Further challenges arise in ensuring that older people comprehend the medical treatment information provided and that consent is not vitiated by coercion or undue influence. Existing mechanisms to address issues surrounding consent for older adults only address incapacity and raise further challenges. As the ageing population increases, these issues are likely to become more profound, thus action is required to address these challenges. Raising awareness, more education, engaging with people with dementia, and conducting further research would assist in beginning to overcome these challenges. [ABSTRACT FROM AUTHOR]

The article presents a qualitative study on the assessment and management of concurrent hearing, vision, and cognitive impairments in older persons by conducting a survey on the perspectives of professionals in hearing, dementia and vision care. Topics include the need for cross-discipline training and guidelines for clinicians for better assessment and care strategies and the specialties of the professionals involved in the study, including psychology, audiology, and optometry.

Diabetes and dementia are both complex and increasingly common conditions which, in combination, make the successful management of diabetes a challenge. The focus for the person with diabetes is to have a good understanding of the condition, follow a regular plan of healthy eating and physical activity, monitor glucose levels, attend clinic reviews and take medication as prescribed. The presence of dementia, with increasing problems with memory and communication, can make these tasks difficult. Diabetes in turn can have a negative impact on memory and confusion, worsening the appearance of dementia. The combination of diabetes and dementia will influence the treatment choices, treatment targets, and type of care, with the main aim of success being the safety of the individual, avoidance of hypoglycaemia and unplanned hospital admission, and a good quality of life. [ABSTRACT FROM AUTHOR]

This study clarifies the role of advance directives in the process of decision making in nursing homes. Physicians reported on the actual use of advance directives in a medical decision making process related to status changes in 70 nursing home residents (mean age = 89 years). Charts were also reviewed to assess the specifics of the advance directives. Despite a high prevalence of advance directives, the directives themselves had a very limited role in affecting treatments. The physicians surveyed viewed directives related to hospitalization as the most useful, though these were not the most available directives. The attention and format given to advance directives in the nursing home may need to be reevaluated. [ABSTRACT FROM AUTHOR]

Purpose: An operational definition of dementia-related wandering is proposed to aid in clinical recognition, to promote research precision and validity, and to provide a pathway toward standardization of language in wandering science. Design and Methods: (1) One-hundred-and-eighty-three journal articles from multiple databases (Medline, OVID, CSA Journals, OCLC First Search, Google Scholar, PubMed, EBSCO) were reviewed to extract alternative terms and definitions for wandering or wandering-related behaviours; (2) terms and definitions were ordered alphabetically into a glossary; (3) a consensus approach was used to group glossary terms with related meanings into possible domains of wandering; (4) four domains (locomotion, drive, space and time) were found sufficient to encompass all wandering definitions; (5) wandering terms were placed into a conceptual map bounded by the four domain concepts and (6) a new provisional definition of wandering was formulated. Results: An empirically-based, operational definition improves clinical and research approaches to wandering and explicates historical inattention to certain beneficial aspects of the behaviour. Implications: Adoption of the proposed operational definition of wandering behaviour provides a platform upon which dementia care may be improved and standardized language may evolve in wandering science. [ABSTRACT FROM AUTHOR]

Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results. Objectives: This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers' depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers' depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers' level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relative's problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted. [ABSTRACT FROM AUTHOR]

This study investigates whether a modified version of the COOP/WONCA charts is suitable to assess quality of life (QOL) in persons with dementia in nursing homes. A group of 112 institutionalized persons with moderate to severe dementia were approached for an interview. Twenty-two were observed not to be communicative, leaving 90. Sixty-seven persons were able to answer four out of six questions adequately (interviewable). Inter-observer reliability (n=38) was excellent (weighted kappa 0.90 to 0.97). Test-retest reliability (n=34; one week interval) ranged from poor for Daily and Social Activities and for the QOL charts, to moderate for Feelings and Pain, and satisfactory for Physical Functioning (weighted kappa 0.23 to 0.67). Interviewability was associated with severity of the dementia and communication ability. Support for convergent validity was found in medium-sized Spearman correlations between the COOP/WONCA charts and related variables. Support for discriminant validity was found in the absence of association between the Ccharts and non-related variables. The modified COOP/WONCA charts can be used to assess QOL in 60% of people with dementia in nursing homes but further modification is needed. Severe cognitive impairment and communication disabilities proved limiting factors for the use of the instrument. Although the illustrations on the charts appeared not to be helpful, the written response options in addition to verbal presentation proved useful during the administration of the charts. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore the main and mediating influences of stressors, a caregiver's appraisal, coping, personal conditions and social resources on the burden of dementia caregivers. Method: The study sample consisted of 95 spousal caregivers of non-institutionalized persons with dementia. A path-analytic approach was used to test the conceptual model. Results: The most important factors that were related to burden were the social and behavioural problems of the person with dementia; perceiving the caregiver role as a threat; perceived instrumental support; and the caregiver's functional health status and self-efficacy. The results showed no support for the mediating role of appraisal and coping on the relationship between the demands of the caregiving situation and burden. Conclusion: Although we found insufficient support for the empirical tenability of the hypothesised model, this study revealed some new findings of practical interest. The relationships found suggest that it might be possible to reduce the caregiving burden by improving the social functioning of the person with dementia, the caregiver's perceptions and the caregiver's capacity to function in daily life. [ABSTRACT FROM AUTHOR]