Search

Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

What Is Known on the Subject: Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions., What This Paper Adds to Existing Knowledge: To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments., What Are the Implications for Practice: The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare., Abstract: INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions., Aim: The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia., Method: An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance., Results: The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences., Discussion: The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours., Implications for Practice: The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Introduction: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day mentorship program. Methods: An online survey was completed by participants prior to the training workshop and a similar survey at least 6 months following completion of the program to measure perceived changes related to knowledge, ability, and confidence to assess and manage memory problems, and comfort in speaking to patients and caregivers about concerns regarding dementia. Participants also completed a paper-based reaction survey at the end of the workshop and observership day. Results: Twenty-two FHTs, with 124 health professionals, participated in this program. At follow-up there were statistically significant increases in self-reported knowledge of and ability to assess and manage cognitive impairment, confidence, comfort level in speaking to patients about memory problems, and the ability of participants' FHT to manage cognitive impairment independently. Engagement in dementia care practice activities increased following the program. All but one FHT successfully formed a memory clinic. Discussion: This training program represents a significant opportunity to bring about evidence-based practice change through a capacity development initiative to support primary care providers to maintain the majority of dementia care within primary care practice. The provision of practical knowledge and resources and incorporating best teaching practices to maximize knowledge transfer contributed to the success of this program. (Contains 5 tables and 1 figure.)

Background: The objective of this paper is to describe the activities, challenges and mitigation strategies, lessons learned and reflections on the importance of engagement from the first year of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia (EPLED) Advisory Group and cross-cutting program. EPLED was created to support persons with dementia and care partners to be actively involved in the CCNA research process. Main body: The Advisory Group was formed to work with CCNA researchers and programs to develop new ways to further collaborate and advance the methods of patient engagement in research on dementia. A role profile and recruitment poster were developed and, after interviews, 17 people were invited to join the Advisory Group. We planned three online EPLED meetings to take place between July–August of 2020, with one in-person meeting to be held in Canada. Due to COVID-19, we moved all of these meetings online. In the first year, EPLED and the Advisory Group met seven times formally, four times informally, developed a website, engaged with CCNA research projects, participated in CCNA "Central" activities and formulated an evaluation plan. For researchers and people with lived experience of dementia, motivations for patient engagement included challenging stigma, making meaning from their experience (such as building relationships and having their voices heard) and contributing to research. Common challenges to engagement were related to navigating the impact of COVID-19, such as difficulty in getting to know each other and technical issues with video-conference software. We learned that developing trusting relationships, providing education, offering support, being flexible and acknowledging tensions between research, practice and lived experience, were vital to the success of the Advisory Group. Conclusion: The first year of the EPLED Advisory Group demonstrated the potential contributions of people with lived experience of dementia as partners in research. Building these collaborations with individuals and communities—people living with dementia, care partners, researchers and research institutions—has the potential for positive impact across these groups and, ultimately, improve the lives of people living with dementia and their care partners. Plain English summary: In this paper, we describe the development of the Canadian Consortium of Neurodegeneration in Aging (CCNA) Engagement of People with Lived Experience of Dementia (EPLED) cross-cutting program and the first year of the EPLED Advisory Group. EPLED was created to build opportunities for patient engagement in the CCNA's research on dementia. People living with dementia and current/former friends, family and care partners were recruited from across Canada to join the Advisory Group. In the first year, the Advisory Group met seven times formally, four times informally, developed a website, engaged with CCNA research projects, participated in CCNA "Central" activities and formulated an evaluation plan. Challenges included the impacts of the COVID-19 pandemic, online meetings, and differing expectations and priorities. Lessons learned and reflections on the importance of engagement are discussed in the context of research on dementia and from the perspectives of researchers and Advisory Group members. [ABSTRACT FROM AUTHOR]

Aim: To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia. Background: Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities. Design and methods: :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines. Results: Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment. Conclusion: Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required. [ABSTRACT FROM AUTHOR]

Background: Social Frailty is a significant public health concern affecting the elderly, particularly with the global population aging rapidly. Older adults with social frailty are at significantly higher risk of adverse outcomes such as disability, cognitive impairment, depression, and even death. In recent years, there have been more and more studies on social frailty, but no bibliometrics has been used to analyze and understand the general situation in this field. Therefore, by using CiteSpace, VOSviewer, and Bilioshiny software programs, this study aims to analyze the general situation of the research on social frailties of the older adults and determine the research trends and hot spots. Methods: A bibliometric analysis was conducted by searching relevant literature on the social frailty of the older adults from 2003 to 2022 in the Web of Science core database, using visualization software to map publication volume, country and author cooperation networks, keyword co-occurrences, and word emergence. Results: We analyzed 415 articles from 2003 to 2022. Brazil has the highest number of articles in the field of social frailty of the older adults, and the United States has the highest number of cooperative publications. Andrew MK, from Canada, is the most published and co-cited author, with primary research interests in geriatric assessment, epidemiology, and public health. "Social Vulnerability," "Health," "Frailty," "Mortality," and "Older Adult" are among the research hotspots in this field. "Dementia," "Alzheimer's disease," "Population," and "Covid-19" are emerging research trends in social frailty among the older adults. Conclusion: This scientometric study maps the research hotspots and trends for the past 20 years in social frailty among the older adults. Our findings will enable researchers to better understand trends in this field and find suitable directions and partners for future research. [ABSTRACT FROM AUTHOR]

Practices of creativity and compliance intersect in interaction when directing local dances remotely for people living with dementia and their carers in institutional settings. This ethnomethodological study focused on how artistic mechanisms are understood and structured by participants in response to on-screen instruction. Video data were collected from two long-term care facilities in Canada and Finland in a pilot study of a dance program that extended internationally from Canada to Finland at the onset of COVID-19. Fourteen hours of video data were analyzed using multimodal conversation analysis of initiation–response sequences. In this paper, we identify how creative instructed actions are produced in compliance with multimodal directives in interaction when mediated by technology and facilitated by copresent facilitators. We provide examples of how participants' variably compliant responses in relation to dance instruction, from following a lead to coordinating with others, produce different creative actions from embellishing to improvising. Our findings suggest that cocreativity may be realized at intersections of compliance and creativity toward reciprocity. This research contributes to interdisciplinary discussions about the potential of arts-based practices in social inclusion, health, and well-being by studying how dance instruction is understood and realized remotely and in copresence in embodied instructed action and interaction. [ABSTRACT FROM AUTHOR]

WHAT IS KNOWN ON THE SUBJECT?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non-pharmacological care interventions that address environmental and situational variables that reflect military action. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Specialized education and training is needed to improve the identification of PTSD when existent with other co-occurring neurocognitive conditions such as delirium, dementia and depression. ABSTRACT: Introduction Co-occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia-related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co-occurrence of PTSD symptoms in Veterans with dementia. Methods Eight semi-structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust-based and validation-oriented strategies resulting in more effective care management. Discussion Improvement in the identification of co-occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice Recognizing the complex needs of older Veterans with co-occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement This paper provides mental health nurses with new understanding of co-occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs., (© 2022 John Wiley & Sons Ltd.)

Background: Dementia is one of the main public health priorities for current and future societies worldwide. Over the past years, eHealth solutions have added numerous promising solutions to enhance the health and wellness of people living with dementia-related cognitive problems and their primary caregivers. Previous studies have shown that an environmental scan identifies the knowledge-to-action gap meaningfully. This paper presents the protocol of an environmental scan to monitor the currently available eHealth solutions targeting dementia and other neurocognitive disorders against selected attributes. Objective: This study aims to identify the characteristics of currently available eHealth solutions recommended for older adults with cognitive problems and their informal caregivers. To inform the recommendations regarding eHealth solutions for these people, it is important to obtain a comprehensive view of currently available technologies and document their outcomes and conditions of success. Methods: We will perform an environmental scan of available eHealth solutions for older adults with cognitive impairment or dementia and their informal caregivers. Potential solutions will be initially identified from a previous systematic review. We will also conduct targeted searches for gray literature on Google and specialized websites covering the regions of Canada and Europe. Technological tools will be scanned based on a preformatted extraction grid. The relevance and efficiency based on the selected attributes will be assessed. Results: We will prioritize relevant solutions based on the needs and preferences identified from a qualitative study among older adults with cognitive impairment or dementia and their informal caregivers. Conclusions: This environmental scan will identify eHealth solutions that are currently available and scientifically appraised for older adults with cognitive impairment or dementia and their informal caregivers. This knowledge will inform the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate eHealth solutions according to their needs and preferences based on trustable information. [ABSTRACT FROM AUTHOR]

To address risks associated with critical dementia-related wandering, three guidelines were developed for use by persons living with dementia, their care partners, and professional staff, to choose wander-management strategies. This evidence-based research incorporates knowledge mobilization approaches that directly involve the three types of stakeholders in using the guidelines in the real world. The purpose of this project was to evaluate the knowledge translation of three guidelines on wander-management strategies, and to further deploy these guidelines to organizations across Canada. Steering committees across Canada were established for consultation. Guidelines were then shared among these organizations via Google slides. Health professionals, caregivers, community organizations and persons living with dementia completed an online survey (via Google) or paper-based survey to provide feedback on the guidelines. The guidelines were then translated from English to French using a forward-translation method. The guidelines were adopted across ten organizations in four Canadian provinces. Adoption included introduction and formal training to staff. It took 22 months from the development of the guidelines to the dissemination and launch of the guidelines to the organizations. Participants (n = 73) were very satisfied with the developed guidelines and agreed they were easy to navigate, easy to understand, and the information provided was useful. A stakeholder-driven approach used for guideline development and dissemination were successful methods for minimizing the time for this work to become practice. This in addition to the use of online platforms can replace conventional methods which take longer and become quickly outdated. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a qualitative study conducted in Ontario, Canada with the purpose of identifying the barriers and facilitating factors of access to dementia care by foreign-born individuals, including immigrants and refugees. Interview data revealed seven overarching themes related to access and participation in dementia care programs by migrants, including structural, process, and outcome barriers. Our study findings suggest that incorporating culturally inclusive activity components in recreational dementia care programs will promote program participation by individuals from ethno-cultural backgrounds. It is essential to train health care providers to assist with building competence in working with people from different cultural and linguistic backgrounds. To prevent normalization of symptoms of dementia and promote timely access to dementia care, it is important to focus on generating awareness and acknowledgement of dementia as an illness rather than as a normal part of aging or a condition associated with stigmatization. [ABSTRACT FROM AUTHOR]

People with dementia have typically been treated as homogenous groups with little recognition of unique aspects of identities, including age and gender. The purpose of this paper is to illuminate the experiences of women living with young onset dementia which led them to take up advocacy roles as a result of their experiences. Five women from Canada who were diagnosed with young onset dementia and had then taken on advocacy roles were interviewed. Two main themes emerged–Moving In (the challenges of a diagnosis) and Moving On (into a new life). They described the challenges of a diagnosis as stopping work, being taken seriously, fighting for support, failing to meet requirements for programs and services, and changing relationships with friends. The challenges led them to move into a new life, accepting their diagnosis, and moving into new roles of advocacy and supporting others with dementia in their journey. Further research should seek to explore diversity, rather than treating people with dementia as the same. The experience of dementia is different for everyone. From getting a diagnosis to living a life with dementia, these experiences are unique. Based on interviews with five women living with dementia diagnosed before age 65, it was found that the challenges of getting a diagnosis led the women to become advocates for supporting others with dementia in their journey. The challenges of a diagnosis included stopping work, being taken seriously, fighting for support, not meeting requirements for programs and services, and changing relationships with friends. As a result of their experiences, the women moved on into a new life, accepting their diagnoses, and taking on advocacy roles to create change for others living with dementia. The advocacy roles undertaken by these women demonstrate the need to recognize the unique aspects of people with dementia, in particular women with young onset dementia, without making assumptions that the experience of dementia is the same for everyone. [ABSTRACT FROM AUTHOR]

The prevalence of persons living with dementia and at risk of going missing is rising. In this study, we engaged persons living with dementia, care partners, police services, search and rescue organizations, and health and social service providers to develop Community ASAP, a mobile alert system that engages community citizens, as volunteers, to look out for persons with dementia reported missing. We completed three phases of development and evaluation of the usability and functionality of the alert system with stakeholders in three Canadian provinces. In this paper we describe features of the Community ASAP and the findings of these evaluation phases., Competing Interests: The authors have declared that no competing interests exist.

Purpose The purpose of this paper is to critically reflect on the global dementia prevention views of the Japanese leaders at both the Japanese Young Leaders in Dementia Event and the Japanese Global Legacy Against Dementia event, from a Canadian perspective.Design/methodology/approach This paper undertook a global comparison of the discussion and recommendations from both the Japanese Young Leader Event and the satellite Global Dementia Legacy Event.Findings The paper provides insights about the cultural and intergenerational differences in both the Japanese solutions compared to the Canadian solutions.Originality/value The authors encourage leaders involved in global prevention dementia discussions to remember the importance of context, in regards to both cultural and intergenerational collaborations, in the search for global dementia solutions. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study. Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care. Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources, while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Although the seminal work of McCormack et al. (International Practice Development Journal, 2015, 5, 1) and Nolan, Davies, Brown, Keady, and Nolan () provides useful conceptual frameworks in person‐centred care, research is needed to understand how theoretical concepts can be applied into practice to support dementia care. Also, evidence is needed to demonstrate the impacts of implementing person‐centred care and staff experiences. What does this paper add to existing knowledge?: This paper adds to the emerging work that is providing a greater understanding of how team education in practice can make a difference in building capacity to improve dementia care.We offer timely evidence and useful insights into how an education programme, Gentle Persuasive Approaches (GPA), was implemented ("what worked" and "how") in a large Canadian hospital to improve knowledge and skills among staff in dementia care.The GPA education helped hospital staff enact person‐centred care by cultivating shared values and a learning environment to change attitudes, practices and conditions for continuous practice development. What are the implications for practice?: Mental health nurses in advance practice are well positioned to lead dementia education and advocate for person‐centred care in hospitals.Hospital leaders are responsible for providing resources to cultivate a supportive environment for continuous learning to ensure the workforce gains the capacity to meet the changing demands and needs of the ageing population. System support is essential for creating conditions to enable person‐centred care. Introduction: Hospital staff lacks knowledge and skills in dementia care. There is a need to understand how person‐centred care theory can be operationalized in staff's practices to improve dementia care. Aims: To describe the staff's experiences of learning and applying the Gentle Persuasive Approaches (GPA) to enact person‐centred care in a hospital. Methods: Mixed methods, including posteducation survey and focus groups, were used. Thematic analysis was conducted to identify themes that describe participants' experiences. Results: Three hundred and ten staff and leaders in a hospital participated in the GPA education and completed a posteducation survey (n = 297). After 1 year, two follow‐up focus groups were conducted with interdisciplinary staff (n = 24) across medicine and mental health programmes. Our analysis identified three themes to enable person‐centred care: (a) changing attitudes, (b) changing practices and (c) changing conditions. Discussion: This study contributes to the literature by providing evidence of how an education programme was implemented in a large Canadian hospital to build capacity for dementia care. Joint education for interprofessional staff offers value in enabling person‐centred care. Implication: Mental health nurses are in position to lead dementia education and advocate for person‐centred care in hospitals. Staff need structural support to engage in team learning for practice improvement. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share information regarding the Global Action Against Dementia Legacy, to critically reflect on the views of the Canadian Young Leaders of Dementia and to strengthen the impact of their voices in the global discussion surrounding dementia. Design/methodology/approach – This offers a critical reflection and review of the innovative intergenerational discussions and solutions offered by younger Canadians – specifically, the Millennial Generation. Findings – The paper provides insights about how change and solutions in dementia actions may be established through intergenerational collaboration. Research limitations/implications – Researchers are encouraged to make room for the voices of younger, less established generations in both discussions and research related to dementia. The younger generations will provide future direction to the Global Action Against Dementia Legacy so it is time to hear their voice too. Originality/value – This paper draws on developments in the Canadian context to highlight the potential of encouraging a less-usual, intergenerational approach to developing engagement, research and solutions in dementia. [ABSTRACT FROM AUTHOR]

Background: Biomarker research is gaining increasing attention focusing on the preclinical stages of the disease. Such interest requires special attention for communication and disclosure in clinical contexts. Many countries give dementia a high health policy priority by developing national strategies and by improving guidelines addressing disclosure of a diagnosis; however, risk communication is often neglected., Main Text: This paper aims to identify the challenges of disclosure in the context of dementia prediction and to find out whether existing clinical guidelines sufficiently address the issues of disclosing a dementia diagnosis and of disclosing the risk of developing dementia in asymptomatic and MCI stage. We will examine clinical guidelines and recommendations of three countries (USA, Canada and Germany) regarding predictive testing and diagnostic disclosure in dementia and Mild Cognitive Impairment (MCI) to show their potentials and limits. This will provide a background to address ethical implications of predictive information and to identify ways how to proceed further. We will start by examining the guidelines and recommendations by focusing on what there is already and what is missing regarding the challenges of disclosing dementia prediction and MCI. Then, we will highlight the novel ethical issues generated by the shift to identify preclinical stages of the disease by biomarkers. We will argue for the need to develop guidelines for disclosing a risk status, which requires different considerations then disclosing a diagnosis of dementia. Finally, we will make some suggestions on how to address the gap and challenges raised by referring to German Stakeholder Conference, which presents us a good starting point to the applicability of involving stakeholders., Conclusions: This paper underlines the need to develop empirically based guidelines that address the ethical and social strategies for risk communication of dementia prediction by genetic as well as non-genetic biomarkers. According to our analysis, the guidelines do not address the new developments sufficiently. International efforts should aim for specific guidelines on counseling, communicating risk and disclosing results. We argue that guidelines on (risk) disclosure should be developed by involving various stakeholders and should be informed by socio-empirical studies involving laypersons' needs and wishes regarding risk communication.

In their paper, Morton-Chang et al. (2016) discuss how aging societies are struggling and trying to cope with the rapidly increasing numbers of persons living with dementia (PLWD). In that sense, the Canadian case is not unique. On the contrary, it is very similar to other developing countries. Therefore, it is worthwhile to reflect from another country's perspective on this unprecedented societal development. In this paper, I will consider the challenge of dealing with increasing numbers of PLWD from the European and, in particular, Dutch perspectives. Whereas, MortonChang et al. pose the question: "How do we get there from here?" I will address the issues of what the "there" should be and how we get there from my European/Dutch perspective. I will provide my view on how the roadmap can be drawn, who needs to be on the tour, who might be the guide and what conditions need to be in place to arrive at the desired destination., (Copyright © 2019 Longwoods Publishing.)

In 2012, the World Health Organization estimated that the number of people living with dementia worldwide was approximately 35.6 million; they projected a doubling of this number by 2030, and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing providers is a common part of the dementia journey in most countries. Previously published research confirms that caring for people living with dementia in such facilities often creates moral distress for nursing care providers. In this paper, the authors share additional findings from a two-year, two-phase, mixed methods study of moral distress as experienced by nursing caregivers of residents with dementia in residential care settings in a Western Canadian province. The findings relate to strategies to reduce moral distress in this caregiving group, with a particular focus on the role of supportive and responsive leadership. Important implications for practice and for leadership in the residential care sector are presented., (Copyright © 2019 Longwoods Publishing.)

This paper challenges traditional definitions of work and leisure as separate concepts by suggesting that a space where individuals engage in employment (paid work) can, at the same time, be a space of respite (leisure) for employees who are also family caregivers. The research aims to better understand what caregivers perceive as ideal respite space, what that space means to them, how the space where employment takes place fits that ideal and what forces restrict caregivers' ability to engage with employment as a space of respite. The term space is used because a caregiver's presence in a particular space (inside or outside of a place) gives it meaning that is simultaneously social, political and emotional. We report on a qualitative intrinsic case study of primary caregivers who are both employed and providing care to relatives with dementia. Using a reflective iterative process, 12 participants were recruited and interviewed from two Canadian provinces in 2013/14. Using a non-temporal view of respite facilitated the identification of employment as an important space for caregivers to experience effective respite. Although this connection has been noted by other scholars, our research goes beyond this to identify four forces that create challenges for caregivers who want to maintain engagement with employment as a space of respite. These forces are internalised socialisation, family and organisational pressures and government policy. In addition, this research is one of the first to suggest ways that caregivers resist these forces. In concluding remarks, we reflect on the limitations of the study and offer suggestions for further research aimed at elucidating the spatiality of caregiver respite and the complex and dynamic aspects of resistance., (© 2019 John Wiley & Sons Ltd.)

Purpose: Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians' and specialists' perspectives on such a system and identify barriers to its implementation., Design/methodology/approach: The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs., Findings: Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care., Practical Implications: This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record., Originality/value: Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.

Introduction: In the last decade, increasing research interest has been expressed in responsive behaviours of older adults living in long-term care (LTC) homes, including nursing homes and assisted living facilities. Responsive behaviours are not only a sign of underlying unmet needs, but when directed against (towards) paid staff can lead to decreased quality of work life, and may contribute to lower quality of care. In this systematic review, we aim to synthesise empirically based quantitative and qualitative evidence on factors and stakeholder (eg, staff and family members) experiences of factors associated with the responsive behaviours of people living in LTC directed towards staff., Methods and Analysis: This study will be a systematic review of published and 'grey' literature. Twelve bibliographical databases will be searched, and for each database, we will use appropriate subject headings and keywords that cover two concepts: LTC and responsive behaviour. No publication date or language filter will be used. The title and abstract of each extracted record will be screened, followed by screening of full text of included papers. Then data extraction and quality assessments will be undertaken. Each stage will be completed independently by pairs of authors. For quantitative studies, meta-analysis will be conducted if pooling is possible; otherwise, a critical narrative analysis will be conducted. For qualitative studies, thematic analysis will be conducted. Factors will then be organised at the individual, interpersonal, institutional and larger societal levels. Sensitivity analysis will be conducted to explore the influence of risk of bias and publication bias on the results. Subgroup analysis will be conducted for people who live with dementia and those who do not., Ethics and Dissemination: Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

ABSTRACTBackground:The Fountain of Health (FoH) initiative is a knowledge transfer (KT) project on the science of brain health and resilience promotion, in alignment with positive psychiatry., Objectives: Assess the effectiveness of FoH KT delivered in individual and group-based formats., Design: Pre- and post-intervention quality assurance survey of FoH KT., Setting: Interventions occurred in Nova Scotia, Canada., Participants: Adults over age 50 years without pre-existing dementia were targeted. A total of 92 participants received FoH KT in individualized (n = 41) and group-based (n = 51) formats., Intervention: FoH KT (e.g. sharing evidence, lifestyle coaching, and goal setting) using a range of KT supports (e.g. FoH website, paper materials) was delivered to (1) individual patients by primary care clinicians and (2) community-based groups by lay leaders., Measurements: The main outcome measure was participant pre- and post-quality assurance self-reports., Results: Improvements were found in participant awareness of FoH, knowledge of evidence-based mental health promotion initiatives, and in application of this information in daily life in both individual and group-based settings. Improvements in participant knowledge about epigenetic factors that impact health and confidence with health behavior goal setting were reported in both contexts. Changes in self-perceptions of aging scores reached significance in the group intervention., Conclusions: FoH KT produced short-term positive self-reported changes in participants in both individual and group formats. Larger control studies with long-term follow up are needed to better assess effects of both individual and group formats of FoH KT and longer term impacts on health behaviors and outcomes.

Background With the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention. Purpose To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care. Methods An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade. Results The current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care. Conclusions Further progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper. [ABSTRACT FROM AUTHOR]

Aims: To report on the development and validation of the Moral Distress in Dementia Care Survey instrument., Background: Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care., Design: The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 - June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument., Methods: The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed., Results: The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff., Conclusion: The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress., (© 2018 John Wiley & Sons Ltd.)

Health and social science researchers are increasingly interested in the range of new possibilities and benefits associated with diary methods, particularly using digital devices. In this article, we explore how a flexible diary method, which enables participants to choose the device (i.e., paper notebook, tablet, or computer) and medium (i.e., text, photographs, sketches) through which they narrate their experiences, can be used to promote sensitive and rigorous research engagement with family carers to people with dementia. We used a diary interview method with 10 carers over the course of 6 weeks to explore how they experience and interpret the changing behaviors of their cognitively impaired kin. We reflect on how the quality of diary data can be enhanced alongside the ethical dimensions of research with carer populations, through different forms of diary keeping, regular interaction with participants, reflexive practice, and follow-up interviews. [ABSTRACT FROM AUTHOR]

Background: Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period.Methods: We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs.Results: We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts.Conclusions: Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused. [ABSTRACT FROM AUTHOR]

Behaviours such as hitting, spitting, swearing and kicking can be a common response to personal, social and environmental challenges experienced by people with dementia. Little attention, however, has been given to how partners in care experience and respond to these behaviours in the home. This paper examines the emerging theme of 'aggression,' in seven interviews with nine former partners in care of people with dementia in Ontario, Canada. We explore how partners in care talk about, interpret and respond to these behaviours drawing on recent conceptualizations of structural and interpersonal violence in health and social geography and contributing to the growing body of research on relational care. We discuss the responses to, and implications of, these behaviours at a range of spatial scales and identify important considerations for future research. [ABSTRACT FROM AUTHOR]

Background: Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators., Methods: A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver., Conclusions: An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Background Community support programs can improve quality of life for people living with dementia and their care partners. Important to the successful implementation of such programs is close engagement with end-users to gain a better understanding of their needs. This study describes the perspectives of people living with dementia, care partners, and health-care providers on the First Link® dementia support program provided by the Alzheimer Society of British Columbia (ASBC). Methods Following a large-scale survey (N=1,164), semi-structured interviews were conducted with participants to explore in greater detail the different needs and themes that emerged from the first phase of the study. The interviews explored: 1) experiences with the program; 2) future planning; 3) meaning of independence; and 4) impact of the program on emotional and physical well-being. Results A total of 48 participants were interviewed in this study. Knowledge and education were key factors that helped participants manage the impact of dementia. Learning about dementia, the experiences of others, strategies on how to manage symptoms, what to plan for in the future, and how to access different services in the community, was tied to increased feelings of confidence and comfort, and decreased stress. Participants also provided suggestions for improvement of the First Link® dementia program such as further embedding the program into the patient journey, providing more services in remote areas, providing education for health-care providers, and increasing awareness of the program. Conclusion By emphasizing the lived experiences and needs of those living with dementia and their caregivers, this work will inform future research-based program evaluations globally and, in turn, improve the existing services to support people living with--and impacted by--dementia. [ABSTRACT FROM AUTHOR]

Although there is a growing literature on the use of telepresence robots in institutional dementia care settings, limited research focused on the perspectives of frontline staff members who deliver dementia care. Our objective was to understand staff perspectives on using telepresence robots to support residents with dementia and their families. Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups and 11 semi-structured interviews across four long-term care (LTC) homes and one hospital in Canada. We included 22 interdisciplinary staff members (e.g., registered nurses, social workers, occupational therapists, recreational therapists) to understand their experiences with telepresence robots. Thematic analysis identified three key themes: 1) Staff Training and Support; 2) Robot Features; 3) Environmental dynamics for Implementation. Our results underscore the imperative of structural support at micro-, meso- and macro-levels for staff in dementia care settings to effectively implement technology. This study contributes to future research and practice by elucidating factors facilitating staff involvement in technology research, integrating staff voices into technology implementation planning, and devising strategies to provide structural support to staff, care teams, and care homes. [ABSTRACT FROM AUTHOR]

Longstanding concerns about quality care provision, specifically in the area of long-term care, have prompted calls for changing the culture of care to reflect more client-driven and relationship-centred models. Despite an increase in culture change initiatives in both Canada and the United States, there is insufficient information about the theories and approaches that guide culture change. The purpose of this paper is to describe a culture change initiative currently underway in Canada, the Partnerships in Dementia Care Alliance, and the theoretical foundations informing our work. More specifically, we describe how the theoretical and philosophical underpinnings of the Alzheimer Disease and Related Dementias framework, the authentic partnership approach, participatory action research and Appreciative Inquiry have been integrated to guide a culture change process that encourages working collaboratively, thinking and doing differently and re-imagining new possibilities for changing the culture of dementia care., (© The Author(s) 2014.)

In their paper, Morton-Chang et al. (2016) discuss how aging societies are struggling and trying to cope with the rapidly increasing numbers of persons living with dementia (PLWD). In that sense, the Canadian case is not unique. On the contrary, it is very similar to other developing countries. Therefore, it is worthwhile to reflect from another country's perspective on this unprecedented societal development. In this paper, I will consider the challenge of dealing with increasing numbers of PLWD from the European and, in particular, Dutch perspectives. Whereas, Morton-Chang et al. pose the question: "How do we get there from here?" I will address the issues of what the "there" should be and how we get there from my European/Dutch perspective. I will provide my view on how the roadmap can be drawn, who needs to be on the tour, who might be the guide and what conditions need to be in place to arrive at the desired destination.

Improving dementia care in Canada is a challenge to which we must rise. Dementia care strategies with a strong community focus are a key means of doing so. This paper outlines and expands upon the following five core areas that will contribute to the success of dementia care strategies: 1) the relationship between frailty and dementia is critical to understanding and addressing dementia risk and management; 2) social circumstances are important to formally consider, both as risk factors for adverse outcomes and as practical factors that contribute to care and support planning; 3) a dementia care strategy must span the continuum of care, which has important ramifications for our systems of primary, acute and long-term care; 4) prevention and public education are essential components of dementia care strategies; 5) research and evaluation are critically important to any dementia care strategy, and must be seen as core components as we strive to learn what works in dementia care. Given that a coordinated effort is needed, Canada needs to join other countries that have recognized dementia as a momentous challenge to national and global health. The time for a comprehensive national dementia care strategy is now.

Background: Indigenous populations may be at increased risk, compared with majority populations, for the development of dementia due to lower education levels and socio-economic status, higher rates of diabetes, hypertension, cardiovascular disease and alcohol abuse, an aging population structure, and poorer overall health. This is the first systematic review investigating the prevalence and incidence of dementia in indigenous populations worldwide., Methods: This systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE, Embase, and PsycInfo for relevant papers published up to April 2015. Studies were included if they reported prevalence or incidence, the disease typically occurred after the age of 45, the study population included indigenous people, and the study was conducted in the general population., Results: Fifteen studies representing five countries (Canada, Australia, the USA, Guam, Brazil) met the inclusion criteria. Dementia prevalence ranged from 0.5% to 20%. Retrospective studies relying on medical records for diagnoses had much lower prevalence rates and a higher risk of bias than population-based prospective studies performing their own diagnoses with culturally appropriate cognitive assessment methods., Conclusions: The prevalence of dementia among indigenous populations appears to be higher than it is for non-indigenous populations. Despite a building body of evidence supporting the need for dementia research among indigenous populations, there is a paucity of epidemiological research, none of which is of high quality.

Aims: A discussion of the extent to which people with dementia's perspectives on quality of life have been included in quantitative research., Background: Capturing the perspective of people with dementia may improve understanding of their quality of life. Quantitative tools to assess quality of life exist, but the extent to which these reflect the perspective of people with dementia has not been evaluated., Design: A discussion paper., Data Sources: Ten tools (designed between 1992-2012) to measure quality of life from the perspective of people with dementia were located from existing reviews., Discussion: Each tool was rated according to the extent to which the developers included the perspectives of people with dementia at three different points of quality of life conceptualization: during quality of life assessment, to identify quality of life domains and to define an overall conceptual framework. This analysis demonstrates that tool developers were inconsistent in their approach to including the perspectives of people with dementia to understand quality of life. The perspective of people with dementia was included primarily to assess, but not to select domains or define overall quality of life., Implications for Nursing: Nurses should consider not only who assesses quality of life, but also whose understanding of quality of life is being assessed., Conclusion: It is unclear whether the quantitative quality of life literature reflects the perspective of people with dementia. Debate is needed regarding the impact of this issue on the lives of people with dementia., (© 2015 John Wiley & Sons Ltd.)

Background: As the number of people living with dementia rapidly increases worldwide, the support provided by their informal caregivers remains key to the sustainability of most healthcare systems, this voluntary contribution representing 40% of the costs of dementia worldwide. Informal caregiving in dementia, however, is linked to long periods of chronic stress with frequent and serious negative consequences on the health and quality of life of the caregiver. A psycho-educational group intervention focusing on coping with the daily stress of dementia caregiving ("Learning to feel better... to help better"), developed in French-speaking Canada and showing broad effects on quality of life, was selected with the aim of 1) adapting it to a new cultural context (French-speaking Switzerland) based on identified facilitators and barriers, using a participative approach; and 2) conducting a feasibility study to evaluate whether the adapted programme showed similar or improved feasibility and effects compared to the original Canadian programme. Methods: A mixed-methods concurrent nested design was used to evaluate the feasibility and the effects on five quantitative core outcomes. Additional qualitative data helped document in depth the acceptability and impact of the intervention. Results: We shortened the programme from 30 to 21 h in total, which resulted in increased accessibility, in terms of facilitated recruitment of participants and inclusion of a broader range of informal caregivers. There were significant reductions in subjective burden (effect size: d = -0.32) and psychological distress (d = -0.48), as well as decreases in the stress reactions of informal caregivers related to the behaviour problems of the persons with dementia (d = -0.57). The qualitative results emphasized the usefulness of providing informal caregivers with structured procedures for efficiently tackling everyday challenges, and of enabling learning through a variety of channels and activities. Conclusions: Substantial improvements are associated with this 21-h group intervention, organised in 7 sessions of 3 h each, focused on learning more efficient strategies to cope with the daily stress of dementia caregiving. This intervention empowered informal caregivers to master their daily challenges with more confidence, satisfaction and calm. Trial registration: ISRCTN13512408 (registration date 17.05.2021, retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings: Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAID) is available in Canada for competent persons meeting the legal requirements. Extending access to persons lacking decisional capacity is being considered. Social workers may be called upon to accompany these persons through the MAID process. As part of a larger survey, we asked social workers from Quebec whether they would be willing to be involved should advance requests for MAID be legalized. Of the 367 respondents, 291 replied that they would. Using multivariable logistic regression, we identified characteristics that distinguish them from the other social workers surveyed: importance of religious or spiritual beliefs, being born in Canada, having received assisted-death requests from families, professional experiences with MAID, and dreading the prospect of participating in MAID for persons lacking decisional capacity. These findings underline the need for educational interventions that would increase social workers' confidence in providing high-quality care to clients who opt for MAID [ABSTRACT FROM AUTHOR]

Purpose - There is much evidence of bias in research on the effectiveness and efficacy of drugs as a result of the influence of the pharmaceutical industry. The purpose of this paper is to present the views of those involved in a major evidence-based policy initiative from Canada and examine the adequacy of existing academic conflict of interest (COI) rules. Design/methodology/approach - Data came from the Alzheimer's Drug Therapy Initiative in British Columbia, a coverage with evidence development (CED) initiative, where a form of action research collected insights from the authors' experiences, combined with qualitative interviews with members of the research team. Findings - The majority of researchers perceive the influence of pharmaceutical manufacturers as problematic. Even when the strictest of COI rules are followed, extending well beyond disclosure, the reach of industry is so great that existing COI rules lag far behind their expanding influence. Practical implications - The authors support others who call for the funding of independent research, enforcement of existing disclosure rules, and unfettered publication rights. In addition, the authors urge the education of all research team members, including clinicians, on the evidence indicating the variety of forms through which industry influence is exerted. The authors believe that this awareness-raising can help toward minimizing that influence in the analyses that are conducted. Originality/value - Consideration of pharmaceutical influence on CED research is important. There may be an untrue assumption that CED is functioning at arms-length from the drug companies. [ABSTRACT FROM AUTHOR]

In 2010, approximately 500,000 Canadians suffered from a dementia-related illness. The number of sufferers is estimated to double in about 25 years. Due to this growing demographic, dementia (most frequently caused by Alzheimer's disease) will increasingly have a significant impact on our aging community and their caregivers. Dementia is associated with challenging behaviours such as agitation, wandering, and aggression. Care providers must find innovative strategies that facilitate the quality of life for this population; moreover, such strategies must value the individual person. Social commitment robots - designed specifically with communication and therapeutic purposes - provide one means towards attaining this goal. This paper describes a study in which Paro (a robotic baby harp seal) was used as part of a summer training program for students. Preliminary conclusions suggest that the integration of social commitment robots may be clinically valuable for older, agitated persons living with dementia in long-term care settings.

The use of judgment-based global measures of clinical treatment effects has a long history in the regulatory approval of drugs for the treatment of dementia. This paper reviews current use of these measures, noting several practical difficulties with their implementation. Importantly, global measures have usually yielded general estimates of drug effects similar to psychometric test batteries, even though correlations between global and psychometric measures at the individual patient level is modest. Like psychometric tests, global measures can tell us that some clinically detectable effect is present but often yield only limited evidence about what those effects might be. Steps should be taken to improve the specificity of treatment effect description and to incorporate patient/caregiver preferences in global measures about disease treatment in dementia.

This paper describes a process of identifying best practice guidelines for non-pharmacological management for individuals with dementia and disseminating them to a group of frontline practitioners in specialized geriatric services. Our dissemination plan involved early participation of practitioners, development of a chart summarizing five guidelines showing commonalities, contrasts, and gaps in the guidelines, and their interpretation, colour-coded for the strength of the evidence on which they were based. Two sequential workshops were held in which recommendations for action were developed. Outcomes of the process included a resource manual, a network of practitioners, and action recommendations based upon survey data. An early follow-up evaluation showed increased adoption of guidelines.

This paper examines the associations between clinical dementia and underlying cause of death (UCD) in a population-based sample of seniors who took part in the Canadian Study of Health and Aging (CSHA). Cause-of-death data were obtained via death certificates for 2,924 of 2,982 deceased subjects. Among the decedents were 823 clinically demented and 670 clinically non-demented participants. Using logistic regression we examined factors associated with a particular UCD in the overall group and also in the subgroup of demented seniors. Dementia was found to be associated with an increased risk of death from pneumonia. Both Alzheimer's disease and vascular dementia appear to decrease the risk of mortality from neoplasm. To our knowledge, this study is the first of its kind that combines a large, representative sample with thorough clinical assessment of cognitive status., (Copyright (c) 2005 S. Karger AG, Basel.)

There is little written about the pharmacoeconomics of mild cognitive impairment (MCI), particularly with regard to intervention. The aim of the paper is to highlight methodological issues and to present some results that are of importance when drug interventions of MCI are discussed. There is a relationship between severity of dementia and costs, but to what extent such results can be extrapolated to MCI is not known. Even if it is logical to consider a postponement of the shift from MCI to dementia as cost effective, this statement must be proven, particularly in light of the insufficient knowledge about the effects of anti-dementia drugs on survival. From the Kungsholmen project in Sweden, there are indications that the postponement between MCI and manifest dementia may result in short-term benefits (a few years) of about SEK50,000 (5300 US dollars).

The aim of this paper is to document interest in support strategies among caregivers of elderly persons. We used data from the Canadian Study of Health and Aging caregiver questionnaire which included 43 informal caregivers of elderly persons living with dementia and 145 informal caregivers of elderly persons not living with dementia. While the study assessed interest in attending support groups (10.4%), receiving telephone support from either a professional (44.9%) or a fellow caregiver (41.0%), receiving a newsletter (40.5%), receiving volunteer support (24.2%), and interest in support via computer (14.8%), there were no significant differences between the two groups with regard to interest in any of the support services. Implications for program delivery are discussed. Planners may want to consider adding telephone support and newsletters to other supports already available for caregivers.

Background: Subsequent to the development of consensus statements on a clinical topic, it is vital to establish a plan for dissemination, implementation and evaluation of impact. Consensus statements can be used for both guiding continuing medical education (CME) and producing clinical practice guidelines (CPGs). Insufficient attention to dissemination can lead to a failure to change physician behaviour and improve patient outcomes., Methods: A plan to disseminate the conclusions of the Canadian Consensus Conference on Dementia (CCCD) was developed. This plan was based on a literature review of CME and CPGs. A Medline search was performed on the dissemination and evaluation of the 1989 Canadian Consensus Conference on the Assessment of Dementia (CCCAD) and other published guides for physicians on dementia care. CCCD dissemination that has occurred to date (June, 2000) was reviewed in this paper., Results: Lectures and unsolicited printed material are weak forms of CME. Small-group interactive CME that provides practice opportunities appears to be the most effective way to change physician behaviour. The ability of CPGs to change physician behaviour is uncertain. It appears that inadequate attention has been placed on CPG dissemination and implementation. The CCCAD had a modest impact on clinical practice in Canada. While dissemination of the conclusions of the CCCD has taken place, evaluation of the impact of the CCCD has yet to be done. Local initiatives utilizing the conclusions of the CCCD are on-going., Conclusions: Further work is needed on how to optimize the impact of consensus statements and CPGs. While dissemination of the CCCD has occurred, it is currently unknown whether it has led to any change in physician practices.