Search

Cognitive stimulation therapy (CST) was found to significantly improve cognitive function and quality of life (QOL) in patients with mild-to-moderate dementia in the UK. However, indigenous research on older adults with dementia in Taiwan is scarce. Therefore, this study developed and investigated the effects of a Taiwan version of group CST (CST-T) through a quasi-experimental trial. Excluding the dropouts, there were 13 experimental participants (M = 78.9 ± 9.0) and 13 control participants (77.9 ± 5.6). The results indicated significant improvements in cognitive function, QOL, and daily life functioning in the experimental group compared with the control group, and these effects remained evident at a 3-month follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To systematically evaluate the effects of telehealth interventions on the caregiver burden and mental health of caregivers for people with dementia (PWD). Method: Relevant randomized controlled trials (RCTs) of telehealth interventions on caregivers were extracted from nine electronic databases (PubMed, The Cochrane Library, Web of Science, Embase, CINAHL, SinoMed, CNKI, WanFang, and VIP). The retrieval time was from inception to 26 July 2023. Results: Twenty-two articles with 2132 subjects were included in the final analysis. The meta-analysis demonstrated that telehealth interventions exerted a significant effect in reducing caregiver burden (SMD: −0.14, 95 % CI: −0.25, −0.02, p = 0.02), depression (SMD = −0.17; 95%CI: −0.27, −0.07, p < 0.001) and stress (SMD = −0.20, 95%CI: −0.37, −0.04, p = 0.01). However, no statistically significant effect was observed on anxiety (SMD = −0.12, 95%CI: −0.27, 0.03, p = 0.12). Moreover, subgroup analysis showed that tailored interventions were associated with more evident reductions in depression (SMD = −0.26; 95%CI: −0.40, −0.13, p < 0.001) than standardized interventions (SMD = −0.08; 95%CI: −0.22, 0.06, p = 0.25). In addition, telehealth was effective in relieving depression in Internet-based (SMD = −0.17, 95%CI: −0.30, −0.03, p = 0.01) and Telephone-based group (SMD = −0.18, 95%CI: −0.34, −0.02, p = 0.03), while there was no significant difference in the Internet and Telephone-based group (SMD = −0.18, 95%CI: −0.54, 0.18, p = 0.32). Conclusion: Telehealth could effectively reduce the burden and relieve the depression and stress of caregivers of PWD, while its effect on anxiety requires further research. Overall, telehealth has potential benefits in dementia care. [ABSTRACT FROM AUTHOR]

The Montessori method applied in nursing homes is a person-centered approach targeting the enhancement of autonomy, well-being, and quality of life for older adults with dementia. Despite its potential in the aging field, its operationalization remains unclear in the context of institutionalization. This study aims to outline the method's components and adoption factors using a behavior change intervention framework among professionals from a French institution demonstrating a high level of method application. We employed a qualitative descriptive approach based on thematic analysis. Nine professionals from the same institution underwent a semi-structured individual interview within the facility. The findings were modeled using the Behavior Change Intervention Ontology. We obtained a final framework defining the intervention, mechanisms of action, exposure, contextual factors, and behavioral outcomes. The method is based on values, principles, and techniques such as facilitation, choice, meaningful activities, environmental adjustments, and specific tools. Applied continuously to residents, families, and professionals, its implementation is influenced by several contextual factors leading to practice changes at various levels. This study constitutes both a theoretical and practical contribution, providing a better definition of the method and the key factors influencing its appropriation. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dementia is increasing worldwide and many people with the condition require some level of palliative care. However, the trajectories of function and symptom burden in palliative care services at the end of life remain unclear. This study aimed to describe and compare the longitudinal trajectories of function and symptom burden among patients with dementia between hospital versus palliative community care services in the last two weeks of life. Methods: A retrospective cohort study used data from the Australian Palliative Care Outcomes Collaboration. Patients with dementia who died between 1 January 2013 and 31 December 2020 from the Australian Palliative Care Outcomes Collaboration. Four validated clinical instruments were used to collect outcomes on each individual's function and symptom distress and severity. Multilevel models were used to estimate the differences in clinical trajectories between hospital and community-based palliative care in the last two weeks of life. Results: Patients with dementia tended to have low levels of distress for most symptoms but increasing levels of functional impairment. There were no or only marginally significant differences in the symptom trajectories between the community and hospital groups (OR ranged from 0.57 to 1.97). Although clinical trajectories of function were relatively similar between two groups, statistically higher functional indicators were observed for people when admitted to community palliative care services (OR = 0.42 and 2.27, respectively). Conclusions: Our findings suggest that community-based palliative care services can be as effective as hospital-based care for many patients with dementia nearing the end of life. With appropriate support for families, community-based care could serve as a viable alternative to hospital-based care for some patients in the final stages of dementia. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the impact of Traditional Chinese Medicine (TCM) on dementia patients, utilizing real-world data. Specifically, it seeks to evaluate how TCM influences clinical outcomes by examining changes in the Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) scores, as well as its effect on medical expenses over a two-year period. Data from a multi-center research database spanning from 2004 to 2021 will be used to achieve these objectives, addressing the current gap in empirical data concerning intuitive outcomes and cognitive function assessments. Methods: Propensity score matching was adopted to improve comparability among the intervention and control groups. Due to repeated dependent variable measurements, the generalized estimating equation was used to control for socio-demographic characteristics, regional characteristics, and Western medicine treatments for dementia. Results: After propensity score matching, a total of 441 research subjects were included: 90 in the TCM intervention group and 351 in the non-TCM intervention group. The results of multivariate regression analysis showed that compared with the non-TCM intervention group, the MMSE scores in the TCM intervention group increased by 0.608 points each year. The annual change in CDR scores in the TCM intervention group was 0.702 times that of the non-TCM utilization group. After TCM intervention, annual outpatient expenses increased by US$492.2, hospitalization expenses increased by US$324.3, and total medical expenses increased by US$815.9, compared with the non-intervention group. Conclusions: TCM interventions significantly decelerate cognitive decline in dementia patients, evidenced by slower reductions in MMSE scores and mitigated increases in CDR scores. However, these benefits are accompanied by increased medical expenses, particularly for outpatient care. Future healthcare strategies should balance the cognitive benefits of TCM with its economic impact, advocating for its inclusion in dementia care protocols. [ABSTRACT FROM AUTHOR]

Introduction: The increasing prevalence of dementia in the United Kingdom presents significant challenges for healthcare, with projections estimating over a million affected individuals by 2025, costing the NHS £6.3 billion annually. Hospital admissions among dementia patients are common, occupying about 25% of UK hospital beds and leading to prolonged stays and diminished health outcomes. Method: This paper presents the opening stages, part of a larger project where Patient and Public Involvement and Engagement (PPIE) was employed to understand and navigate what it means for hospital care for a person living with dementia. To understand hospital care for dementia patients, focus groups were conducted through dementia cafés in Essex and Suffolk from February to July 2023 engaging patients, carers and family members. Results: Recognised processes for reporting PPIE and thematic analysis were used and identified six themes and 21 subthemes regarding hospital care: individualised care, role of carers, basic care, interpersonal communication, information sharing and staffing. Discussion: The results from the PPIE will be used to inform and work with stakeholders through the next phases of the project, which involves examining care processes in the hospital, identifying touchpoints and evaluating these areas. The project continues to be informed by stakeholders including people living with dementia, carers and staff. Additionally, the results may inform other service providers for care enhancements, processes and delivery. Conclusion: Moving forward, the study emphasises the importance of building collaborative relationships with stakeholders involved in dementia care. Additionally, it provides insights to focus areas that are fundamental for acute care organisations when delivering care to people living with dementia. By incorporating insights from PPIE, this project seeks to identify inequalities in dementia care services, improve hospital care for people living with dementia, fostering a more inclusive and supportive healthcare environment. Patient or Public Contribution: The purpose of the study was to explore the most important issues around hospital care for people with dementia, their carers and families. Persons living with dementia, carers and family members were involved in the study through community dementia cafés and recruited to take part in focus groups to discuss hospital care for patients with dementia. The design of questions and materials for the discussions was developed through consultation with the university department's service user lead and dementia specialist and reviewed by a service user member living with dementia. A pilot focus group was conducted with a group of carers. We worked with the dementia café managers to coordinate recruitment and a suitable environment to run the focus groups. Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: People with dementia have complex palliative care needs that are often unmet, including physical and psycho‐social needs. It is essential to empower people with dementia, family carers and professionals to better assess and manage care needs. We aimed to co‐design a palliative dementia care Framework delivered through a digital app to support holistic assessment and decision making for care in the community and care homes—the EMBED‐Care Framework. Methods: A systematic co‐design approach was adopted to develop the EMBED‐Care Framework across three stages: 1) Framework analysis to synthesise data from preceding evidence reviews, large routine clinical data and cohort studies of unmet palliative dementia care need; 2) Co‐design using iterative workshops with people with dementia, family carers and health and social care professionals to construct the components, design of the app and implementation requirements; and 3) User testing to refine the final Framework and app, and strengthen use for clinical practice and methods of evaluation. Results: The Framework was co‐designed for delivery through an app delivered by aTouchAway. It comprised five main components: 1) holistic assessment of palliative care needs using the Integrated Palliative care Outcome Scale‐Dementia (IPOS‐Dem); 2) alert system of IPOS‐Dem scores to highlight unmet needs; 3) IPOS‐Dem scores and alerts enable shared decision making between the practitioner, patient and/or carer to support priority setting and goals of care; 4) evidence‐informed clinical decision support tools automatically linked with identified needs to manage care; and 5) Training package for users incorporating face‐to‐face sessions, clinical champions who received additional face‐to‐face sessions, animated videos and manual covering the main intervention components and email and telephone support from the research team. Conclusions: This is a novel digital palliative dementia care intervention to link holistic assessment with clinical decision support tools that are practical and easy to use but address the complexity of palliative dementia care. The Framework is ready for feasibility testing and pilot studies for people with dementia residing at home or in a care home. Patient or Public Contribution: We were guided by our Patient and Public Involvement (PPI) group consisting of three people with mild dementia, including younger onset dementia, and seven family carers throughout the project. They supported the overall development of the Framework, including planning of workshops, interpreting findings and testing the framework in our PPI meetings. [ABSTRACT FROM AUTHOR]

Background: Whilst there is a drive to increase diagnosis rates in dementia, there is a lack of attention on getting a correct and timely subtype diagnosis. For people with a rarer subtype of dementia, getting the correct diagnosis, and subsequent care, might be more difficult than for people aged 65+ presenting with the more common symptoms of Alzheimer's disease dementia. Thus, the aim of this mixed‐method systematic review was to synthesise the evidence base on misdiagnosis of dementia. Methods: Misdiagnosis in dementia was defined as either receiving an initial incorrect dementia subtype diagnosis or receiving an incorrect non‐dementia diagnosis. Post‐mortem assessments of subtype diagnosis were excluded. Nine databases were searched in June 2023, with screening of titles and abstracts and consequent full texts completed independently by two researchers. Findings were synthesised using narrative synthesis. Results: Twenty studies were included. Studies were categorised into four themes: (i) Factors associated with delayed diagnosis or misdiagnosis; (ii) Difficulties related to the diagnostic process; (iii) Economic consequences of misdiagnosis; and (iv) Experiences of delayed diagnosis or help‐seeking. People with Lewy Body dementia or behavioural variant fronto‐temporal dementia were found to experience longer diagnosis times and often incorrect initial diagnoses. Whilst evidence is limited regarding the economic impacts, evidence from the US points towards increased economic costs of misdiagnosis. Conclusions: There is an urgent need to investigate the rates and emotional and economic impacts of misdiagnosis on people with dementia, their carers, and the health and social care system. Advancing the evidence base is crucial to reduce misdiagnosis and inform clinical practice. [ABSTRACT FROM AUTHOR]

Background: One‐third of people living with dementia (PLWD) have highly fragmented care (i.e., care spread across many ambulatory providers without a dominant provider). It is unclear whether PLWD with fragmented care and their caregivers perceive gaps in communication among the providers involved and whether any such gaps are perceived as benign inconveniences or as clinically meaningful, leading to adverse events. We sought to determine the frequency of perceived gaps in communication (coordination) among providers and the frequency of self‐reported adverse events attributed to poor coordination. Methods: We conducted a cross‐sectional study in the context of a Medicare accountable care organization (ACO) in New York in 2022–2023. We included PLWD who were attributed to the ACO, had fragmented care in the past year by claims (reversed Bice‐Boxerman Index ≥0.86), and were in a pragmatic clinical trial on care management. We used an existing survey instrument to determine perceptions of care coordination and perceptions of four adverse events (repeat tests, drug–drug interactions, emergency department visits, and hospital admissions). ACO care managers collected data by telephone, using clinical judgment to determine whether each survey respondent was the patient or a caregiver. We used descriptive statistics to summarize results. Results: Of 167 eligible PLWD, surveys were completed for 97 (58.1%). Of those, 88 (90.7%) reported having >1 ambulatory visit and >1 ambulatory provider and were thus at risk for gaps in care coordination and included in the analysis. Of those, 23 respondents were patients (26.1%) and 64 were caregivers (72.7%), with one respondent's role missing. Overall, 57% of respondents reported a problem (or "gap") in the coordination of care and, separately, 18% reported an adverse event that they attributed to poor care coordination. Conclusion: Gaps in coordination of care for PLWD are reported to be very common and often perceived as hazardous. [ABSTRACT FROM AUTHOR]

Background: The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia‐specific ACP communication skills toolkit for Japanese primary care clinicians. Methods: We delivered 13 training sessions in primary care clinics across central Japan and conducted a post‐training survey to assess whether the toolkit increased confidence in dementia‐specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5‐point Likert scale from strongly agree to strongly disagree. Results: All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre‐ post‐comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self‐care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%). Conclusions: Dementia‐specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia‐specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit. [ABSTRACT FROM AUTHOR]

Background: Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization. Methods: Retrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1‐year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health‐care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization. Results: In 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47–0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27–0.28), home health stays (0.25, 95% CI 0.25–0.26), or observation stays (0.82, 95% CI 0.77–0.87). Similar patterns were observed with ED use without hospitalization and health‐care costs. Conclusions: Persons with ADRD frequently use the ED—particularly those with recent hospitalizations, rehab/SNF stays, or home health use—and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal‐concordant care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the challenges of managing diabetes mellitus alongside dementia • To learn about the importance of sharing patient information among healthcare professionals in various settings • To consider how the use of IT might promote more effective communication between specialties. Background: Managing diabetes mellitus alongside the onset and development of dementia poses many challenges for those living with these conditions as well as their families, carers and service providers. Aim: To describe nurses’ positive experiences when managing adults with diabetes and dementia, as well as the issues and challenges. Method: Qualitative, semi-structured focus group interviews were conducted with community and diabetes specialist nurses drawn from five health and social care trusts. Findings: Four themes were identified: whose responsibility is it?; community and diabetes specialist nurses – the pivot point; education to manage comorbidities; and interprofessional communication. Conclusion: Community and diabetes specialist nurses experience many challenges when supporting individuals living with diabetes and dementia. Sharing patient information among practitioners in different settings is critically important. IT could overcome the limitations of note-keeping ‘silos’, but further education is recommended to establish more effective communication and partnership working. [ABSTRACT FROM AUTHOR]

Objectives: Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits. Methods: The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form. Results: A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F(1) = 6.68, p=.012, partial η2=.10), depressive symptom endorsement, (F(1) = 6.41, p=.014, partial η2=.09, and anticipatory grief, (F(1) = 6.22, p=.02, partial η2=.1), post-treatment. Conclusions: Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions. Clinical Implications: Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC. [ABSTRACT FROM AUTHOR]

Objectives: To review evidence about the effectiveness of educational programmes in promoting the delivery of person-centered care by staff in dementia services. Methods: Several databases were searched, and the methodological quality of identified studies systematically evaluated. A summary mean effect size was calculated for several types of outcome (direct knowledge, applied knowledge, attitudes, self-reported and observed working practices). Results: Eighteen studies were identified. Results were mixed, with findings of no change, significant improvement, and (in attitude) significant deterioration. Effect size was modest for direct knowledge (standardized mean difference = 0.6), but small or negligible for applied knowledge (0.29) and self-reported (0.06) and observed (0.25) working practices. There was a negative effect for attitudes (−0.17). Conclusions: The quality of evidence was poor. Apart from attitudes, the effect sizes are likely to be overestimates. There was little evidence that education programmes can reliably produce substantial improvements in working practices. Clinical implications: Education alone is unlikely to be sufficient for establishing high standards of person-centered care in services. It needs to be supplemented by steps to ensure that staff develop skills in delivering such care in practice, and by organizational support to ensure staff have sufficient motivation, cues and opportunities for implementation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the effect of 8-weeks of a 60-minute PARO intervention to reduce depressive symptoms and loneliness in older adults with dementia and investigated changes in their emotional or behavioral expressions and level of engagement with the PARO robot. Methods: This was a quasi-experimental study with a repeated measures design. The outcome measures were evaluated at four time-points: before the intervention, week 4, immediately after the intervention, and one month after the PARO intervention. Results: Fifty-two participants were recruited. The age of the participants ranged from 65 to 96 years, with a mean age of 81.81 years (SD = 8.54) in the PARO group and 79.08 years (SD = 7.71) in the control group. Using a mixed between-within subjects' analysis of variance, the results showed that there were significant interaction effects between the groups and time-periods for depression (p <.000), loneliness (p <.000), and engagement (p <.000). Conclusions: The PARO intervention alleviated depression and loneliness for older adults. Furthermore, the process of engagement with PARO may play an important role in the PARO effects. Clinical Implications: A tailored PARO intervention of at least 4 weeks could engender positive psychological benefits for older adults. [ABSTRACT FROM AUTHOR]

Purpose: To examine the use of the PARO robotic pet seal for hospitalized older adults with dementia and compare the effects of PARO use with visits by a human on various outcomes, including physical restraint use, psychotropic medications, bedside sitters, and delirium. Method: Complete data for 38 participants were analyzed using Mann-Whitney U and chi-square tests. Results: Participants interacting with PARO spent less time in their interactions; however, they received fewer psychotropic medications and had fewer instances of delirium than those who interacted with human visitors only. Conclusion: Aspects of hospitalization may limit the time an older adult can sustain attention or be free from interruption; however, short, repeated visits with PARO may affect the development of delirium and decrease use of medications to alter behavior in the hospital setting. [Journal of Gerontological Nursing, 50(10), 11–16.] [ABSTRACT FROM AUTHOR]

Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N = 906), post-training evaluations (N = 761), and optional validated surveys on perceptions of Montessori training (N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N = 22). Findings: The majority of staff (83%–90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training (p =.002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners. [ABSTRACT FROM AUTHOR]

More than half of older people in long-term care facilities have dementia. Little is currently known about the methods and instruments which can be used to capture the perspectives of older people, including those with dementia, regarding the quality of care provided in such facilities. The main aims of this scoping review were two-fold. Firstly, to identify quality of care instruments that have been applied in long-term care settings. Secondly, to evaluate how these instruments have been developed and validated, particularly in terms of their applicability among older people with dementia. Seven databases (Medline, Web of Science, Scopus, ProQuest, Ageline, CINHAL and google scholar) were searched for relevant literature without any date limit. We used quality criteria adapted from COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines to assess the psychometric properties of the instruments. The search identified 16 quality of care instruments which had been used in long-term care settings. Of which, two (12.5%) were specifically designed for older people with dementia, and three instruments (18.7%) were modified for use with older people with mild to moderate dementia. A variety of methods were used to develop the identified instruments including literature reviews, qualitative interviews, expert panel reviews, pre-testing and piloting with older people. None of the identified instruments had been subjected to comprehensive psychometric assessment. Most instruments for assessing quality of care in long term care settings lack alternative communication techniques tailored to people with dementia. This review highlights the need for more rigorous psychometric testing of existing instruments for assessing quality of care in long-term care settings. Several existing measures show promise and may be taken forward for further testing and development for widespread application with older people, including those living with dementia, in long term care settings. [ABSTRACT FROM AUTHOR]

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Objective: To examine racial and ethnic differences in costs of informal caregiving among older adults with dementia in the United States. Methods: We used data from the 2002 to 2018 Health and Retirement Survey to estimate annual informal care hours for adults with dementia (n = 10,015). We used regression models to examine racial and ethnic differences in hours of informal care for activities of daily living (ADL) and instrumental ADL, controlling for demographic characteristics, education, and level of disability. Results: Our sample was 70% non-Hispanic White, 19% non-Hispanic Black, and 11% Hispanic. Hispanics received, on average, 35.8 hours of informal care each week, compared to 30.1 for Blacks and 20.1 for Whites. Racial and ethnic differences persisted when controlling for covariates. Discussion: Informal care is a greater cost to racial and ethnic minoritized families. Informal care was valued at a replacement cost of $44,656 for Hispanics, $37,508 for Blacks, and $25,121 for Whites. [ABSTRACT FROM AUTHOR]

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Background: Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods: This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results: Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion: Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia. [ABSTRACT FROM AUTHOR]

In dementia care, the concept of dignity has garnered substantial attention from both researchers and policymakers. However, the concept often remains vague and open to interpretation, potentially leading to misunderstandings and suboptimal care for people with dementia. As healthcare professionals occupy a critical role in upholding dignity, exploring their viewpoints on this complex concept is paramount. In this study, we explore Danish healthcare professionals' views on the dignity of people with dementia and discuss these perspectives against existing theoretical accounts. We employed thematic analysis of data collected during facilitated discussions with a total of 99 healthcare professionals, including nurses and healthcare workers, during which we posed the question, "What is dignity to you?" and documented their perspectives. Through a systematic process of data coding and interpretation, we identified recurring patterns in their responses. This approach allowed us to uncover the depth and complexity of their viewpoints, providing valuable insights into the multifaceted nature of dignity as perceived by healthcare professionals. Our findings revealed that healthcare professionals possessed a nuanced understanding of dignity, recognizing both a subjective element and a universal aspect applicable to all individuals, aligning with theoretical interpretations. However, conceptual ambiguity remained a challenge. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this assessor‐blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild‐to‐moderate dementia. Methods: The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6‐month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370). Results: Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6‐ or 12‐months (between‐group differences [95% CI] for primary outcomes at 6‐months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT‐A 2.7 s [−14.1, 19.5]; TMT‐B −17.1 s [−79.3, 45.2]). At the 12‐month follow‐up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver‐rated participant quality of life and higher caregiver quality of life compared to control. Conclusions: This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia. [ABSTRACT FROM AUTHOR]

Introduction: Group‐based cognitive stimulation has shown short‐term benefits for the cognitive outcomes of people with dementia living in nursing homes (NH). However, group participation can be a barrier for people with advanced dementia, bedridden people or isolated people. The CogStim24 project seeks to develop and implement a new psychosocial intervention based on cognitively stimulating (CS) activities integrated into daily nursing care. As part of the intervention development process, this study aimed to survey NH managers' attitudes and describe currently used approaches to CS activities in German NH. Methods: We performed a multicentre cross‐sectional study between September and December 2021 in randomly recruited NH in the German federal state of North Rhine‐Westphalia. NH representatives were asked to fill in a self‐developed online questionnaire. We analysed data descriptively, presenting means and standard deviations. For case scenario questions, we used a summative content analysis. Results: We contacted 354 NH and 106 agreed to participate. Representatives of 64 facilities completed the survey. Almost all stated to have implemented CS activities. Cognitive exercises (98%), physical and relaxation exercises (98%) and reminiscence therapy (95%) were most often used. The majority (96%) thought that CS activities could support people with dementia in maintaining their cognitive functions and that nurses should have a key role in the implementation of CS activities. More than half believed that regular CS activities were easy to implement alongside routine nursing care. Conclusions: Results indicate that CS activities are frequently applied in German NH. The positive attitude of NH managers regarding the implementation and effects of CS activities is an important implementation resource. Implications for Practice: Nursing staff should be more involved in providing CS activities for people with dementia. Training, information, and implementation material must be made available for nursing staff who wish to have an active role in providing CS activities. [ABSTRACT FROM AUTHOR]

Introduction: Many older people who cannot live independently live in aged residential care facilities to obtain support with social and healthcare needs. Despite old age being a precious time for people to live well, many facility residents have limited access to activities that promote their well‐being and connectedness. In New Zealand, one provider of aged residential care developed a village inspired by de Hogeweyk in the Netherlands, where resident engagement in valued activities supports continuing lifelong identities. Methods: The study aimed to explain the transition from a traditional Aged Residential Care facility to a clustered domestic model of care. A critical realist theoretical perspective underpinned case study research. Data comprised transcripts of interviews with key informants, facility staff, residents and their families, records of observation of residents' daily lives, organisational documents, photographs and the first author's study journal. Results: The intersection of philosophical workplace change to support delivery of person‐centred care and a change in the physical environment enabled realisation of the organisational vision of residents living normal lives. Conclusion: Policy makers and practitioners must be aware that while a domestic‐scale environment provides cues to normal living, staff who know residents and what is important to them enable participation in community and valued activities. Implications for Practice: Innovative living arrangements are a synthesis of philosophical aspirations, architectural and design vision, dedicated leadership and committed teamwork. [ABSTRACT FROM AUTHOR]

Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants' recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings. [ABSTRACT FROM AUTHOR]

The article focuses on a study which assesses the feasibility of implementing a culturally appropriate Alzheimer's disease and related dementias (ADRD) workflow in primary care setting in the U.S. To determine the impact of the new workflow, ADRD workflow outcomes and demographic data pre- and post-implementation were extracted from the electronic medical record (EMR). Results revealed that all ADRD workflow outcomes were higher post-implementation compared to pre-implementation.

Introduction We report a mixed-methods process evaluation embedded within a randomised controlled trial. We aimed to test and refine a theory of change model hypothesising key causal assumptions to understand how the New Interventions for Independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over 1 year. Methods In 2021–2022, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions. We conducted qualitative interviews with dyads and intervention facilitators, purposively selected for diverse follow-up GAS scores. We collected observational data from intervention session recordings. We thematically analysed data, then integrated qualitative and quantitative data. Results 174/204 (85.3%) dyads allocated to NIDUS-Family, fully completed it, 18 partially completed, while 12 received no intervention. We interviewed 27/192 (14%) of dyads receiving any sessions, and 9/10 facilitators; and observed 12 sessions. 47/192 (24.5%) of carers completed the acceptability questionnaire. We identified four themes: (A) 'Someone to talk to helps dyads feel supported'; (B) 'NIDUS-Family helps carers change their perspective'; (C) 'Personalisation helps people living with dementia maintain their identity' and (D) 'Small steps help dyads move forward'. Conclusion Key causal pathway mechanisms were: a respectful, trusting and impartial relationship with the facilitator: supporting the development of meaningful goals and support to find manageable solutions. Core implementation factors were delivery of the modules from a consistent facilitator across regular sessions. Core contextual factors influencing these mechanisms were dyadic participation and understanding of abilities. [ABSTRACT FROM AUTHOR]

Objectives This qualitative descriptive study explored the perceptions of dementia, dementia care, and caregiving within the African immigrant community. Methods Six community conversations (focus groups) were held with 24 participants. Three conversations were led by project advisory board members and utilized a 12-question conversation guide. The recorded conversations were transcribed and analyzed using thematic analysis. Results Of the 24 African immigrants who participated, 52% were 55–75 years old, 67% identified as female, and 39% were married or cohabitating. Twenty percent were currently providing care to a relative with dementia and 40% had provided care to a relative with dementia in the past. Four themes were identified. These included (1) attitudes toward mental health, illnesses, and poor health, (2) community attitudes toward dementia, and dementia caregiving, (3) barriers to dementia care and caregiving, and (4) current dementia care resources in the African immigrant community. Discussion The findings show that African immigrant cultural beliefs significantly shape dementia care and caregiving attitudes, preferences, and behavioral practices. African immigrants' cultural backgrounds influence (or have the potential to influence) timely access and engagement in dementia care. And, depending on how deeply held these cultural beliefs are, they could affect dementia care and caregiving both positively and negatively. With the rapidly growing immigrant older adult population, there is a need for systemic strategies to facilitate affordable and culturally responsive dementia care for African immigrants and other minoritized older adults. [ABSTRACT FROM AUTHOR]

Dementia is characterized by a progressive decline in cognition, behavioral and psychological symptoms (BPSD), and quality of life (QoL). The lack of curative therapies has led to a psychosocial discourse prioritizing QoL of people thriving with dementia (PTD). Group reminiscence therapy (RT) is a relatively inexpensive intervention, with music prompts being a preferred choice, owing to robust musical memory in the early disease stage. However, a synthesis of current evidence is needed to inform research and clinical use of group music RT in dementia care. Therefore, we conducted a systematic review on PubMed, Scopus, CINAHL, APA PsycInfo, and APA PsycArticles to critically appraise published randomized controlled trials examining group music RT to improve cognition, BPSD, and QoL in PTD. Of 14,725 articles, two RCTs involving 102 PTD were included. All studies used prerecorded music for group music RT. All studies were deemed of good quality, adhering to intention‐to‐treat analysis and assessor blinding. Based on the American Academy of Neurology guidelines, we assigned a Level C recommendation for group music RT for cognition and Level B recommendations for BPSD and QoL (ineffective). In conclusion, group music RT may be useful for symptomatic management in PTD. However, heterogeneous study designs, disease severity, dementia subtype, and outcome measures are likely barriers to meaningful clinical translation. Therefore, the rating of recommendations only serves as a point of reference. Future avenues include live performances as prompts for group music RT. [ABSTRACT FROM AUTHOR]

Purpose: The manifestation of behavioral and psychological symptoms of dementia (BPSD) poses a considerable care burden and precipitates adverse health outcomes. Despite the increasing development of digital interventions, their application in the dementia population, specifically regarding their effectiveness in addressing BPSD, remains limited. Therefore, in this study, we aimed to describe a study protocol for evaluating the effectiveness of a mobile app-based individualized non-pharmacological intervention to improve BPSD in community-dwelling older adults. Methods: Employing a randomized control group pretest-posttest design, 36 dyads comprising people living with dementia (PLWD) and their family caregivers will be assigned to either an experimental or control group. The experimental group will engage in a 4-week regimen using a mobile app-based individualized non-pharmacological intervention, which includes recording and predicting BPSD. The control group will use the BPSD record system without accessing the individualized interventions. Both groups will continue with their usual care practices throughout the study period. Results: We hypothesize that the implementation of the mobile app-based individualized non-pharmacological intervention will alleviate BPSD. After the intervention, results will be analyzed to evaluate the effectiveness of the mobile app-based individualized non-pharmacological intervention on BPSD. Conclusion: The research team may encounter several challenges owing to the novelty of digitalized interventions. Nevertheless, the results of this study will provide robust evidence regarding the efficacy of mobile app-based individualized non-pharmacological interventions for community-dwelling older PLWD. [ABSTRACT FROM AUTHOR]

Objectives : This study aimed to understand the care needs, care arrangements and burden of care for people with dementia in Northern Tanzania. Methods : This was a cross-sectional, observational study. People with dementia and their carers (n = 53) were recruited from an outpatient clinic, and data on carer burden and independence in activities of daily living were collected. Associations with carer burden and characteristics were explored through non-parametric tests and regression analyses. Results : Thirty-six carers were female (68%). Levels of impairment in instrumental activities of daily living were high, with a median score of 38 out of 44 on the Identification and Intervention for Dementia in Elderly Africans – Instrumental Activities of Daily Living (IDEA-IADL). Carer burden was moderate with a median Zarit Burden Interview (ZBI) score of 46 out of 88. Being a female carer was associated with higher carer burden (odds ratio 3.68, 95% CI 1.04–12.99). Discussion : Carer burden was found to be higher than in previous studies based in low-and-middle income countries. Further research is needed to explore this difference, and to identify interventions to support care needs and reduce carer burden. [ABSTRACT FROM AUTHOR]

Extra care housing (ECH) is a type of housing with care and support designed to enable older people to age in place. Approximately one fifth of residents living in ECH are living with dementia and yet, there remains gaps as to how best to support people to live well with dementia in the context. ECH stock across the United Kingdom (UK) includes a diverse range of options that can be grouped into integrated, specialist and separated accommodation. Integrated models involve residents with dementia living alongside residents without dementia. Specialist ECH offer accommodation exclusively for people living with dementia. Separated models offer a separate area for residents with dementia within a larger, integrated site. How these different models work for residents living with dementia is little known and has remained a significant gap in knowledge that impairs both professionals and people living with dementia when choosing housing and care. This paper reports on findings from a large study of residents living with dementia in ECH. The focus is on the potential benefits and challenges of different models of provision. Data were generated from interviews with 100 participants (residents, family members, staff, and adult social care professionals) at eight case study sites across England. Findings demonstrated that there are potential benefits and challenges within each model, but the limited diversity of stock limits choice. Multiple variables beyond the model of provision affect the lived experience, meaning that there is no universal model of optimal support. Rather, the approach and resources of each site is more important than the model of provision. Suggestions for future research directions are considered. [ABSTRACT FROM AUTHOR]

Access to technology is getting more important in human services with older adults. However, the digital divide exists between older adults and younger people, as well as among older adults from different social groups. To close the digital divide, we need to consider justice in technology for older adults. This article aims to understand how justice is involved in the use of technology with older adults. It conducted a secondary analysis by looking into the data of a larger study about using dementia-friendly videos with older adults living with moderate to severe dementia in care settings, one of the most marginalized older adult populations in Vancouver, Canada. It refers to Nancy Fraser's framework on the three dimensions of justice, including redistribution, recognition, and representation, as the guiding framework of analysis. It suggests that different dimensions of justice are intertwined with each other. It also suggests that future researchers may consider this framework to guide their understanding of justice in the use of technology with older adults. [ABSTRACT FROM AUTHOR]

Objectives: For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed‐methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers. Methods: Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed‐method studies, published in English or German, focused on experiences of using technology‐delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included. Results: From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech‐literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes. Conclusions: Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery. Key points: Evidence emphasises benefits and challenges to the availability, implementation, use, of technology in health and social care access in dementia.Though there are issues, technology can help improve quality of life for people with dementia, can support carers to care, and facilitate positive relationships between unpaid carers and people with dementia.Proliferation of technology for care access was expedited during COVID‐19, but has not been equally rolled out, making remote and disadvantaged groups less well‐served.A hybrid delivery of services in which people are given choice of delivery method, and are supported in accessing and using technology, will better serve people with dementia and unpaid carers. [ABSTRACT FROM AUTHOR]

Background: Differences in the post‐acute care (PAC) destinations among racial, ethnic, and socioeconomic groups have been documented before the COVID‐19 pandemic. Yet, the pandemic's impact on these differences remains unknown. We examined the impact of the COVID‐19 pandemic on PAC destinations and its variation by individual race, ethnicity, and socioeconomic status among community‐dwelling older adults with Alzheimer's disease and related dementia (ADRD). Methods: We linked 2019–2021 national data (Medicare claims, Minimum Data Set, Master Beneficiary Summary File) and several publicly available datasets, including Provider of Services File, Area Deprivation Index, Area Health Resource File, and COVID‐19 infection data. PAC discharge destinations included skilled nursing facilities (SNFs), home health agencies (HHA), and homes without services. Key variables of interest included individual race, ethnicity, and Medicare‐Medicaid dual status. The analytic cohort included 830,656 community‐dwelling Medicare fee‐for‐service beneficiaries with ADRD who were hospitalized between 2019 and 2021. Regression models with hospital random effects and state‐fixed effects were estimated, stratified by the time periods, and adjusted for the individual, hospital, and county‐level covariates. Results: SNF discharges decreased while home and HHA discharges increased during the pandemic. The trend was more prominent among racial and ethnic minoritized groups and even more so among dual‐eligible beneficiaries. For instance, the reduction in the probabilities of SNF admissions between the pre‐pandemic period and the 2nd year of COVID was 4.6 (White non‐duals), 18.5 (White duals), 8.7 (Black non‐duals), and 20.1 (Black duals) percentage‐point, respectively. We also found that non‐duals were more likely to replace SNF with HHA services, while duals were more likely to be discharged home without HHA. Conclusions: The COVID‐19 pandemic significantly impacted PAC destinations for individuals with ADRD, especially among socioeconomically disadvantaged and racial and ethnic minoritized populations. Future research is needed to understand if and how these transitions may have affected health outcomes. [ABSTRACT FROM AUTHOR]

Background: Novel hospital diversion strategies are needed to support a growing number of patients with dementia living in the community. One promising model is community paramedicine (CP), which deploys paramedics to the home, who consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP can manage many patients without escalation to the emergency department (ED), no studies have evaluated optimal CP utilization for patients with dementia. Therefore, we compare the use and outcomes of CP for homebound patients with and without dementia. Methods: This retrospective cohort study examines 251 homebound patients receiving home‐based primary care, who utilized a physician‐led CP service between March 2017 and May 2022. Linked electronic health record data included patient demographics, clinical characteristics, and CP encounter details. Dementia status and CP outcomes, including rates of ED transport, over‐transport (i.e., transported, but not hospitalized), and under‐transport (i.e., not transported, but ED visit within 3 days), were determined via chart review. Using logistic regression, we modeled the association of dementia status with over‐ and under‐transport, adjusting for age, sex, and chief complaint. Results: Fifty‐three percent of CP patients had dementia. Their most common chief complaints were dyspnea (24.3%), altered mental status (17.9%), and generalized weakness (9.8%). We found no significant difference in ED transport rates by dementia status (25.4 vs. 22.8%, p = 0.54). Dementia diagnosis was associated with lower rates of over‐transport (OR = 0.21, p = 0.03, CI [0.05, 0.85]) and comparable rates of under‐transport (OR = 0.70, p = 0.47, CI [0.27, 1.83]) in adjusted models. Conclusions: CP has effectively managed a diverse population of homebound patients with dementia cared for via home‐based primary care. Future work should examine potential cost savings and use of CP in dementia care across geographic and healthcare settings. See related article by Kim et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Patient portal secure messaging can support age‐friendly dementia care, yet little is known about care partner use of the portal and how message concerns relate to age‐friendly issues. Methods: We conducted a two‐part observational study. We first assessed the feasibility of automating care partner identification from patient portal messages by developing and testing a natural language processing (NLP) rule‐based classification system from portal messages of 1973 unique patients 65 and older. Second, two independent reviewers manually coded a randomly selected sample of portal messages for 987 persons with dementia to identify the frequency of expressed needs from the 4M domains of an Age‐Friendly Health System (medications, mentation, mobility, and what matters). Results: A total of 267 (13.53%) of 1973 messages sent from older adults' portal accounts were identified through manual coding as sent by a nonpatient author. The NLP model performance to identify nonpatient authors demonstrated an AUC of 0.90. Most messages sent from the accounts of persons with dementia contained content relevant to the 4Ms (60%, 601/987), with the breakdown as follows: medications—36% (357/987), mobility—10% (101/987), mentation—16% (153/987), and what matters (aligning care with specific health goals and care preferences)—21%, 207/987. Conclusions: Patient portal messaging offers an avenue to identify care partners and meet the informational needs of persons with dementia and their care partners. [ABSTRACT FROM AUTHOR]

Adult child caregivers of persons with severe dementia (PWSDs) experience absenteeism due to caregiving. We quantified employed adult child caregivers' absenteeism; its association with PWSDs' functional impairment and health shocks; and characteristics of caregivers not experiencing absenteeism in the presence of PWSDs' health shocks and high functional impairment. We used a prospective cohort of 111 employed adult child caregivers of community-dwelling PWSDs in Singapore surveyed every 4 months for 1 year. We calculated absenteeism days due to caregiving and the corresponding absenteeism cost. Findings showed that 43% of the caregivers experienced absenteeism due to caregiving at least once during 1 year. On average, in a month, caregivers experienced 2.3 (SD = 5.9) absenteeism days and S$758 (SD = 2120) absenteeism cost. Those caring for PWSDs with high functional impairment experienced an additional 2.5 absenteeism days and S$788 absenteeism cost versus caregivers of PWSDs with low functional impairment. Caregivers whose PWSDs experienced a health shock experienced an additional 1.8 absenteeism days and S$772 absenteeism cost versus caregivers of PWSDs without a health shock. Co-residence with PWSDs worsened the impact of PSWDs' high functional impairment on caregivers absenteeism. Caregivers not co-residing with PWSDs and not using a maladaptive coping style were less likely to experience absenteeism when caring for PWSDs with a health shock. Results suggest a need to support caregivers of PWSDs to better cope with their caregiving in order to mitigate caregivers' absenteeism. [ABSTRACT FROM AUTHOR]

Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care. [ABSTRACT FROM AUTHOR]

Aim: To explore home‐dwelling people with dementia and family members' perceptions of the feasibility and acceptability of an intervention using dementia‐related literature excerpts to facilitate conversations on ethical issues related to living with dementia. Background: Ethical issues in dementia care emerge throughout the illness. In the early stages, they may involve decisions about disclosing the illness to the family, shifting roles and responsibilities, and considerations of transitioning to a nursing home. Addressing ethical issues and providing adequate support to home‐dwelling people with dementia and their families are often lacking. Design: An exploratory‐descriptive qualitative study. Methods: We conducted eight interviews with 14 home‐dwelling persons with dementia and their family caregivers. Six were dyadic interviews, and two were individual interviews with family caregivers. We analysed the interview data using template analysis. We adhered to the COREQ checklist in reporting this study. Results: Using excerpts from dementia‐related literature was a feasible and acceptable way of initiating discussions on ethical issues among home‐dwelling persons with dementia and family caregivers. However, engaging the families of newly diagnosed individuals was challenging due to emotional distress. The intervention provided peer support, including identifying with others and sharing experiences. Moreover, participating couples found intimacy and relational attunement through shared reflections. Conclusion: Based on the findings, it appears that the participants in this study felt that using excerpts from dementia‐related literature to deliberate on ethical issues was feasible and acceptable. Deliberating on ethical issues with peers and family caregivers offers valuable social support and opportunities for strengthening relationships. Implications for patient care: This study makes an important contribution by providing valuable insights into how ethical issues related to living with dementia can be addressed using related literature and suggests how the intervention can be integrated into existing care initiatives for home‐dwelling people with dementia and their families. Reporting method: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. Patient or public contribution: A healthcare professional working as a so‐called dementia coordinator (a title used in the Danish context) was involved in the conduct of this study by being responsible for the recruitment of home‐dwelling people with dementia and their family members. Moreover, she had joint responsibility for facilitating the intervention along with the first author. [ABSTRACT FROM AUTHOR]

Purpose: Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia. Method: A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis. Results: Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes. Conclusion: This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia. [ABSTRACT FROM AUTHOR]

Background and Objectives Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. Research Design and Methods We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (M age = 64.7, SD age = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p =.003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = −0.21, p <.001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p =.046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Discussion and Implications Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions. [ABSTRACT FROM AUTHOR]

Background and Objectives Emerging evidence suggests music-based interventions can improve the well-being of people living with dementia, but little is known about the ways in which music might support dementia caregiving relationships as part of everyday life at home. This study examined music engagement in the context of daily life to identify patterns of music engagement and potential targets for the design of music-based interventions to support well-being. Research Design and Methods This ethnographic, in-home study of people living with dementia and their family and professional care partners used methods from ethnomusicology, including semistructured interviews and in-home participant observation with a focus on music engagement. Results A total of 21 dyads were purposively recruited for diversity in terms of gender, ethnicity/race/heritage, caregiving relationship, and music experiences. Despite participants' diverse music preferences, 3 distinct music engagement patterns emerged. (a) Professional care partners intentionally integrated music listening and singing into daily life as part of providing direct care. (b) Family care partners, who had prior dementia care nursing experience or family music traditions, integrated music into daily life in ways that supported their personal relationships. (c) In contrast, family care partners, who lacked dementia care experience and had high levels of caregiver burden, disengaged from prior music-making. Discussion and Implications The distinct music engagement patterns reflect different needs on the part of dyads. It is important to continue to support dyads who engage in music daily and to consider developing music-based interventions to support well-being among dyads who have become disengaged from music. [ABSTRACT FROM AUTHOR]

Young-onset dementia (YOD) affects individuals under 65 years of age, often leading to loss of employment and independence. Families provide increasing levels of care to family members with YOD, resulting in changes to their daily lives, including their occupational pursuits. This review examines evidence of the occupational implications for family members who provide care to a family with YOD to identify: (i) the influence and impact caregiving tasks and responsibilities have on employment, volunteering, and education, and (ii) caregiver, and caregiving situation factors associated with changes in employment, volunteering, and education. A scoping review was performed using eight electronic databases. Included articles were narratively synthesized using a thematic analysis. Sixteen studies met the inclusion criteria and were included for review. The over-arching (main) theme of 'decision-making' was identified, with family members required to make choices about their own occupational goals and roles to be able to provide care to family living with YOD. The outcomes of these decisions are dynamic and changeable across the caregiving trajectory. Three caregiving factors influence decision-making: (1) Implications of Combining Caregiving and Occupations, (2) Altered Identity (3) Strategies to Support Caregivers of Individuals Living with YOD. A fourth theme was also identified 'Guidance for Researchers To Support Caregivers'. There is a scarce body of literature examining the influence caregiving has on occupational outcomes for the YOD caregiver population. Much of this work is descriptive and lacks focus on the implications, particularly long-term impacts. This review provides a foundational guide for future research and practices to support YOD family caregivers to obtain and sustain occupations. [ABSTRACT FROM AUTHOR]

Background: The use of life stories in dementia care has been described as a way of seeing every person as an individual, looking beyond their dementia. Life stories have become synonymous with high-quality care, while in Sweden their mere existence in dementia care settings is taken to indicate quality in national comparisons. Such life stories are often standardised, generated by a family member answering predetermined questions in a template. Aim and methods: Using a constructionist approach, this study will (1) chart what versions of a person's life story the templates produce, and (2) establish the intended purpose of such life stories, as communicated by the templates. This study departs from the assumption that life story templates communicate something about the conceptions of people living with dementia. The thematic analysis used data comprising 30 blank templates, totalling about 1,700 questions. Findings: The life story templates were found to generate two very different versions of the individual: (1) a person before symptoms of dementia or (2) a patient with dementia. We also found contradictions about what information should be included, whose life story it was, and the intended use. Discussion: Despite strong pressure on dementia care providers to collect life stories from residents, the life story templates they use are without clear direction, ideology, or purpose. The lack of direction is key given that life stories can be considered actants that shape assumptions about people with dementia and construct realities in dementia care settings. We highlight the need to develop ethical guidelines for life story template design, matched with guidelines for their intended use. [ABSTRACT FROM AUTHOR]

Background: Little is known about mental health among Medicare beneficiaries with Alzheimer's disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID‐19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in‐person and telehealth use of ambulatory mental health visits among AL residents with ADRD, pre and during the COVID pandemic, focusing on race/ethnicity and Medicare/Medicaid dual status. Methods: A CY2018 cohort of AL residents with ADRD was identified. Outcome was any quarterly in‐person or telemedicine mental health visit based on national CY2019‐2020 Medicare claims. Key independent variables were individual race/ethnicity and dual status and the AL‐level proportion of dual residents. We estimated a linear probability model with random effects and robust standard errors. Quarterly indicators captured service use before and after the onset of the pandemic. Results: The study included 102,758 fee‐for‐service Medicare beneficiaries with ADRD in 13,400 ALs. One in five residents had any mental health visits prior to the COVID‐19 pandemic. Black residents, and those with dual Medicare/Medicaid eligibility, were significantly less likely to use mental health services prior to and during the pandemic. There were no significant differences in visits via telemedicine by race/ethnicity or individual dual status. Residents in AL communities with a higher proportion of duals had a lower likelihood of visits before and during the pandemic. Conclusions/Implications: Mental health service use among AL residents with ADRD was low and declining prior to the pandemic. Telehealth allowed for mental health visits to continue during the pandemic, albeit at a lower level. Residents in ALs with a higher proportion of duals were less likely to have in‐person or telehealth visits. The results suggest that some ALs may find it difficult to assure mental health service provision to this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives: To explore the experiences, acceptability and utility of a decision aid for family carers of people with dementia towards the end of life. Methods: We conducted semi‐structured interviews with a sample of family carers enroled into a 6‐month feasibility study in England, sampling to gain a range of experiences and views, based on relationship to person they cared for (e.g., spouse, adult child), age, gender, and self‐reported use of the decision aid during the feasibility study. Interviews were conducted in March 2021–July 2021 and analysed using reflexive thematic analysis. We used COREQ checklist to report our methods and results. Results: Family carers found the decision aid acceptable, describing it as comprehensive, accessible with relevant information and its presentation enabled good engagement. Experiences of the decision aid covered four main themes which demonstrated the perceived acceptability and utility: 1. A source of support and reassurance; 2. Empowering conversations and confidence; 3. Including the person living with dementia; and 4. Breaking down complexity. Conclusions: An aid focussing on decisions about dementia end of life care supported family carers break down complex and emotive decisions, not only with making decisions in the moment but also in future planning. Patient or Public Contribution: Our three Patient and Public Involvement (PPI) members (all former family carers) were crucial throughout the wider study. PPI supported development of the topic guides, supported trialling the topic guide and interview procedures and finally supported the development of themes as part of the analysis. [ABSTRACT FROM AUTHOR]

Background and Objectives The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. Research Design and Methods A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. Results Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. Discussion and Implications There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time. [ABSTRACT FROM AUTHOR]